Parker Kathrine, Needham Abigail, Thachil Jecko, Mitra Sandip, Lewis Penny
Division of Pharmacy and Optometry, School of Health Sciences, The University of Manchester, University of Manchester, Manchester, M13 9PT, UK.
Manchester Institute of Nephrology and Transplantation, Manchester University NHS Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
BMC Nephrol. 2025 Jan 28;26(1):42. doi: 10.1186/s12882-025-03966-y.
People with chronic kidney disease are at increased risk of thrombotic and bleeding episodes making anticoagulant treatment decisions challenging. Currently, there are no support tools for people with chronic kidney disease regarding anticoagulant therapy decisions. This work aimed to co-produce materials to support shared-decision making when considering anticoagulant use in advanced chronic kidney disease.
Focus groups were undertaken to explore the views of people with kidney disease towards anticoagulant prescribing. Data was thematically analysed based on Makoul and Clayman's model of shared-decision making. Co-production methods were used to develop a question prompt list based on themes from the focus groups in conjunction with people with kidney disease over three meetings.
A question prompt list, to be used by patients when initiated on anticoagulant therapy, was co-produced. These questions were based upon participants' experiences of the various stages of shared-decision making within the context of anticoagulant use in advanced chronic kidney disease. Of particular importance to participants was the individualised discussion around treatment risks and follow up arrangements.
Shared-decision making is important when initiating medication to ensure the best outcomes for patients, yet it can be difficult to engage in shared-decision making without prompts or guidance. This co-produced question prompt list could be included as part of national guideline to support shared-decision making for anticoagulant initiation in patients with advanced chronic kidney disease.
慢性肾脏病患者发生血栓形成和出血事件的风险增加，这使得抗凝治疗决策具有挑战性。目前，对于慢性肾脏病患者在抗凝治疗决策方面没有支持工具。这项工作旨在共同制作材料，以支持在考虑晚期慢性肾脏病患者使用抗凝剂时的共同决策。
开展焦点小组讨论，以探讨肾病患者对抗凝剂处方的看法。基于马库尔和克莱曼的共同决策模型对数据进行主题分析。采用共同制作方法，结合肾病患者在三次会议上提出的焦点小组主题，制定问题提示清单。
共同制作了一份患者在开始接受抗凝治疗时使用的问题提示清单。这些问题基于参与者在晚期慢性肾脏病使用抗凝剂背景下共同决策各个阶段的经验。对参与者特别重要的是围绕治疗风险和随访安排的个性化讨论。
开始用药时共同决策对于确保患者获得最佳结果很重要，但没有提示或指导很难进行共同决策。这份共同制作的问题提示清单可作为国家指南的一部分，以支持晚期慢性肾脏病患者抗凝治疗起始的共同决策。
