Table 1.

Summary of Patient-Focused Themes That Influence RRT Decision Making and the Various Solutions to Overcome Patient Barriers to Education and SDM via Clinician-Focused Themes.

Themes	Descriptions
1. Patient-Focused	Influences
Social Influences: The relationship patients have with family, friends, clinicians, and other patients	• Past experiences with dialysis • Being married/living with a partner • Partnership with nephrologist • Experiences of other patients
Values and Beliefs: What is most important to patients and the beliefs they hold	• Individualized standardization of care • Preservation of QOL and lifestyle • Differing values between HD/PD users • Performance indicators less valued by patients • Values and beliefs change over time
Comprehension: The degree to which patients understand the information they are being educated with	• Quality of predialysis education • Amount of end-of-life support • Gap between perceived and actual knowledge • Low health literacy and numeracy • Lack of tailored education
Autonomy: Patients’ need for control over their health and the amount of independence in decision making	• Lack of knowledge curtails autonomy • Level of confidence • Decisional conflict • Lack of “choice” over dialysis
Sociodemographics: Patients’ age, sex, race, comorbidities, and socioeconomic status	• Lower informed and executive level decision making with age • Complexity managing comorbidities • Lower health-related QOL in women • Lower rates of kidney transplantation in those of low socioeconomic status • Poorer access to care and mistrust in those of ethnic minorities
2. Clinician-Focused	Practical Implications
Screening: Exposing potential patient barriers to effective education and SDM	• Screen for: psychological/cognitive status, level of function, preferences, health literacy and behavioral stage of change • Cognitive Behavioral Therapy/Psychoeducation • Geriatric Assessment • Health literacy screening tools
Communication: Utilizing effective methods of transferring knowledge to patients	• Structured education sessions covering all RRT options • Motivational interviewing • Framing information and risk • Personalizing information • 3-step SDM model • Improved support for caregivers • Role clarification between specialists
Engagement: Encouraging patients to become active members of the health care team	• Decision aids • Utilize patient technology • Patient-held records • Education via social media • SDM with multidisciplinary team

Note. RRT = renal replacement therapy; SDM = shared decision-making; QOL = quality of life; HD = hemodialysis; PD = peritoneal dialysis.