FP705PATIENT PREFERENCES FOR HEALTHCARE DECISION-MAKING IN END STAGE RENAL DISEASE

Abstract

Introduction and Aims:Medical decision-making is critical to patient survival and well-being. The benefits of engaging patients in the medical decision-making process are multitude. Patients with chronic kidney disease are faced with incrementally complex decision-making throughout their treatment journey. The extent to which patients with end stage renal disease (ESRD) seek involvement in the actual decision-making process once information is acquired is unclear. Methods: The study data are derived from a cross-section of 535 patients with ESRD. Patients were enrolled from ‘predialysis’ clinics, for the CKD-5 group (group A), prevalent ‘in-centre’HD patients (group B) and self-care haemodialysis patients (93% at home-group C) from across five tertiary renal centres. The Autonomy Preference Index has been employed to study patient preferences for information-seeking and decision-making. Demographic, clinical, psychosocial and neuropsychometric assessments are considered for analysis. Results: A total of 458 complete responses were available. API items have high internal consistency in the study population (Cronbach’s alpha > 0.71 for both subscales). The median score for the API information-seeking scale was 78.13 (75.00, 90.63) in the ESRD groups, and the mean score for the API decision-making scale was significantly lower, 50.53 (SD17.84) in this group, indicating that although patients had a strong preference to be well informed, they were more neutral in their preference to participate in decision-making (p75 and white ethnicity background were significant predictors of active involvement in decision-making. Decision-making subscale scores were also subdivided into tertiles to identify variables associated with high (DM>70: and low DM (≤30) scores. This shows association of higher decision-making scores with lower age, lower comorbidity index scoring, higher executive brain function, belonging in the self-caring cohort and being unemployed, although this may have been the patient’s conscious decision. Conclusions: The study explored decision-making preferences and its influencing factors in ESRD patients. ESRD patients prefer to receive information, but this does not always translate into active involvement in decision-making. By identifying factors which might affect patient preference for involvement, health professionals will move away from a normative, ‘one size fits all’ approach and be more sensitive to individual patient’s preferences.