Evaluation of a shared decision-making intervention for dialysis choice at four Danish hospitals: a qualitative study of patient perspective

OBJECTIVE: To evaluate the ‘Shared Decision-making and Dialysis Choice’ (SDM-DC) intervention with regard to patients’ experience and involvement. DESIGN: Semistructured individual interviews and systematic text condensation for data analysis. SETTING: The SDM-DC intervention was implemented and evaluated at four different hospitals in Denmark. PARTICIPANTS: A total of 348 patients had received the SDM-DC intervention, and of these 29 patients were interviewed. INTERVENTIONS: SDM-DC was designed for patients facing a choice of dialysis modality. The available modalities were haemodialysis and peritoneal dialysis, either performed by patients on their own or with help from a healthcare professional. The intervention was tailored to individual patients and consisted of three meetings with a dialysis coordinator who introduced a patient decision aid named ‘Dialysis Choice’ to the patient. FINDINGS: The following were the four main findings: the decision was experienced as being the patient’s own; the meetings contributed to the decision process; ‘Dialysis Choice’ contributed to the decision process; and the decision process was experienced as being iterative. CONCLUSIONS: The patients experienced SDM-DC as involving them in their choice of dialysis modality. Due to the iterative properties of the decision-making process, a shared decision-making intervention for dialysis choice has to be adapted to the needs of individual patients. The active mechanisms of the meetings with the dialysis coordinator were (1) questions to and from the patient, and (2) the dialysis coordinator providing accurate information about the options. The overview of options and the value clarification tool in the decision aid were particularly helpful in establishing a decision-making process based on informed preferences.