P1847IMPROVING SHARED DECISION MAKING FOR END-STAGE RENAL DISEASE PATIENTS IN THE NETHERLANDS
Authors: Van Eck van der Sluijs Anita , Riemann Aase , Prantl Karen , Bonenkamp Anna , Van Jaarsveld Brigit , Abrahams A 
Published: June 2020

Abstract

Background and Aims
Annually, more than 2.000 end-stage renal disease (ESRD) patients in the Netherlands receive education regarding renal replacement therapies (RRT). The choice for RRT has major impact on a patient’s life. Ideally, this choice is made during a process of Shared Decision Making (SDM), since this improves satisfaction of patients and quality of care. Since 2017, three decision aids for SDM are available in the Netherlands: the 3 Good Questions, Option Grids and Dutch Kidney Guide (www.nierwijzer.nl). However, it is unknown whether these decision aids are sufficiently implemented in daily practice. Therefore, we evaluated SDM and developed an SDM workshop to train centres how to implement these decision aids.

Method
Twelve centres in the Netherlands were randomly selected and invited to participate. In these centres, the degree of SDM experienced by patients, who recently received RRT information, was measured using the SDM-Q-9 and collaboRATE questionnaires. Furthermore, SDM awareness and use of the decision aids by health care professionals was explored. Finally, we provided a 2-hour workshop for professionals with information regarding SDM and the three decision aids.

Results
In the twelve participating centres (two academic, ten non-academic), 176 patients completed the questionnaires; 73% found the general impression of the received information (very) good, 84% found the total number of consults good, and 86% found the received amount of information good.
On a scale from 0 – 100, with a higher score indicating better SDM, the mean SDM-Q-9 score was 75±22 and the collaboRATE score 86±14. Overall, no significant difference between centres in the SDM-Q-9 and collaboRATE scores was found.
When centres with the worst SDM-Q-9 score (&lt; 70) were compared to centres with the best score (&gt; 77), a difference was noticed in the use of kidney-specific decision aids, i.e. Option Grids and Dutch Kidney Guide, and the eGFR level at which the information was given. Only 50% of the worst scoring centres used the decision aids compared to 100% of the best scoring centres. The majority of the worst scoring centres started at an eGFR between 20 and 30 ml/min/1.73 m2, while the best scoring centres all started at an eGFR between 15 and 20 ml/min/1.73 m2. In addition, best scoring centres provided information about all treatment modalities, including nocturnal haemodialysis and conservative treatment (100% of the best vs. 50% of the worst scoring centres), and more often provided information at home (67% of the best vs. 25% of the worst scoring centres).
A total of 117 health care professionals (27% physicians, 8% physician assistants, 38% nurses, 14% social workers, 13% other) completed the questionnaire; 81% found the general impression of the education process (very) good, 80% found the total number of consults good, and 56% found the amount of provided information good, while 28% found the amount too much.
Fifty-six percent of the professionals believed SDM was applied, however only 28% used the 3 Good Questions and 31 – 33% the Option Grids. The Dutch Kidney Guide was used by 51%.
Subsequently, ten of the twelve centres participated in the SDM workshop which was appreciated with a 7.5±0.4 on a scale from 0 – 10.

Conclusion
Although patients and health care professionals are fairly satisfied with the RRT information and degree of SDM, the use of SDM decision aids by health care professionals is limited. An SDM workshop introducing the decision aids was developed to train centres how to implement them. When optimizing SDM for ESRD patients in the Netherlands, attention should be paid to providing information about all treatment options, including nocturnal haemodialysis and conservative treatment, and providing information at home, to patients with an eGFR between 15 and 20 ml/min/1.73 m2.
This project was funded by Stichting Kwaliteitsgelden Medisch Specialisten (SKMS) and health insurers CZ, Menzis and Stichting Achmea Gezondheidszorg.