Integrating Clinical Reasoning Into a Patient Decision Aid for People Making Conservative Kidney Management and Dialysis Decisions: A User-Centered Intervention Development Design.

Rationale & Objective: For older adults with kidney failure, conservative kidney management can provide better quality of life, less treatment burden, and for some, the same length of life benefit. Patient decision making around kidney treatments is complex and emotionally demanding for both patients and health professionals. Resources provided by kidney units about dialysis and conservative kidney management options are frequently not sufficient to support people making reasoned decisions between options. This article describes 2 studies underpinning the development of the Yorkshire Dialysis and Conservative Care Decision Aid. Study Design: Study 1: cross-sectional study using in-depth interview methods; study 2: user-centered iterative design with multiple stakeholders. Setting & Participants: Older adults with kidney failure and health professionals from 3 kidney units in the North of England. Resource development included input from co-applicants, patient and public involvement team, multidisciplinary health professionals, and academics in the United Kingdom and Denmark. Analytical Approach: Thematic analysis was used to analyze the data. Results: Three themes synthesized stakeholder responses: transition to a conservative kidney management pathway, clinical and social indicators for changing kidney care management, and preparation for end-of-life care. The findings informed the patient decision aid content, which was structured with reference to international guidance. There were 16 iterations of the patient decision aid addressing multiple-stakeholder evaluations. People with kidney failure, family members, and kidney professionals agreed the final resource provides accurate, balanced, accessible, and relevant information supporting engagement with the decision between conservative kidney management care and dialysis within the kidney care pathway in the context of their everyday life. Limitations: There was a lack of ethnic diversity in the sample. Conclusions: People with kidney failure must choose between dialysis and conservative kidney management when planning their kidney care. Development of this resource used evidence of professionals' clinical reasoning about kidney disease management. Providing details of the research underpinning patient decision aid development demonstrates why the resource can enhance health literacy and supports shared decision making conversations with people making these difficult decisions.