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The following is a summary of “Communicating treatment options to older patients with advanced kidney disease: a conversation analysis study,” published in the November 2024 issue of Nephrology by Selman et al. 

Choosing between dialysis and conservative management is challenging for older patients with advanced kidney disease. The impact of clinical communication on decision-making is not well understood. 

Researchers conducted a retrospective study to explore how clinicians present kidney treatment options to older patients and its impact on patient engagement. 

They adopted an observational, multi-method study design, recording outpatient consultations at 4 UK renal units. Eligible patients (≥65 years, eGFR ≤20 mL/min/1.73m²) completed the SDM-Q-9 post-consultation. Units were sampled based on variable rates of conservative management. Video recordings were screened for instances where both dialysis and conservative management were presented, then transcribed in detail. Conversation-analytic methods were used to identify recurrent practices in clinician-patient interactions. 

The results showed that 110 consultations were recorded (105 video, 5 audio), involving 38 clinicians and 94 patients (mean age 77, 61 males/33 females, mean eGFR 15). About 2 practices were identified: presenting both treatments equally (6 cases) and presenting conservative management as secondary to dialysis (15 cases). The first practice allowed more patient questions and led to higher post-consultation SDM-Q-9 scores (median 37 vs. 24, P = 0.041). It also provided patients with more opportunities to evaluate conservative management as a personally relevant option. 

They found that presenting conservative management and dialysis equally allowed patients to take a more active role in decision-making. These findings highlighted the need for improved clinical communication skills training. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03855-w