Implementation and evaluation of SDM in AKD

The primary objectives are to assess the effectiveness of shared decision-making supported by outcome data; alongside its implementation in daily clinical practice. The secondary objectives are to assess the extent to which shared decision-making supported by outcome data leads to changes in the utilisation and outcomes of healthcare.

The succesful implementation of shared decision making, supported by outcome measures, for treatment modality decisions in advanced kidney disease facilitates and improves this decisional process and the quality of delivered healthcare.

In total, all seven hospitals will participate in this trial for 20 months. In the first 6 months we will assess daily clinical practice in the hospitals with the aim to measure the current level of shared decision-making. Each month from May 2020 onwards, one hospital will make the transition, that will take approximately 1 month, to using shared decision-making supported by outcome data (see the description of the intervention), until all seven hospitals have implemented this in their daily clinical practice. Subsequently, for at least 6 months, we will assess the effectiveness and the extent to which shared decision-making supported by outcome data is implemented. Due to the stepwise design, some hospitals will be monitored longer before the transition, while others will be monitored longer after the transition, allowing us to make between-hospital comparisons. In each hospital 5 patients will be included per month. Patients included before and after the transition will receive a questionnaire and two follow-up questionnaires (after 6 and 12 months) to monitor patients’ experiences in consultation, their daily functioning and other subjects related to the care they received. Also, in each hospital, 15 patients, both before and after the transition, will be asked permission to audio-tape consultations. These will be used to monitor the length of consultation and for two trained observers to assess shared decision-making supported by outcome data during consultation. Healthcare professionals will receive a questionnaire 3 months after the transition phase, to evaluate the effectiveness and extent to which shared decision-making supported by outcome data is implemented.

Healthcare professionals, guiding patients facing the decision for a treatment modality in advanced kidney disease, will be introduced to a patient decision aid including (personalised) care outcomes, to support the process of shared decision-making. In addition, they will receive a training on shared decision-making: they will be informed on the guiding principles, motivated to use shared decision-making in clinical practice, and taught how to apply it.