P1544SHARED DECISION MAKING FOR TREATMENT OPTIONS FOR ELDERLY PATIENTS ON DIALYSIS

• Published in: Nephrology, dialysis, transplantation Vol. 35; no. Supplement_3
• Main Authors: Kato, Akihisa, Saka, Yosuke, Naruse, Tomohiko
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.06.2020
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfaa142.P1544

Abstract Background and Aims The numbers of elderly patients on dialysis are increasing rapidly around the world. The quality of life (QOL) should be emphasized rather than survival for such patients. Shared decision making (SDM) regarding dialysis treatment options is one way to increase patient satisfaction with treatment, which should result in a better QOL. Thus, we investigated whether SDM affects the lives of elderly patients after dialysis initiation. Method We retrospectively collected clinical information about patients aged ≥ 80 years who started dialysis at our hospital between January 2013 and December 2017. The experience of SDM was defined as whether patients participated in a multidisciplinary approach to decision making about dialysis treatment options. Mortality rates, length of hospital stay and place of death during 2 years after dialysis initiation were determined. Results Among 124 patients, 40 participated in SDM. Functional activity, dementia, and daily assistance did not differ between patients with and without SDM. Participants in SDM were more likely to select PD (SDM vs. non-SDM: 50.0% vs. 3.6%; p < 0.001). Mortality rates did not differ between patients with and without SDM, but the rate of hospitalization for > 240 days was higher among patients without SDM (with vs. without SDM: 0.0 vs. 15.5%; p = 0.009). Among 70 deceased patients within two years, 59 died in hospital. Patients without SDM died in hospital more frequently (with vs. without SDM: 66.7% vs. 91.8%; p = 0.006). Conclusion Shared decision making reduced long-term hospitalization and death in hospital, indicating that more desirable home care therapy should be available for elderly patients on dialysis.