TY - JOUR
T1 - Asking the right questions
T2 - towards a person-centered conception of shared decision-making regarding treatment of advanced chronic kidney disease in older patients
AU - Verberne, Wouter R.
AU - Stiggelbout, Anne M.
AU - Bos, Willem Jan W.
AU - van Delden, Johannes J.M.
N1 - Funding Information:
WV and WB have received grant support from Zilveren Kruis Health Insurance. All other authors declared that they have no competing interests.
Funding Information:
The study was funded by an unrestricted grant from Zilveren Kruis Healthcare Insurance Company. The funder played no role in defining the content of the manuscript; writing of the report; or in the decision to submit the article for publication.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/12
Y1 - 2022/12
N2 - An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease (CKD), involving dialysis or conservative care. Shared decision-making (SDM) is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient's values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs further implementation. A shift from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient's perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient's relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD.
AB - An increasing number of older patients have to decide on a treatment plan for advanced chronic kidney disease (CKD), involving dialysis or conservative care. Shared decision-making (SDM) is recommended as the model for decision-making in such preference-sensitive decisions. The aim of SDM is to come to decisions that are consistent with the patient's values and preferences and made by the patient and healthcare professional working together. In clinical practice, however, SDM appears to be not yet routine and needs further implementation. A shift from a biomedical to a person-centered conception might help to make the process more shared. Shared should, therefore, be interpreted as two persons bringing two perspectives to the table, that both need to be explored during the decision-making process. Starting from the patient's perspective will enable to determine the mutual goals of care first and, subsequently, determine the best way for achieving those goals. To perform such SDM, the healthcare professional needs to become a skilled companion, being part of the patient's relational context, and start asking the right questions about what matters to the patient as person. In this article, we describe the need for a person-centered conception of SDM for the setting of older patients with advanced CKD.
KW - Conservative care
KW - Dialysis
KW - Older patients
KW - Person-centered care
KW - Shared decision-making
UR - http://www.scopus.com/inward/record.url?scp=85128927762&partnerID=8YFLogxK
U2 - 10.1186/s12910-022-00784-x
DO - 10.1186/s12910-022-00784-x
M3 - Article
C2 - 35477488
SN - 1472-6939
VL - 23
SP - 1
EP - 8
JO - BMC Medical Ethics
JF - BMC Medical Ethics
IS - 1
M1 - 47
ER -