In search of common ground - nephrologists’ experiences in preparing and informing patients on the path to end-stage kidney disease

Background
Patient education and dialogue are important when choosing a future treatment strategy for patients with chronic kidney disease. To support patients in their decision-making process, it is critical to provide information in a way that patients can understand. This study was conducted to understand how nephrologists view the goals of information sharing, the challenges involved, and the strategies used as part of treatment planning.

Methods
This study had a qualitative design using semi-structured interviews with 14 practicing nephrologists working in different hospitals in Sweden and with experience in providing information to patients approaching the need for dialysis. The interviews were conducted in 2022. The data were analyzed using qualitative content analysis.

Results
The results are presented thematically under the headings Objectives, Content, Challenges, and Strategies. Participants tried to find common ground with patients, in terms of shared knowledge, shared views on the appropriate decision-making process, and ultimately also agreement on which treatment option was best. There was a tension between allowing patients to make their own decisions and guiding patients to make decisions with the best outcomes as judged by the nephrologist. Achieving common ground was not always possible, both because of factors related to the patient’s preferences or limited capacity, and because of boundaries set by the physician to protect the patient from unwarranted or harmful information. Dealing with competing sources of information was seen as challenging. The nephrologists felt a professional responsibility for their treatment recommendations, combined with uncertainty about which patient would benefit from dialysis and when to start.

Conclusions
Planning future treatment for patients with chronic kidney disease involves a complex information process that leaves room for both paternalism and respect for autonomy. Nephrologists face many competing challenges when discussing treatment options with patients. These challenges should be taken into account in the development of support for nephrologists in the area of information sharing.