Shared Decision Making Increases Living Kidney Transplantation and Peritoneal Dialysis
Shared Decision Making Increases Living Kidney Transplantation and Peritoneal Dialysis
复制标题
DOI：
10.1016/j.transproceed.2019.02.025
复制
发表时间：
2019-06-01
影响因子：
0.9
通讯作者：
Wu, Ming-Ju
中科院分区：
文献类型：
--
作者：
Lee, Cheng-Ting;Cheng, Ching-Yao;Wu, Ming-Ju
背景。台湾的医院认证鼓励在医疗保健领域更多地使用共享决策 (SDM)。本研究旨在探讨初诊终末期肾病（ESRD）患者使用SDM前后肾脏替代治疗（RRT）治疗方式的分布变化。 RRT 的 SDM 流程是通过基于互联网的患者教育程序和智能系统设计的。 SDM项目经部门共识会议审议，自2017年1月起持续执行。入组2016年1月至2017年12月期间接受长期RRT的患者。结果。 2017年，310名患者（187名男性，平均63.9岁）接受了长期RRT。其中，220 名 (71%) 患者完成了 RRT 的 SDM。 66例患者接受腹膜透析（PD），67例患者进入活体肾移植（KT）项目评估，18例患者最终接受活体KT手术。与2016年相比，2017年实施RRT SDM后，执行RRT SDM与活体KT（38.5%）和PD（112.9%）的数量急剧增加有关。抢先活体KT的数量也从1名患者增加到5名患者。此外，91.3%的患者对SDM用于RRT的过程感到满意。结论。我们的研究结果表明，在患者进入长期 RRT 之前实施 SDM 会导致更多的 ESRD 患者接受活 KT 并进入 PD 治疗。如果 RRT 的 SDM 能够在全国范围内开展，那么生活 KT 的增长趋势是可以合理预期的。
Background. Hospital accreditation in Taiwan encourages greater use of shared decision making (SDM) in health care. This study aimed to explore the distribution change of treatment modalities for renal replacement therapy (RRT) before and after the use of SDM in newly diagnosed end-stage renal disease (ESRD) patients.Methods. The processes of SDM for RRT were designed with Internet-based patient educational program and smart system. The project of SDM was reviewed by departmental consensus meeting and continuously executed since January 2017. Patients received long-term RRT between January 2016 and December 2017 were enrolled.Results. In 2017, 310 patients (187 male, average 63.9 years old) received long-term RRT. Of them, 220 (71%) patients completed SDM for RRT. Sixty-six patients received peritoneal dialysis (PD), 67 patients entered the evaluation of living related kidney transplantation (KT) program, while 18 patients finally received operation for living KT. Compared to 2016, execution of SDM for RRT was associated with drastically increase of the number of living KT (38.5%) and PD (112.9%) after the implementation of SDM for RRT in 2017. The number of preemptive living KT was also increased from 1 patient to 5 patients. Moreover, 91.3% patients were satisfied with the process of SDM for RRT.Conclusion. Our findings suggest that the implementation of SDM before patients entering long term RRT lead to more ESRD patients receiving living KT and entering PD therapy. The increasing trend of living KT could be reasonably expected if SDM for RRT could be carried out nationwide.