Shared Decision Making in Dialysis Modality Selection: a Lived Experience From Nephrologists. A Nationwide Qualitative Study.

NCT07364292 | Completed DMC

• 1 other identifier: SRB2023343
• Study Type: interventional
• Target: 25
• Locations: 1 country
• Sites: 1

Brief Summary

International guidelines for kidney failure emphasize the importance of aligning renal replacement therapy (RRT) modality selection with individuals' preferences through high-quality, structured education. However, observational qualitative studies suggest that pre-dialysis education remains inconsistently delivered, with substantial centre-to-centre variation in the content and organization of Belgian pre-dialysis programs despite a shared healthcare policy. Multiple barriers to home-based therapies have been repeatedly reported at both the unit and patient levels, including nursing shortages, limited availability of trained staff, financial constraints, high rates of unplanned dialysis initiation, distress at treatment start, low health literacy, and an increasingly frail and comorbid patient population. Yet, a minority of dialysis units appear able to mitigate these barriers more effectively than others. This discrepancy raises concern that centre-oriented priorities (unit throughput, cost-effectiveness, technical performance) may still outweigh patient-centred goals (supporting life priorities and meaningful shared decision-making). This study aims to explore nephrologists' beliefs, knowledge, and attitudes regarding shared decision-making in dialysis modality selection and their potential influence on the adoption of alternative RRT modalities beyond in-centre hemodialysis. Q methodology will be used to capture and compare shared viewpoints and patterns of disagreement across participants.

Conditions

End Stage Renal Disease

Keywords

shared-decision-making; dialysis modality selection; kidney failure; home-based therapies

Outcome Measures

Primary Outcomes (1)

• Number of distinct Q-methodology viewpoints (factors) identified from nephrologists' Q-sorts related to shared decision-making in dialysis modality choice, as derived from Q-factor analysis.

  Q-sort data will be collected using a forced-ranking of predefined actions in response to clinical vignettes. The primary quantitative endpoint is the number of interpretable factors extracted from participants' Q-sorts using principal component factor analysis with varimax rotation. Results will be reported as: * Number of factors identified (count), * Number (%) of participants significantly loading on each factor (p \< 0.01) * Factor loadings (correlation coefficients) per factor reported as mean (SD) and range.

  Time Frame: Once, at the baseline study visit (single Q-sort session), up to 90' per participant

Secondary Outcomes (1)

• Number and content of overarching themes and sub-themes identified from semi-structured interviews relevant to dialysis-decision making.

  Once, during the baseline session (up to 30 minutes per participant)

Study Arms (1)

nephrologists

OTHER

no other arm

Behavioral: Q methodology

Interventions

Q methodology BEHAVIORAL

Q- sorting operation is done during a face-to-face meeting of the participant and the interviewer. Participants rank-order a set of statements or opinions into a grid. They rank the importance of statements relative to all others. A specific characteristic of Q Sort is that participants are forced to prioritize amongst statements. During the ranking procedure, they must explain their reasoning process on their positioning of their cards ("thinking-aloud" their reasoning). This audiotaping of the thinking aloud during the actual completion of the Q-Sort allows to not only gain insights in the perceptions of the participants, but also in their underlying reasoning, emotions, and motivation.

nephrologists

Eligibility Criteria

• Age: 30 Years - 67 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• nephrologists professionnaly active

You may not qualify if:

• non active or retired nephrologists
• nephrologist who do not have regular contact with ESKD patients or who do not engage in treatment discussion

Sponsors & Collaborators

• Erasme University Hospital: lead

Study Sites (1)

HUB Erasme

Brussels, Belgium

Location

Related Publications (3)

• Allen K, Shaw KL, Spry JL, Dikomitis L, Coyle D, Damery S, Fotheringham J, Lambie M, Williams IP, Davies S. How does organisational culture facilitate uptake of home dialysis? An ethnographic study of kidney centres in England. BMJ Open. 2024 Dec 27;14(12):e085754. doi: 10.1136/bmjopen-2024-085754.

  PMID: 39732481 BACKGROUND

• Brown EA, Brivio GB, Van Biesen W. Towards a better uptake of home dialysis in Europe: understanding the present and looking to the future. Clin Kidney J. 2024 Jun 5;17(Suppl 1):i3-i12. doi: 10.1093/ckj/sfae082. eCollection 2024 May.

  PMID: 38846418 BACKGROUND

• Cortvrindt C, Van Biesen W, Gambino G, Clause AL. Factors influencing renal replacement therapy modality choice from the nephrologist's perspective. J Nephrol. 2024 Apr;37(3):635-645. doi: 10.1007/s40620-024-01915-w. Epub 2024 Mar 21.

  PMID: 38512379 RESULT

MeSH Terms

Conditions

Kidney Failure, Chronic; Renal Insufficiency

Condition Hierarchy (Ancestors)

Renal Insufficiency, Chronic; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Urogenital Diseases; Male Urogenital Diseases; Chronic Disease; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: HEALTH SERVICES RESEARCH
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Medical doctor in nephrology

Model Details: explanatory study using mixed method qualitative data analysed systematically by quantitative method (Q method)

Study Record Dates

• First Submitted: January 28, 2024
• First Posted: January 23, 2026
• Study Start: March 15, 2024
• Primary Completion: September 15, 2025
• Study Completion: December 30, 2025
• Last Updated: January 23, 2026

Record last verified: 2026-01

Locations

BE (1)