Supporting shared-decision making for anticoagulation initiation in people with advanced kidney disease

Abstract

Abstract Background Patients with chronic kidney disease are at increased risk of thrombotic and bleeding episodes making anticoagulant treatment decisions challenging. Currently, there are no decision support tools for patients with CKD regarding anticoagulant therapy. This work aimed to co-produce patient materials to support shared-decision making of anticoagulant use in advanced chronic kidney disease. Methods Focus groups were used to explore the views of kidney patients towards anticoagulant prescribing. Data was thematically analysed based on Makoul and Clayman’s model of shared-decision making. Co-production was used to develop patient material in conjunction with kidney patients over three meetings. Results A list of questions, to be used by patients when initiated on an anticoagulant, were co-produced. These questions were based upon participants’ experiences of the various stages of shared-decision making within the context of anticoagulant use in advanced chronic kideny disease, EGFR < 30ml/min/1.73m2. Of particular importance to participants was the provision of information relating to treatment risks and follow up arrangements. Conclusion Shared-decision making is important when initiating medication to ensure the best outcomes for patients, yet it can be difficult to engage in shared-decision making without prompts or guidance This co-produced patient guide could be used to support shared-decision making for anticoagulant initiation in patients with advanced chronic kidney disease.