Tool Helps Chronic Kidney Disease Patients Make Dialysis Decisions Interview with:
Suma Prakash MD, MSc, FRCPC

Department of Medicine, Division of Nephrology
Case Western Reserve University
MetroHealth Medical Center Cleveland, Ohio

Medical Research: What is the background for this study? What are the main findings?

Dr. Prakash: Patients with advanced chronic kidney disease are often faced with difficult decisions of having to choose between options to replace their kidney function. Many patients may not be ready to make treatment decisions since most people don’t want to need a chronic medical treatment.

The behavioural stage of change model originally used to help people with smoking cessation has been used to help patients make decisions about self-care with diabetes and undergo cancer screening. It has not been studied in patients with chronic kidney disease. As patients progress through the stages, they are more ready to make decisions. Focusing on better understanding the decision making process from patients’ perspectives allows us as medical professionals to help patients make timely decision about their options.

Medical Research: What should clinicians and patients take away from your report?

Dr. Prakash: In this study, we designed and tested a tool to measure stage of behavioural change in chronic kidney disease patients. We wanted to see if this correlated with them making decisions about their treatment options. The stage of change algorithm developed in this study appears to be a useful tool in measuring readiness to make option decisions. Patients’ readiness (later stages of behaviour change) correlated with decisions being made. Having their doctor discuss all their dialysis options with them, knowledge of options and fewer lifestyle barriers to home dialysis correlated with greater patient readiness and more patients making decisions.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Prakash: This study is a starting point. Future studies might follow later stage chronic kidney disease patients over time to examine whether and how readiness and decisions change as one gets closer to needing dialysis. Future studies might examine what interventions work best to help chronic kidney disease patients progress through the stages of change. Also they might examine relationships between stages of change longitudinally and patients starting their selected dialysis modalities, transplant or conservative management, getting timely access for chosen modality and urgent dialysis starts.


Suma Prakash, Anna McGrail, Steven A. Lewis, Jesse Schold, Mary Ellen Lawless, Ashwini R. Sehgal, and Adam T. Perzynski

Behavioral Stage of Change and Dialysis Decision-Making CJASN CJN.05560614; published ahead of print January 15, 2015, doi:10.2215/CJN.05560614

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