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Shared Decision-Making Values Exploration — ESENeph MCQ

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EasyChronic Kidney DiseaseShared Decision-Making Values ExplorationESENeph

A 78-year-old woman with CKD G5 (eGFR 8 mL/min/1.73m2) is struggling with the decision between starting haemodialysis or choosing conservative management. She lives alone, has moderate frailty, and her main concern is maintaining independence. What communication approach is MOST consistent with shared decision-making?

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Correct answer: D — Explore her values, daily priorities, and what quality of life means to her before discussing treatment options

Shared decision-making is a process of exploring the patient's values, goals, and priorities BEFORE presenting treatment options, so that information can be framed in personally meaningful terms. NICE NG203 and KDIGO 2024 emphasise that this is not simply presenting options and asking 'what do you want?' — it involves understanding what matters most to the patient (e.g., independence, avoiding hospital, symptom control) and then mapping each treatment option against those priorities. For frail older patients, conservative management may offer better quality of life without survival disadvantage. The decision should not be paternalistic in either direction.

Reference: NICE 2021 – NG203 RRT and Conservative Management; KDIGO 2024 – CKD Guideline; RPA/ASN 2010 – Shared Decision-Making