‘Talk CKD Options’: improving how clinicians communicate treatment options in advanced kidney disease using a conversation analysis-based training intervention

Abstract

Abstract Background Most older people with kidney failure and multiple co-morbidities must decide between dialysis or conservative kidney management. Dialysis is often presented as the default, despite providing uncertain survival benefits in this population. The Optimising Staff-Patient Communication in Advanced Renal Disease (OSCAR) study used conversation analysis of real consultations to develop a communication training intervention to support the provision of person-centred shared decision-making: ‘Talk CKD Options’. This pilot study aimed to: (i) deliver the intervention and (ii) assess its feasibility and acceptability. Methods Talk CKD Options comprised a 3-hour online, interactive session, plus two pre-recorded pre-training presentations. Pre-training surveys explored experience, previous training, and self-reported knowledge, skill and confidence. Post-training surveys assessed self-reported outcomes and gauged opinions on the training. Semi-structured interviews were conducted ≥ 2 weeks post-training. Interview data were analysed using thematic analysis. Results Twenty-seven clinicians from 20 English renal centres attended: 9 doctors, 17 nurses, 1 psychologist. 74% had no previous training in communicating treatment options. Post-training surveys demonstrated improved self-reported knowledge ( p < 0.001), skill ( p = 0.002) and confidence ( p = 0.001) in communicating about treatment options; all reported it would influence their practice. In interviews the value of multidisciplinary team training and breakout group-work were highlighted as strengths. Participants desired a summary handout and more breakout group-work. Conclusions Talk CKD Options demonstrates novel use of conversation analysis-based communication training in advanced kidney disease. That only one quarter of our motivated participants had formal training in this area, suggests a training need. It was highly rated, improving self-reported knowledge, skill and confidence. Talk CKD Options provides renal clinicians with tools that aim to support the provision of person-centred shared decision-making.