Opportunities for Shared Decision Making in Kidney Transplantation

Authors

  • E. J. Gordon,

    Corresponding author
    1. Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
    2. Northwestern University Comprehensive Transplant Center, Chicago, IL
    3. Northwestern University Transplant Outcomes Research Collaborative, Chicago, IL
    4. Chicago Transplant Ethics Consortium, Chicago, IL
    5. Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL
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  • Z. Butt,

    1. Northwestern University Comprehensive Transplant Center, Chicago, IL
    2. Northwestern University Transplant Outcomes Research Collaborative, Chicago, IL
    3. Chicago Transplant Ethics Consortium, Chicago, IL
    4. Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL
    5. Department of Medical Social Sciences, Northwestern University, Chicago, IL
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  • S. E. Jensen,

    1. Northwestern University Comprehensive Transplant Center, Chicago, IL
    2. Northwestern University Transplant Outcomes Research Collaborative, Chicago, IL
    3. Chicago Transplant Ethics Consortium, Chicago, IL
    4. Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL
    5. Department of Medical Social Sciences, Northwestern University, Chicago, IL
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  • A. Lok-Ming Lehr,

    1. Chicago Transplant Ethics Consortium, Chicago, IL
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  • J. Franklin,

    1. Northwestern University Comprehensive Transplant Center, Chicago, IL
    2. Northwestern University Transplant Outcomes Research Collaborative, Chicago, IL
    3. Chicago Transplant Ethics Consortium, Chicago, IL
    4. Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL
    5. Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
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  • Y. Becker,

    1. Chicago Transplant Ethics Consortium, Chicago, IL
    2. Division of Transplantation, Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, IL
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  • L. Sherman,

    1. Chicago Transplant Ethics Consortium, Chicago, IL
    2. Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
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  • W. J. Chon,

    1. Chicago Transplant Ethics Consortium, Chicago, IL
    2. Division of Nephrology, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, IL
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  • N. Beauvais,

    1. Chicago Transplant Ethics Consortium, Chicago, IL
    2. University of Minnesota Physicians, Solid Organ Transplantation, Minneapolis, MN
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  • J. Hanneman,

    1. Chicago Transplant Ethics Consortium, Chicago, IL
    2. Kovler Abdominal Solid Organ Transplantation Center, Northwestern Memorial Hospital, Chicago, IL
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  • D. Penrod,

    1. Chicago Transplant Ethics Consortium, Chicago, IL
    2. Kovler Abdominal Solid Organ Transplantation Center, Northwestern Memorial Hospital, Chicago, IL
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  • M. G. Ison,

    1. Northwestern University Comprehensive Transplant Center, Chicago, IL
    2. Northwestern University Transplant Outcomes Research Collaborative, Chicago, IL
    3. Chicago Transplant Ethics Consortium, Chicago, IL
    4. Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL
    5. Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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  • M. M. Abecassis

    1. Northwestern University Comprehensive Transplant Center, Chicago, IL
    2. Northwestern University Transplant Outcomes Research Collaborative, Chicago, IL
    3. Chicago Transplant Ethics Consortium, Chicago, IL
    4. Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL
    5. Kovler Abdominal Solid Organ Transplantation Center, Northwestern Memorial Hospital, Chicago, IL
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Abstract

Health researchers and policy-makers increasingly urge both patient and clinician engagement in shared decision making (SDM) to promote patient-centered care. Although SDM has been examined in numerous clinical settings, it has received little attention in solid organ transplantation. This paper describes the application of SDM to the kidney transplantation context. Several distinctive features of kidney transplantation present challenges to SDM including fragmented patient–provider relationships, the time-sensitive and unpredictable nature of deceased organ offers, decision-making processes by transplant providers serving as both organ guardians (given the

organ scarcity) versus advocates for specific patients seeking transplantation, variable clinical practices and policies among transplant centers, and patients’ potentially compromised cognitive status and literacy levels. We describe potential barriers to and opportunities for SDM, and posit that SDM is feasible, warranting encouragement in kidney transplantation. We propose strategies to promote and overcome obstacles to SDM in kidney transplantation. We contend that engagement in SDM can be facilitated by re-organization of clinical care, communication and education of providers and patients.

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