“Deciding Not to Decide” is important in shared decision-making for kidney replacement therapy selection

Abstract

Shared decision-making for kidney replacement therapy (KRT) selection is a two-way process that should constitute an equal partnership between the healthcare team and patient. However, some patients are at a disadvantage due to a difference in power relations because the discussion is led by the healthcare team. In the United States and United Kingdom, Deciding Not to Decide (DND) has been added to the KRT options. DND provides a period before the selection decision is made after explaining to the patient the physical risks of delaying the decision. Then, patients feel less anxious and are more likely to make a decision. The option of DND, based on open communication between the healthcare team and patient/their family, provides the patient with flexibility in treatment planning, and this option should be welcomed by all concerned. When providing information on KRT, the option of DND (postponing the selection decision) should be provided at an appropriate time prior to kidney transplantation, peritoneal dialysis, or hemodialysis, thereby increasing patientsʼ autonomy and making it easier for them to come to their own decisions.