Article Behavioral Stage of Change and Dialysis Decision-Making

Background and objectives Behavioral stage of change (SoC) algorithms classify patients ’ readiness for medical treatment decision-making. In the precontemplation stage, patients have no intention to take action within 6 months. In the contemplation stage, action is intended within 6 months. In the preparation stage, patients intend to take action within 30 days. In the action stage, the change has been made. This study examines the influence of SoC on dialysis modality decision-making. Design, setting, participants, &measurements SoC and relevant covariates weremeasured, and associationswith dialysis decision-making were determined. In-depth interviews were conducted with 16 patients on dialysis to elicit experiences. Qualitative interview data informed the survey design. Surveys were administered to adults with CKD (eGFR#25 ml/min/1.73 m2) from August, 2012 to June, 2013. Multivariable logistic regression modeled dialysis decision-making with predictors: SoC, provider connection, and dialysis knowledge score. Results Fifty-five patients completed the survey (71 % women, 39 % white, and 59 % black), and median annual incomewas $17,500. In total, 65 % of patients were in the precontemplation/contemplation (thinking) and 35 % of patients were in the preparation/maintenance (acting) SoC; 62 % of patients had made dialysis modality decisions. Doctors explaining modality options, higher dialysis knowledge scores, and fewer lifestyle barrier