Shared Decision-Making in Conservative Care for Patients with CKD: A Concept Analysis

Background: Patients with chronic kidney disease (CKD) face difficult decisions about treatment, especially whether to pursue conservative care or renal replacement therapy. Conservative care focuses on symptom control and quality of life for patients with CKD. In this context, shared decision-making (SDM), a collaborative process between providers and patients, is essential for aligning care with patient values. Methods: We conducted a concept analysis using Walker and Avant’s method to clarify the concept of SDM in CKD conservative care. A literature search was performed in February 2025 using five databases, and 12 studies were included in the analysis. Results: We identified three defining attributes—the key characteristics consistently associated with SDM: (1) patient-centered dialogue emphasizing individualized goals and advance care planning; (2) balance between autonomy and medical guidance, which helps patients make informed choices; and (3) interdisciplinary collaboration, integrating nephrologists, palliative care specialists, and nurses. Three key antecedents, which are conditions that must exist before SDM can occur, were identified: (1) patient education to enhance understanding of disease trajectory and care options; (2) provider training in SDM and communication; and (3) system-level support. The consequences, or outcomes resulting from SDM, included (1) improved quality of life, as patients received care aligned with their goals; (2) reduced family-provider conflict due to active family involvement in the decision-making process; and (3) better use of healthcare resources, including fewer hospitalizations and unwanted interventions. Empirical referents such as the Shared Decision-Making Questionnaire were used in multiple studies to quantify patients’ perceptions of their involvement in decision-making. Conclusion: This concept analysis defines SDM in conservative CKD care as a collaborative, patient-guided process supported by interdisciplinary input and informed by education and systemic structures. Our findings provide a potential conceptual foundation for advancing SDM interventions and informing nephrology practice and research.