Understanding Influencers of Decision-Making Behaviors Towards Advance Care Planning Among Chronic Kidney Disease Dyads: A Qualitative Descriptive Secondary Data Analysis

Shared decision-making is essential in managing chronic kidney disease, yet little is known about how patient-caregiver dyads develop these skills through structured interventions. This study aimed to characterize how patients with chronic kidney disease and their family caregivers' decision-making behaviors evolve when participating in a decision-skill-building intervention (Improving the Decisional Partnership). This qualitative descriptive secondary data analysis analyzed postintervention interview transcripts and coach follow-up notes from a parent study (November 2022-May 2023) using thematic analysis. The analysis revealed 2 themes demonstrating how patients' and caregivers' decision-making behaviors evolve when engaging in a decision-making intervention: (1) Facilitators of decision-making behaviors, and (2) The impact of decision-support training on decision-making. The first theme included 2 subthemes: (1a) disease stability, and (1b) relationships. The second theme included 2 subthemes: (2a) knowledge acquisition as a driver of decision-making behavior, and (2b) communication skills training as a catalyst for engaging in decision-making behaviors. Findings suggest that patient-caregiver dyad decision-making behaviors towards advance care planning can be shaped through exposure to knowledge and skills, fostering proactive information-seeking, and improved communication during clinical encounters.