Family involvement and shared decision-making quality in renal replacement therapy selection: a nationwide cross-sectional study

Shared decision making in renal replacement therapy should reflect patient values. However, the quantitative impact of family involvement—particularly in Asian contexts—on decision-making quality remains underexplored. This nationwide, multicenter cross-sectional study (October 2022–February 2025) involved 475 adults with stage 5 chronic kidney disease across 49 facilities in Japan. Following the selection of renal replacement therapy, participants were surveyed regarding the final decision-makers and their specific roles. Shared decision-making quality was evaluated using the three-item CollaboRATE scale, assessing information exchange and preference integration. Compared with “physician-only” decisions, CollaboRATE scores (points; 95% confidence interval) were significantly higher in the “patient and physician” (+ 12.3; 1.5–23.2) and “patient, physician, and key person” groups (+ 13.7; 0.8–26.7). Role-based analyses showed that shared decision-making with the physician or key person was associated with a + 10.0 point increase (3.2–16.8) versus decisions without patient involvement. Among patients with family members, scores were significantly higher for patient only (+ 9.5), patient-led with input from physician or key person (+ 10.4), and shared decision-making (+ 12.1) categories, compared with no patient involvement. Family involvement is positively associated with higher shared decision-making quality when selecting renal replacement therapy, particularly when the process remains collaborative and guided by patient preferences.

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Publication Details

Journal
Scientific Reports
Published
2026-09-11
DOI
https://doi.org/10.1038/s41598-026-71177-y
Primary Topic
Patient-Provider Communication in Healthcare
Type
article
Field-Weighted Citation Impact
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article

Family involvement and shared decision-making quality in renal replacement therapy selection: a nationwide cross-sectional study

Yasushi Kunisho, Ryo Zamami, Shigeru Shibata, Izaya Nakaya et al.
Scientific Reports
Patient-Provider Communication in Healthcare
article

Family involvement and shared decision-making quality in renal replacement therapy selection: a nationwide cross-sectional study

Yasushi Kunisho, Ryo Zamami, Shigeru Shibata, Izaya Nakaya, Takayuki Adachi, Daisuke Komukai, Tsukasa Naganuma, Yoshihiko Raita, Seita Sugitani, Hideaki Oka, Michiya Shinozaki, Susumu Toda, Ryohei Inanaga, Hiroaki Asada, Tomo Suzuki, Hiroshi Kado, Shigeyuki Arai, Kumiko Muta, Nobuyuki Nakano, Kiichiro Fujisaki, Masahide Furusho, Megumi Oikawa, Keiko Nishi, Kenichiro Asano, Tsuyoshi Watanabe, Noriaki Kurita, Shuma Hirashio, Tatsunori Toida, Hideki Shimizu, Kojiro Nagai, Hiroyuki Terawaki, Tadashi Sofue, Hitoshi Miyasato, Tatsuo Tsukamoto, Atsuhiro Maeda, Hiroki Nishiwaki, Yugo Shibagaki, Yoshitaka Ishibashi, Keita Iwasaki, Shohei Yamada, Minoru Murakami, Shohei Nakanishi, Keita Uehara, Keita Mori, Tomoya Nishino, Tomomi Endo, Ken‐ichi Miyoshi, Makoto Yamamoto, Takayuki Nakamura, Yasuhiro Taki, Kosuke INOUE, Y. TAMURA, Takafumi Ito, Chisato Fukuhara, Takeshi Okamoto, Fumika Nagase, Hideaki Shimizu, Kenta Torigoe, Tsuyoshi Ohshiro, Satoshi Furukata, Yuuki Itou, Hiroo Kawarazaki, Takaaki Tsutsui, Ryo Sugiyama, Mari Yamamoto, Kei Nagai, PREPARES Study Group, Yosuke Yamada, Shinichi Abe
article en

Abstract

Shared decision making in renal replacement therapy should reflect patient values. However, the quantitative impact of family involvement—particularly in Asian contexts—on decision-making quality remains underexplored. This nationwide, multicenter cross-sectional study (October 2022–February 2025) involved 475 adults with stage 5 chronic kidney disease across 49 facilities in Japan. Following the selection of renal replacement therapy, participants were surveyed regarding the final decision-makers and their specific roles. Shared decision-making quality was evaluated using the three-item CollaboRATE scale, assessing information exchange and preference integration. Compared with “physician-only” decisions, CollaboRATE scores (points; 95% confidence interval) were significantly higher in the “patient and physician” (+ 12.3; 1.5–23.2) and “patient, physician, and key person” groups (+ 13.7; 0.8–26.7). Role-based analyses showed that shared decision-making with the physician or key person was associated with a + 10.0 point increase (3.2–16.8) versus decisions without patient involvement. Among patients with family members, scores were significantly higher for patient only (+ 9.5), patient-led with input from physician or key person (+ 10.4), and shared decision-making (+ 12.1) categories, compared with no patient involvement. Family involvement is positively associated with higher shared decision-making quality when selecting renal replacement therapy, particularly when the process remains collaborative and guided by patient preferences.

Scientific Reports
Nihon University (JP), Kyushu University of Health and Welfare (JP), Fukushima Medical University (JP), Tokai University (JP), St. Marianna University School of Medicine (JP), Kagawa University (JP), University of Kochi (JP), Utsunomiya University (JP), University of the Ryukyus (JP), Kurashiki Central Hospital (JP), Iwate Prefectural Central Hospital (JP), Chubu Rosai Hospital (JP), Fukui Red Cross Hospital (JP), Ijinkai Takeda General Hospital (JP), Okinawa Prefectural Yaeyama Hospital (JP), Hidaka Hospital (JP), Japanese Red Cross Medical Center (JP), Saku Central Hospital (JP), Miyazaki Prefectural Hospital (JP), PVS Memorial Hospital (IN), Kameda Medical Center (JP), Okazaki City Hospital (JP), Nagoya Ekisaikai Hospital (JP), Matsuyama Red Cross Hospital (JP), Okinawa Prefectural Chubu Hospital (JP), Kagoshima City Hospital (JP), Higashihiroshima Medical Center (JP), Uji Hospital (JP), Himeji Medical Center (JP), Naha City Hospital (JP), Teikyo University Chiba Medical Center (JP), Heart Life Hospital (JP), Funabashi Municipal Medical Center (JP), Shizuoka General Hospital (JP), Kawasaki Hospital (JP), Kagoshima Medical Center (JP), Aso Iizuka Hospital (JP), Hitachi General Hospital (JP), Aizawa Hospital (JP), Japanese Red Cross Society Wakayama Medical Center (JP), SHOWA Medical University Fujigaoka Hospital (JP), Takao Hospital (JP), Shirasagi Hospital (JP), Kitano Hospital (JP), Kishokai Medical Corporation (JP), Nagasaki University Hospital (JP), Yamanashi Prefectural Central Hospital (JP), Ehime University (JP), Daido University (JP), Teikyo University (JP)
Japan Society for the Promotion of Science
Peace, Justice and strong institutions
Openalex Percentile: Top 6%
Patient-Provider Communication in Healthcare
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