Effect of Nurse-Patient Shared Decision Making on Dialysis Modality Selection in Peritoneal Dialysis Patients: A Multi-center Randomized Controlled Trial

Abstract Objective To evaluate the impact of shared decision-making (SDM)-based decision aids on decision regret, treatment adherence, and clinical outcomes in patients with end-stage renal disease (ESRD) choosing dialysis modalities, and to explore the relationship between decision regret and treatment behavior. Methods A multi-center randomized controlled trial design was employed. Three hundred ESRD patients meeting inclusion criteria from the peritoneal dialysis centers of three tertiary hospitals, selected from August 1, 2024, to March 31, 2026, were randomly divided into an experimental group (n = 150) and a control group (n = 150). The experimental group received at least 30 minutes of structured dialogue using a decision aid by nurses, with preferences recorded. The control group received routine alternative treatment information and assessment. Follow-up was conducted at 1 month and 3 months to compare decision regret between the two groups. Patients were grouped by decision regret level to analyze performance/theoretical test scores, medication adherence, clinical indicator achievement rates, and psychological burden. Results Follow-up at 1 month revealed significantly lower decision regret in the experimental group compared to the control group (mild regret: 111 vs. 77 cases; severe regret: 7 vs. 27 cases; χ²=20.42, P < 0.001). As decision regret increased, patients' operational and theoretical test scores decreased, and achievement rates for anemia, albumin, potassium, phosphorus, and blood pressure significantly decreased. Fear of disease progression and caregiver burden also significantly increased (all P < 0.05). Conclusion Nurse-patient shared decision-making can significantly reduce decision regret in ESRD patients choosing dialysis modalities. Decision regret is an important factor affecting treatment adherence and clinical outcomes in peritoneal dialysis patients. It is recommended to incorporate SDM tools into clinical pathways to improve patients' self-management abilities and long-term prognosis.