Patient Decision Aid Summary
*Sample Only*
Age: 70-79 | Nursing Home: No | Dementia: No | Function: Stable | Co-morbidities: Heart
Here is a summary of your options based on your responses. You can use it to talk with your healthcare team or loved ones about your decision.
My Treatment Options
| Conservative Kidney Management (CKM) No dialysis or transplant | Dialysis | ||
|---|---|---|---|
| How does this treatment work? | There are many things you can do to ease the problems associated with kidney disease, ranging from diet changes to medications. All of these treatments are available with or without dialysis. The choice is yours. Whatever you decide, your medical team will support you. | Dialysis is a medical treatment that does some of the kidneys’ work to filter toxins from the blood and manage body water. It will not cure kidney disease or stop kidneys from slowing down; maybe to the point that they stop working (or simply…stop kidneys from getting worse). Dialysis will not treat other medical problems a person may have. In many cases it will prolong life, but it requires a great deal of time and effort. Patient’s experiences vary widely. Some people find dialysis more than repays the effort, while others regret ever starting it. In general, the healthier you are, the more likely you are to find it helpful. There are two main types of dialysis. | |
| Peritoneal dialysis This type of dialysis happens inside your body. Fluid goes in and out of your belly through a tube. Clean fluid goes in, fluid with toxins is flushed out. You can do this at home. | Hemodialysis This type of dialysis happens outside your body. A machine filters your blood and then returns it to your body. Hemodialysis is usually done in a special dialysis unit in a clinic or hospital. | ||
| How much time will this treatment take? | No regular treatments | Peritoneal dialysis Peritoneal dialysis needs to be done every day (no days off). You can do it overnight while you sleep (8-10 hours) by using a machine or you can do it for 30 - 60 min at a time, 3-4 times a day. | Hemodialysis Hemodialysis is done 3 times a week. Each treatment usually takes 4 hours. Your total time spent in the dialysis unit will be about 6 hours. This does not include time it takes to travel to and from the dialysis unit. |
| How will I feel? | With or without dialysis, your kidneys will eventually get worse and you may develop symptoms. Your medical team will help you control your symptoms and stay comfortable. | Peritoneal dialysis This is a gentle form of dialysis. Generally you will feel well during and after your treatment. | Hemodialysis This is a more aggressive form of dialysis. Some people feel unwell during the dialysis treatment (4 hours) and most people feel tired and washed out for 6-8 hours after treatment. Recall that you will need treatments three days each week. |
My Prognosis:
Your prognosis is based your age and other factors on the survey:| Conservative Kidney Management (CKM) No dialysis or transplant | Dialysis | |
|---|---|---|
Quality of Life | Quality of life is anticipated to remain stable until the last 1 month of life | Dialysis is NOT likely to improve quality of life. |
Function | Level of function is anticipated to be relatively stable until the last 1-2 months of life. | Patients with poor mental and physical function are unlikely to do well on dialysis and are anticipated to progressively lose physical and mental function after starting dialysis. It is felt that dialysis may speed up this process. |
Symptoms | Symptoms are common with advanced kidney failure. The number and severity of symptoms tend to remain stable with CKM until the last 1 month of life when they may increase. These symptoms can be treated and aggressive symptom management will be a part of your CKM care. | Symptoms are common with advanced kidney failure. The number and severity of symptoms will likely NOT improve with dialysis. The dialysis procedure may cause or worsen some symptoms such as cramping and fatigue. |
Survival |
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My Values:
Your survey preferences are highlighted below where applicable: | Conservative Kidney Management (CKM) No dialysis or transplant | Dialysis | ||
|---|---|---|---|
| Hospitalization | You can expect to spend up to 1-2 days / month in hospital. The vast majority of people will die in location of choice such as home or in hospice. | You can expect to spend up to half of your time in hospital. On average, at least 2/3 of people on dialysis will die in hospital. | |
| Surgery | No surgery is needed. | Peritoneal dialysis A flexible plastic tube will be placed in your belly to allow fluid to drain in and out.  | Hemodialysis You will have surgery on your arm to connect an artery to a vein, which makes the vein grow large. This is needed so two large needles can be placed into it while you are connected to the dialysis machine.  If this surgery is not successful or possible, a flexible tube will be placed in your neck.  |
| Travel | You can choose how often you visit clinic. Your medical team will probably recommend a visit every 3 months. This visit can be in your community with your family doctor or in a specialist kidney clinic. | Peritoneal dialysis You will need to travel about once every 3 months to a peritoneal dialysis clinic. | Hemodialysis You will need to travel 3 times a week to the hemodialysis unit. You may require additional clinic visits. |
| Control of your time | You are in control of your own time. | Peritoneal dialysis Your dialysis schedule is somewhat flexible; it can fit around your personal schedule, but you must do it every day. | Hemodialysis You will be given a fixed, 4 hour appointment (morning, afternoon or evening). You can request changes, but it will depend on availability and your dialysis needs. |
| Which option did you think you would prefer? | Conservative Kidney Management (CKM) | Dialysis | |
| Conservative Kidney Management (CKM) No dialysis or transplant | Dialysis | ||
|---|---|---|---|
| Will this operation affect my body image? | Not applicable | Your dialysis access will most likely be noticeable, but your clothing will usually cover it. | |
| Who will do my treatment? | No special treatments required. It is recommended that every 3 months or so you have a check-up with a doctor and/or other members of your kidney care team to monitor your health. Between visits you can call the team with questions or concerns. | Peritoneal dialysis You will do your own treatment at home. You may need the help of family or friends. | Hemodialysis Specialized medical staff at the hospital or clinic will do the treatment for you. |
| Between visits you can call the kidney care team. The team includes a kidney doctor (nephrologist), nurse, dietician and social worker. | |||
| Will I need special training to do my treatment? | No treatments, so no special training. | Peritoneal dialysis You will need 1-2 weeks of training at a Peritoneal Dialysis clinic. During and after the training you will have the support of specialists on the kidney team. | Hemodialysis You won’t need any special training. All you need to do is travel to a hemodialysis unit for treatments three times a week. |
| Will I have food and fluid restrictions? | Your medical team will offer advice on diet and fluid intake. If you prefer not to change your eating and drinking habits, just let the team know. | Peritoneal dialysis You may have some food and fluid restrictions. | Hemodialysis You will have many food and fluid restrictions. |
| Will I need to buy equipment and supplies to do this treatment? | Your medical team may recommend some home monitoring equipment, but it’s optional. | Peritoneal dialysis Equipment and supplies are provided. You will need to have a digital body weight scale and a blood pressure monitor. | Hemodialysis Treatments are done at specialized dialysis units, they have all necessary equipment and supplies. |
| Will I need to store equipment and supplies at home? | No equipment or supplies are required at home. | Peritoneal dialysis Your supplies will be delivered to your home once a month. They will fill a medium sized bedroom closet. | Hemodialysis No equipment or supplies are stored in your home. |
| Can I change from one treatment to another? | All options may still be possible. | All options may still be possible. | |
Additional Considerations:
Your personal feelings are just as important as the medical facts. You can use the following section to think about what else matters to you in this decision, and record how you feel about the following statements. - Are there other important factors to consider? (example: important milestones, spiritual or cultural beliefs)
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Do you feel you know enough about your options? (Yes / No)
My Reasons for Conservative Care My Reasons for Dialysis [Free text]
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Do you feel comfortable with your decision? (Yes / No)
Do you want others to be involved in this decision? (Yes / No)
If so:Who? [Free text] Which option does this person prefer? [Free text] Is this person pressuring you? [Free text] How can this person help you decide? [Free text] I’m ready to take action (Yes / No)
I want to learn more about my options (Yes / No)
Use the following space to list questions, concerns and next steps:
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