CONTENT OF A DECISION-ANALYSIS FOR TREATMENT CHOICE IN END-STAGE RENAL-DISEASE - WHO SHOULD GE CONSULTED

For an illness whose treatment options lead to similar survival, quali ty-of-life issues determine the choice. If the patient has not yet exp erienced the treatments, then the information provided regarding the o ptions plays a crucial role in the patient's choice. The authors inter viewed 43 people who are intimately involved with the treatments for e nd-stage renal disease (ESRD) (ten physicians, 11 nurses, and 22 patie nts) with a view to determining what information needs to be considere d when choosing between the various treatment options for this illness . They compared the three groups based on the items obtained from the interviews to determine whether the inclusion of patients in the proce ss changed the content of the treatment descriptions. They were also i nterested in determining whether the use of the frequency with which a n item is mentioned in the interviews is a valid measure of its relati ve importance to other items. 1,269 relevant items were obtained from the interviews and categorized into 51 areas of concern (subject domai ns). The health professionals (physicians and nurses) were found to ha ve mentioned seven subject domains more often than the patients, and n o domain was mentioned more often by the patients than by the health p rofessionals. The frequency that an item was mentioned was correlated (r = 0.55) with direct measures of its importance. These results imply that careful consultation with health professionals to determine the content of a decision analysis or informational materials that address treatment choice is sufficient to address patient concerns and that i tems can be chosen for inclusion based on the relative frequencies wit h which they are mentioned.