Application Of Shared Decision Model In Self-management Of Non-dialysis Patients With Chronic Kidney Disease

Objective:In order to explore effective methods to improve the self-management ability of non-dialysis patients with Chronic kidney diseases（CKD）,Shared decision making,The Ottawa Decision Support Framework（ODSF）in SDM is combined with the self-management program to improve patients’self-management ability,improve patients’health status,delay the progression of end-stage renal disease and improve the quality of life.Methods:1.Evidence synthesis of self-management programs for non-dialysis patients in CKD:According to the evidence pyramid"6S"evidence model,the relevant literature of various major databases and guide network was searched by computer,the quality evaluation of the selected literature was carried out according to the literature quality evaluation criteria,and the evidence was extracted according to the research content to form the best evidence summary of self-management for non-dialysis patients in CKD.2.Construction of the program:A group study seminar was held to study and discuss the application strategies of Ottawa Decision support framework in various chronic disease self-management modes,lay the relevant theoretical foundation and master the key points of implementation,and combine it with the best evidence of self-management for non-dialysis patients in CKD to form a preliminary intervention program.Carry out expert demonstration,discuss the items of the self-management program for non-dialysis patients in CKD and the implementation points combined with the shared decision,modify the content and implementation points according to the expert opinions,and form the final plan.3.Carry out intervention:Firstly,a preliminary experiment is carried out to preliminarily evaluate the scientific and clinical operability of the scheme.A non-synchronous controlled trial was used for formal intervention.100 patients from a Grade-III hospital in Yunnan Province from January to June 2021 were selected according to the scheduling standard,and grouped according to the sequence of time.Among them,50 patients from January to March 2021 were the control group,and 50patients from April to June 2021 were the experimental group.The control group was treated with the self-management scheme for non-dialysis patients with CKD summarized by evidence,and the experimental group was treated with the self-management scheme based on shared decision based intervention based on the self-management scheme of the control group.The brief health survey Form（SF-36）and self-management scale for CKD patients were distributed before and after the intervention,and some laboratory test results of patients were collected:Serum creatinine（Scr）,blood urea nitrogen（BUN）,hemoglobin（HB）,serum albumin（ALB）,blood potassium（SK）,blood sodium（SNa）,blood calcium（SCa）,and blood phosphorus（SPO₄）were compared by SPSS25.0 to evaluate the effect of intervention.Results:1.Through literature search and quality evaluation,a total of 17 literatures,5guidelines,1 expert consensus,9 systematic reviews,1 national standard and 1clinical decision were included.From the three aspects of the purpose of development,the content of guidance and the promotion strategy,the evidence is integrated to form22 pieces of best evidence.2.After the expert panel’s demonstration,the self-management plan for non-dialysis patients with CKD based on shared decision making was modified and improved,and the relevant content of assessing patients’decision-making needs was mainly deleted and modified to form the final intervention plan.3.The results of non-synchronous controlled trials showed that after intervention,the scores of self-management ability and the scores of physiological function,physiological function,physical pain,general health status,energy,social function and mental module in the health survey Brief Form（SF-36）of the two groups were statistically significant（P<0.05）.Blood urea nitrogen level and blood phosphorus level were significantly decreased,and the difference was statistically significant（P<0.05）.There was a moderate correlation（0.4≤OR<0.7）between the total score of self-management in CKD patients and the total score of the health survey summary form.Conclusions:The application effect of self-management scheme for non-dialysis patients with CKD based on shared decision making is remarkable,which has clinical reference and reference significance.