Tutorial: Preparing Pre-Dialysis Consultation Materials

This tutorial shows you how to use an AI tool to prepare two supporting documents for a pre-dialysis education consultation: an options comparison document for the patient, and a list of questions you should be prepared to answer. Together, these make the consultation more productive.

The scenario: you are seeing a 71-year-old woman with CKD Stage 5, eGFR now 11, at a pre-dialysis education consultation. She lives with her husband, who attends all appointments. She has been following her care closely for two years and is not naive about what is coming — but she and her husband want to understand the options clearly before making a decision. She has mentioned that her main concerns are independence and not wanting a "machine" running her life.

Step 1: Open the tool and draft the options comparison document first

Open claude.ai or chat.openai.com. Start a fresh conversation. Type:

You are helping a nephrologist prepare a pre-dialysis education 
document for a patient. The document will be given to the patient 
before the consultation so she arrives prepared.

Rules:
- Do not recommend any option
- Do not include clinical eligibility criteria
- Present each option with equal weight
- Emphasise the practical daily life implications
- Maximum 600 words

Step 2: Provide the patient context

Patient: woman in her early seventies, CKD Stage 5, 
approaching dialysis. Lives with her husband who attends 
appointments. Main concern: independence and not wanting 
a 'machine' running her daily life.

Compare three options:
1. Haemodialysis at a dialysis centre
2. Peritoneal dialysis at home
3. Conservative kidney management (supportive/palliative approach)

For each option, describe:
- What it involves day to day
- Time commitment and where it happens
- Practical advantages for someone who values independence 
  and daily routine
- Practical challenges

Step 3: Read the first draft

The tool will produce a comparison document. Here is an example of the structure it might produce:

Understanding Your Kidney Treatment Options

You are approaching the point where your kidneys will need additional support. This document explains your three main options so you can think about them before your appointment. Your specialist will discuss each one with you in detail.

Option 1: Haemodialysis at a Dialysis Centre

What it involves: You attend a dialysis centre three times a week. Each session lasts approximately four hours. A machine cleans your blood while you sit or rest. Most people feel tired afterwards.

Time commitment: Three sessions per week, including travel. This typically takes up a significant part of three days each week.

Practical advantages: All the equipment and care are provided at the centre. You do not manage any medical equipment at home. Some people find the regularity helpful, and the unit becomes a social environment.

Practical challenges: The schedule is fixed and non-negotiable — missing sessions has consequences. Travel to and from the unit three times a week can be tiring. Some people find the time commitment feels significant.

Option 2: Peritoneal Dialysis at Home

What it involves: Dialysis fluid is put into your abdomen through a small catheter and left for a period, then drained. The lining of the abdomen acts as a natural filter. This can be done manually during the day (CAPD — continuous ambulatory peritoneal dialysis) or overnight using a machine while you sleep (APD — automated peritoneal dialysis).

Time commitment: Depends on the method, but dialysis happens at home. APD typically runs overnight while you sleep, leaving days largely free.

Practical advantages: Dialysis happens at home, on your own schedule. No regular travel to a centre. Many people find this offers more independence and flexibility.

Practical challenges: You (and possibly your husband) will need to learn how to manage the process. Strict cleanliness is essential to prevent infection. Storage space is needed for supplies. It is a significant responsibility.

Option 3: Conservative Kidney Management

What it involves: Choosing not to start dialysis. The focus shifts entirely to keeping you as comfortable and well as possible — managing symptoms, maintaining quality of life, and planning ahead. This is an active choice, not giving up.

Practical considerations: Some people, particularly older adults with other health conditions, find that dialysis would involve more burden than benefit. Without dialysis, kidney function will continue to decline. The kidney team and palliative care team work together to support comfort and planning.

What this means day to day: No dialysis sessions. Medications and care continue. You and your family are supported throughout.

Please bring any questions about these options to your appointment. There is no wrong question.

Step 4: Review the comparison document carefully

Read each option with your clinical knowledge active. In this example, you notice:

• The APD description is accurate and directly addresses the patient's concern about independence
• The conservative management section correctly frames it as an active choice — which is important
• One adjustment needed: the haemodialysis section says "typically takes up a significant part of three days each week." This is accurate but could be read as discouraging for someone concerned about their independence. You want to leave the patient feeling neutral about each option, not nudged. Ask:

In the haemodialysis section, the language about time commitment 
feels slightly negative. Rewrite it to describe the time commitment 
neutrally — accurately, but without framing it as a burden.

Read the revision. If it feels more balanced, keep it.

Step 5: Draft your question-preparation list in the same session

Now, in the same conversation, ask the tool:

Based on the case context I described earlier — a woman in her 
early seventies who values independence and is coming with her 
husband — generate a list of questions she and her husband are 
most likely to ask about these three options. Group them by topic.

The tool will return a question list. Here is the kind of thing you might see:

About haemodialysis

• Can I choose which days and times I come in?
• What happens if I need to travel or go on holiday?
• How do I feel during and after a session?
• Will I be able to drive myself to appointments?

About peritoneal dialysis

• How complicated is the equipment to learn?
• What happens if I do something wrong?
• What does an infection look like and what do I do?
• What if I need surgery for something else?

About independence and daily life

• Will I be able to live a fairly normal life on dialysis?
• Can I still travel?
• How will this affect my husband?

About conservative management

• What does "conservative management" actually mean for day-to-day care?
• Is this giving up?
• How long do people typically live on conservative management?

Step 6: Prepare for the hardest questions

The list above includes the question "How long do people typically live on conservative management?" This is the kind of question that requires careful preparation — not because it is unanswerable, but because the answer is clinically complex and emotionally charged. The tool cannot answer it for you. But seeing it on the list means you have thought about it before you walk in.

Review the question list. Note any question you would struggle to answer. Prepare your response before the consultation, not during it.

Step 7: Personalise the comparison document for the consultation

Before sending the comparison document to the patient, add:

• Your name and clinic details at the top or bottom
• The appointment date and location
• Any local information specific to your service (for example, the location of your dialysis centres, the typical training process for peritoneal dialysis in your unit)

The generic comparison document becomes a personalised one. The patient arrives knowing something real about the local context.

What the tool does badly

The tool cannot know the quality of your local services. If your nearest dialysis centre involves difficult travel for this patient, the comparison document should reflect that. If your peritoneal dialysis training programme is particularly well-supported, that context matters. Local service quality significantly affects which option is most practical — and the tool cannot know it. You add that context yourself, either in your prompt or by annotating the document.

The question about conservative management prognosis — "how long do people typically live?" — is one the tool cannot and should not answer. If you ask it to, it will produce something plausible-sounding but clinically inadequate. This is a conversation, not a document.

What to try next

After the consultation, use a similar approach to draft the post-consultation summary letter that records what was discussed and what decision (if any) was made. One clinical session can produce the preparation materials before the consultation and the summary letter after — with the tool doing the structural drafting work both times.

Remember: AI is a helpful assistant, not a clinician. You make the call.