Preparing Patients for Dialysis Modality Decisions

The problem

The dialysis modality decision is one of the most complex conversations in nephrology. It involves clinical factors, patient preferences, lifestyle, family situation, and an honest discussion of what each option means for daily life. Patients arrive at this conversation with varied levels of prior knowledge — some have been watching this moment approach for years, others are newly diagnosed and have had weeks to process it.

The formal decision-making consultation requires your full clinical attention and a genuine two-way conversation. The challenge is that patients can only participate meaningfully if they have some understanding of the options before they arrive. A consultation where you spend the first twenty minutes explaining what haemodialysis and peritoneal dialysis are leaves little time for the patient to ask what they actually want to ask.

How AI helps

An AI tool can prepare supporting materials for this conversation — not to replace it, but to make it more productive. You can use the tool to draft a plain-language overview of the options the patient will be discussing, a list of the questions patients typically raise, or a comparison document that the patient can read before the consultation.

You can also use it to prepare yourself — generating a list of the specific concerns that patients with this patient's clinical profile and life situation tend to raise, so you walk into the consultation having thought through the full range of questions.

A real example

Dr Abdi is a consultant nephrologist. He is seeing a 70-year-old retired woman with CKD Stage 5 approaching the need for renal replacement therapy (RRT). She lives alone, her nearest relative is forty minutes away, and she has expressed anxiety about managing any medical equipment at home. He wants to send her a plain-language comparison document before their decision-making consultation.

He opens an AI tool and types:

Draft a plain-language comparison document for a patient approaching 
dialysis. She is a woman in her early seventies who lives alone. She 
will be discussing three options: haemodialysis in a dialysis centre, 
peritoneal dialysis at home, and conservative kidney management.

For each option, explain:
- What it involves day to day
- How much time it takes and where it happens
- What the main advantages are for someone in her situation
- What the main challenges are for someone in her situation

Do not recommend an option. Do not include clinical eligibility 
criteria or medical contraindications. The goal is to help her 
understand what each option means for daily life.

Tone: clear, honest, and respectful. Acknowledge that this is a 
significant decision. Maximum 600 words.

The tool produces a three-section comparison document. Dr Abdi reads it. He adjusts the peritoneal dialysis section — the tool's description of daily exchanges is accurate but slightly underestimates the practical learning curve for someone living alone. He adds a sentence about the transplant option for the consultation, noting it is something they will discuss separately. He sends the document with the appointment letter.

Try it yourself

Things to watch for

This document supports the consultation — it does not replace it. The pre-consultation information document helps the patient arrive prepared. It does not constitute informed consent and should not be presented to the patient as the basis for a decision. The clinical consultation remains essential.

Conservative management requires careful framing. A plain-language description of conservative kidney management (also called supportive or palliative kidney management) can be very difficult to calibrate — it must be honest about what it means without being presented as "giving up." Read the tool's description of this option particularly carefully and adjust the framing to match how you present it in your practice.

Transplant options may need to be included. Depending on the patient's clinical situation, transplantation may be a relevant option that should be mentioned. The prompt above focuses on dialysis modalities. If transplantation is relevant, either include it in the prompt or add a note at the end of the document explaining that it will be discussed separately.

The patient's specific circumstances matter enormously. Living situation, proximity to a dialysis centre, occupational status, family support, and prior experience with medical equipment all affect which option is most practical. The tool drafts for the clinical profile you describe. You know the patient.

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