Structural Equation Modeling Analysis of Factors Influencing decisional conflict between dialysis modality among end-stage kidney disease patients in Wuhan

Abstract Objectives: To explore the influencing factors and relationships associated with decisional conflict of dialysis modality in ESKD patients. Methods: This study was a survey-based cross-sectional investigation conducted on 150 ESKD patients in a third-class hospital in Wuhan. The general information questionnaire, decisional conflict scale, Montreal cognitive assessment, frail scale, perceived social support scale, and brief health literacy screen were used for investigation. SPSS 25.0 was used to compare the differences between the decisional and non-decisional conflict groups, and AMOS 23.0 was used to construct a structural equation model to explore the influencing factors. Results:The incidence of decisional conflict in 150 ESKD patients was 33.3% (50/150). Binary logistic regression analysis showed that the independent risk factors for decisional conflict of dialysis modality in ESKD patients included monthly household income (OR = 0.184), cognitive function (OR = 7.0), social support (OR = 0.891), health literacy (OR = 0.608), the level of eGFR (OR = 1.488), and the level of cTnI (OR = 9.558). The constructed path analysis model had a good fit (x2/df = 1.499, GFI = 0.957, AGFI = 0.911, NFI = 0.906, CFI = 0.967, RMSEA = 0.055). The path analysis showed that health literacy (0.577) had the greatest impact on the decisional conflict, with a direct effect of 0.480 and an indirect effect of 0.097 through cognitive function and monthly household income. Next was social support with an effect value of 0.434. Conclusions:In clinical practice, it is important to enhance the health literacy of patients and their families and to provide advance education on dialysis plans. Additionally, in managing and planning chronic kidney disease progression and dialysis, it is recommended to regularly and systematically assess cognitive function, particularly before the patient's cognitive impairment worsens or the severity of the disease progresses. Advance care planning can be established through collaboration between healthcare professionals and patients to ensure appropriate decision-making and management. Implications for the profession and/or patient care：This paper finds that the influencing factors and their relationships of dialysis methods in end-stage renal disease patients,helping nurses better exercise autonomy, helping patients reduce their decisional conflict , improving clinical outcomes. Patient or Public Contribution： Patients received a relevant questionnaire survey, and caregivers assisted in conducting the survey.