Best Case/Worst Case nephrology

Conversations about dialysis are challenging. To make decisions consistent with their values and preferences, older adults need information about possible interventions contextualized into a personal framework. To meet this need, we have developed an intervention, called Best Case/Worst Case, to support shared decision making in the context of life-limiting illness. Best Case/Worst Case uses narrative and a hand-written graphic aid to illustrate a choice between treatments and engage patients in deliberation.

Many physicians find Best Case/Worst Case intuitively appealing and some note they already do it. Yet it is different enough from our usual conversations with patients that it takes training and practice to do it correctly. On this page, you will find everything you need for the training and ongoing coaching you will receive to successfully use this tool in your practice. We have worked with nephrologists and palliative care clinicians to create this training program, as well as the Best Case/Worst Case framework itself, to address the specific needs of nephrologists and patients with end-stage kidney disease (ESRD).