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).


Questions about the toolkit?

Amy Zelenski, phD

(608) 957-6710


Research study Participants

We are conducting a clinical trial using Best Case/Worst Case Nephrology. If you are an enrolled nephrologist in the study, you can access the learner manual for your training using the “Download the Learner Manual” button below. If you need help accessing any training sessions, contact Amy Zelenski, PhD by email: or click the “Get Help Accessing Virtual Training” button below.


Thank you, Participants!


Thank you so much for participating in the “Effective Communication between Kidney Specialists and Their Patients” study!

We appreciate your time and support.


We will update this website periodically to share study updates. Study results will not be available for several more years, but they will be posted here as soon as they are available.


December 2022:

As of 12/8/22, there are 174 patients, 52 family members and 56 nephrologists participating in this study at 10 sites across the United States.


Have general questions/comments/suggestions about the study? Please feel free to call or email the study manager directly:

Anne Buffington

phone: 608-265-4443

Learn to use
Best Case/Worst Case
Nephrology in 10 minutes!





See a demonstration
of the tool being
used in clinic


How does this tool help patients?

What do patients think about the tool?

How do you fit this conversation into the clinic?

When do you start the conversation?

What if the patient is already on dialysis?

How do you talk about prognosis?



Wisconsin Surgical Outcomes Research Program
Department of Surgery
University of Wisconsin School of Medicine and Public Health



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