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Kidney Week

Abstract: FR-OR60

Decision Aid for Renal Therapy (DART) Reduces Decisional Conflict and Improves Knowledge Among Older Adults with Advanced CKD: A Randomized Clinical Trial

Session Information

Category: Geriatric Nephrology

  • 1100 Geriatric Nephrology

Authors

  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Rifkin, Dena E., University of California San Diego, La Jolla, California, United States
  • Gordon, Elisa J., Northwestern University, Evanston, Illinois, United States
  • Rossi, Ana Paula, Piedmont Healthcare Inc, Atlanta, Georgia, United States
  • Tighiouart, Hocine, Tufts Medical Center, Boston, Massachusetts, United States
  • Levine, Sarah, Tufts Medical Center, Boston, Massachusetts, United States
  • Degnan, Jack, University of California San Diego, La Jolla, California, United States
  • Kuramitsu, Brianna R., Northwestern University, Evanston, Illinois, United States
  • Sewall, Lexi, Maine Medical Center, Portland, Maine, United States
  • Isakova, Tamara, Northwestern University, Evanston, Illinois, United States
  • Koch-Weser, Susan, Tufts University School of Medicine, Boston, Massachusetts, United States
  • Ladin, Keren, Tufts University, Medford, Massachusetts, United States

Group or Team Name

  • DART Research Team
Background

For older adults, making decisions about kidney failure treatments is challenging, and dialysis may be inconsistent with life goals. Greater decisional conflict is associated with regret, poor outcomes, and worse satisfaction. The DART trial assessed the effectiveness of an interactive, web-based decision aid on decisional conflict and knowledge among older CKD patients facing dialysis decisions.

Methods

Randomized trial evaluating the web-based DART versus usual education, enrolling adults age 70+, English-fluent, with CKD stage 4-5 from 4 US sites. The primary outcome was change in decisional conflict scale (DCS) score from baseline to first follow-up (~ 3 months) compared using ANCOVA. The validated 16-question DCS (100 point scale; lower score indicates less decisional conflict) measures personal perception of uncertainty in choosing among treatment options and modifiable factors contributing to uncertainty. Twelve knowledge questions about CKD and treatment options were assessed at both visits.

Results

Among 363 participants, 180 were randomized to education and 183 to DART; 162 (89%) completed DART. Mean age was 78 years, mean eGFR was 23 mL/min/1.73 m2, 78% were white and 48% had diabetes. Groups were balanced at baseline. At first follow-up, DCS score improved significantly more among the DART group [mean difference 8.7 (5.2, 12.2)]. Results were similar across DCS subscales (Table). DART was also associated with a 7.2% (3.7, 10.7) greater improvement in knowledge.

Conclusion

DART reduced decisional conflict and improved knowledge among older adults facing kidney failure treatment decisions, emphasizing that the decision-making process for older adults with advanced CKD can be improved with use of this effective educational intervention.

Funded by PCORI, CDR-2017C1-6297

Decisional Conflict by Randomization Group
 DARTUsual Education  
ScaleNBaselineFollow-UpNBaselineFollow-UpMean Differencep-value
Overall15846.6 (22.6)30.5 (17.7)15944.7 (24.4)38.3 (20.6)8.7 (5.2, 12.2)<0.001
Informed15752.0 (27.8)27.5 (19.5)15749.6 (30.1)37.5 (23.4)10.9 (6.6, 15.1)<0.001
Values Clarity15549.1 (27.2)31.2 (20.3)15748.9 (29.9)41.0 (24.2)9.8 (5.6, 14.1)<0.001
Support15831.1 (21.3)24.7 (18.4)15931.2 (23.4)28.3 (21.0)3.5 (-0.2, 7.3)0.07
Uncertainty15455.1 (26.3)38.6 (24.8)15652.7 (29.6)47.1 (26.9)9.7 (4.8, 14.6)<0.001
Effective Decision11340.4 (23.9)27.3 (17.9)12239.2 (26.2)34.9 (23.4)8.0 (3.2, 12.8)0.001

N (%) or mean (95% CI)

Funding

  • Private Foundation Support