Abstract: SA-OR32
A Randomized Controlled Pilot Study of a Patient Decision Aid About Conservative Kidney Management
Session Information
- High-Impact CKD Potpourri: Something for Everyone
November 05, 2022 | Location: W307, Orange County Convention Center‚ West Building
Abstract Time: 04:39 PM - 04:48 PM
Category: Geriatric Nephrology
- 1200 Geriatric Nephrology
Authors
- Wong, Susan P.Y., University of Washington Department of Medicine, Seattle, Washington, United States
- Oestreich, Taryn, University of Washington Department of Medicine, Seattle, Washington, United States
- Prince, David K., University of Washington Department of Medicine, Seattle, Washington, United States
- Chandler, Bridgett A., University of Washington Department of Medicine, Seattle, Washington, United States
- Curtis, J. Randall, University of Washington Department of Medicine, Seattle, Washington, United States
Background
Conservative kidney management (CKM) is an important treatment option for patients who do not wish to receive maintenance dialysis. However, most patient decision aids do not present information on this treatment approach.
Methods
We conducted a randomized controlled pilot study (NCT04919941) to assess the feasibility and acceptability of a new decision aid about CKM with patients aged ≥75 years with stage 4 or 5 CKD and family members between August 2020-December 2021. After completing an initial study visit (T1), participants were randomized to receive the aid or to usual care. Acceptability was assessed based on attrition rates in each study arm between (T1) and 3-month follow-up (T3). Our primary outcome measure and measure of feasibility was the proportion who discussed CKM with a healthcare provider at T3. We also explored changes in patients’ decisional uncertainty (Decision Conflict Scale [DCS] scores) about treatment options for their CKD (dialysis, CKM, or unsure) at T3.
Results
We randomized 92 patients of which 86 patients (55.8% male; age 82±6 years; 82.6% White) completed T1—42 in the usual care arm and 44 in the intervention arm—and 56 family members of which 53 (18.9% male; age 71±11 years; 86.8% White) completed T1—20 in usual care arm and 33 in the intervention arm. Attrition rates were low in the usual care and intervention groups for patients (21% vs. 21%, p=1.0) and family members (10% vs. 18%, p=0.46) The intervention was associated with greater discussion of CKM with a healthcare provider for patients (26.4% vs. 3.0%, p=0.007) and family members (26.9% vs. 0%, p=0.02). Patients who were unsure about which treatment option they preferred decreased by 20.0% in the intervention group and by 12.1% in the control group (p=0.27). Patients’ decisional uncertainty about their options also decreased for the intervention (DCS -15.7±21.2) and control (DCS -9.1±20.6) groups (p=0.06).
Conclusion
Our decision aid on CKM was feasible, acceptable, and promoted discussion of this treatment option with healthcare providers. The aid may show promise as a useful adjunct to currently available educational tools on treatments for advanced CKD.
Funding
- Private Foundation Support