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Abstract: SA-PO455

Pandemic Effects on Stability of Goals-of-Care Congruence Between Dialysis Patients and Their Surrogates: A Natural Experiment Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis


  • Song, Mi-Kyung, Emory University, Atlanta, Georgia, United States
  • Paul, Sudeshna, Emory University, Atlanta, Georgia, United States
  • Pelkmans, Jordan L., Emory University, Atlanta, Georgia, United States

The COVID pandemic has brought fear and uncertainty to all aspects of life and to medical care in particular. This study was to assess the effects of a disaster on the stability of dialysis patients’ end-of-life care preferences and dyad congruence on goals of care after an evidence-based advance care planning (ACP) intervention, SPIRIT (Sharing Patient’s Illness Representations to Increase Trust).


In an on-going parent study, a pragmatic trial of SPIRIT included 151 patient-surrogate dyads who completed the baseline (T1) and post-intervention assessment (T2), including goals-of-care preferences (asking patient’s values in specific scenarios), prior to the pandemic lockdown. Of those, 110 dyads (59 intervention and 52 usual care) consented to be in this natural experimental study during the pandemic and completed the measures 2 additional times, at enrollment (T3) and again 6 months later (T4), along with the COVID Stress Scale. Dyad congruence was measured by comparing patients’ and surrogates’ responses to the goals-of-care document.


The sample included 83% non-White. In general, most patients’ goals-of-care preferences and dyad congruence were stable over time. GEE analyses showed a time and pandemic interaction in dyad congruence on goals of care (p=0.04): both groups’ dyad congruence sharply improved at T2 from T1 but more so in intervention dyads before the pandemic (significant treatment effect, p=0.01), and the congruence levels remained stable until T3 during the pandemic followed by an increase in dyads’ congruence at T4 (Fig 1). But group difference during the pandemic (T3, T4) was not significant.


After the ACP intervention, intervention dyads’ congruence was significantly better than controls, but the intervention did not make intervention dyads’ congruence more stable than controls’ during the pandemic.

Dyad Congruence By Group


  • Other NIH Support