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Kidney Week

Abstract: FR-PO882

Patient and Clinician Perspectives on an Advance Care Planning Decision Aid for Older Patients with CKD: Decision Aid for Renal Therapy (DART)-Advance Care Planning (ACP)

Session Information

  • Geriatric Nephrology
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Geriatric Nephrology

  • 1300 Geriatric Nephrology

Authors

  • Kennefick, Kristen, Tufts University, Medford, Massachusetts, United States
  • Weiner, Daniel E., Tufts Medical Center, Boston, Massachusetts, United States
  • Ladin, Keren, Tufts University, Medford, Massachusetts, United States

Group or Team Name

  • DART Team.
Background

Among Medicare beneficiaries 65 and older with chronic kidney disease (CKD), adjusted mortality is over twice as high compared to age-matched non-CKD counterparts. However, few older adults with CKD complete advance care plans (ACP), which can align care with patient preferences. We assessed the accessibility and feasibility of a decision aid tailored to ACP for other populations have been shown to increase knowledge of ACP and readiness for end-of-life conversations.

Methods

Qualitative study using semi-structured interviews (March 2022-March 2023) with purposively sampled patients (CKD stage 4-5 patients, age ≥50) and clinicians (nephrologists). Participants viewed DART-ACP modules prior to interviews. Patient participants were approached in participating nephrology clinics in Greater Boston. Audio recordings were transcribed verbatim, and content and thematic analysis were conducted.

Results

61 participants (29 clinicians; 33 patients) completed interviewed. Among clinicians, 38% were women and 41% were from the Northeast. Among patients, 36% were women, 39% identified as Black, and mean age was 70 ± 9 years. Four themes emerged during thematic analysis: 1) acceptability of DART-ACP among patients and clinicians; 2) difficulty in understanding granularity and impact of end-of-life decisions; 3) demand for information on palliative care; and 4) empowering patients to document wishes. DART-ACP was described as clear, approachable, and informative for patients across demographic categories and among most clinicians. DART-ACP was acceptable even among patients who reported being hesitant about ACP. Suggestions for improvement included incorporating lived experiences, integrating ACP documents into the modules, and including information for carepartners.

Conclusion

Patients and clinicians found DART-ACP accessible and useful in the context of dialysis decision-making, especially information about palliative care. Participant feedback will inform tailoring DART-ACP for clinical use.

Funding

  • Private Foundation Support