Racial/Ethnic Minorities on Dialysis
Conditions
Keywords
Latino, Hispanic, Dialysis, Navigator, Community health worker
Brief summary
Latinos with End-Stage Renal Disease (ESRD) represent 17% of the US adult ESRD community and suffer a disproportionate burden of social challenges that impacts their well-being. With support from the Amos award from the Robert Wood Johnson Foundation (RWJF), the investigators assessed the feasibility of a 1-arm intervention of a 5-visit lay Peer Navigator intervention to support Latino ESRD patients with social challenges and adherence (using motivational interviewing & patient activation). This trial will build on the Amos work as a small Randomized Controlled Trial (RCT). The overall aims of this proposal are to: 1) engage key operational and clinical stakeholders early-on to develop a Peer Navigator-intervention; 2) conduct a pilot RCT of the peer navigator intervention versus standard care to test feasibility and acceptability; and 3) assess the efficacy of the intervention on interdialytic weight gain (primary outcome) as well as health-related quality of life, patient activation, and hemodialysis adherence (secondary outcomes).
Detailed description
The goal of this project is to assess the feasibility and acceptability of a pilot RCT of a culturally tailored peer-navigator (PN) intervention to improve patient-centered and clinical outcomes for Latino patients with end-stage kidney disease (ESKD). We will compare a culturally tailored intervention that includes a PN to control (standard care). In the culturally tailored intervention, the bilingual PN will provide support with social challenges during 5 visits. We will assess the feasibility of (1) referral, (2) recruitment, (3) retention, (4) intervention implementation, and (5) data collection. We will also assess various outcomes including inter-dialytic weight gain and other adherence and patient-centered outcomes. Specific Aim 1: Conduct a pilot RCT of the peer navigator intervention to assess feasibility, acceptability, as well as outcomes of the proposed peer navigator intervention. Hypothesis 1: A culturally tailored intervention that consists of a bilingual/culture-concordant peer navigator that provides support with social challenges and support with adherence using motivational interviewing for Latino end-stage kidney disease (ESKD) patients, is feasible and acceptable.
Interventions
BEHAVIORALActive Comparator: peer navigator
The intervention is aimed to provide support with social challenges and adherence. The peer navigator will meet with patients to provide support with social challenges and use motivational interviewing to provide support with adherence.
OTHERPlacebo Comparator: Control Arm (standard of care)
Control patients will have met the same inclusion and exclusion criteria as intervention patients.
Sponsors
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
University of Colorado, Denver
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Investigator)
Masking description
The PI will not know arm assignment.
Intervention model description
This will be a pilot RCT (randomized controlled trial) of a 3 month intervention of Latino ESRD patients that will be randomized to one of two arms: 1) PN Arm, in which a bilingual PN provides support with social factors and support with adherence using motivational interviewing during 5 visits or 2) Control (standard care) Arm.
Eligibility
Sex/Gender
ALL
Age
18 Years to 90 Years
Healthy volunteers
Yes
Inclusion criteria
1. Self-identify as Latino 2. Age between 18 and 90 years 3. Diagnosed with end-stage kidney disease 4. Received standard (thrice-weekly HD) for at least 3 months 5. No active substance use (e.g. heavy etoh or opiates) 6. Speak English or Spanish as a primary language 7. Participants must be able to provide informed consent
Exclusion criteria
1. Active suicidal intent 2. Present or past psychosis or bipolar disorder 3. Patient to receive kidney transplantation in the next 3 months
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Interdialytic weight gain | Data collection 3 months prior to consent (collected retrospectively) and 6 months following study completion | Inter-dialytic weight gain will be calculated as the monthly average of the difference between the pre-dialysis weight and the weight at the end of the previous dialysis session, divided by determined dry weight, expressed as a percentage of change in weight per day (%Δkg per day). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Hemodialysis shortening | This will be monitored beginning 3 months prior to enrollment and then 3 months following study completion up to 24 months. Detailed: Monthly for 3 months prior to enrollment, monthly during study and then monthly for 3 months after study completion. | Hemodialysis shortening: Defined as shortening the hemodialysis session by greater than or equal to 10 minutes. |
| Hemodialysis adherence | This will be monitored beginning 3 months prior to enrollment and then 3 months following study completion up to 24 months. Detailed: Monthly for 3 months prior to enrollment, monthly during study and then monthly for 3 months after study completion. | Hemodialysis adherence defined defined as the proportion of monthly scheduled sessions missed (other than for vacation or hospitalization) |
| Albumin | This will be monitored beginning 3 months prior to enrollment and then 3 months following study completion up to 24 months. Detailed: Monthly for 3 months prior to enrollment, monthly during study and then monthly for 3 months after study completion. | Albumin |
| Potassium | This will be monitored beginning 3 months prior to enrollment and then 3 months following study completion up to 24 months. Detailed: Monthly for 3 months prior to enrollment, monthly during study and then monthly for 3 months after study completion. | Potassium |
| Phosphorus | Assessed 3 months prior to enrollment, monitored monthly during intervention, and followed for 3 months after intervention | Phosphorus |
| Social determinants of health composite survey | Assessed at twice: At time of enrollment and at time of study completion (up to 1 year) | Several questions from various previously validated surveys that assess social determinants of health. |
| Kidney Dialysis Quality of Life Short Form - 36 questions | Change from baseline health-related quality of life up to 24 months | KDQOL(Kidney Disease Quality Of Life) - Short Form 36 (SF-36). The KDQOL Short Form-36 (KDQOL-SF-36), a 36 item survey with five subscales (Physical Component Summary, Mental Component Summary, Burden of Kidney Disease subscale, Symptoms and Problems subscale, and Effects of Kidney Disease on Daily Life). The KDQOL-SF-36 are scored linearly (with higher score indicating better quality of life) on a range of 0-100 using the developer-recommended scoring (available at https://www.rand.org/health-care/surveys\_tools/kdqol.html). |
| Patient Activation Measure | Assessed at twice: At time of enrollment and at time of study completion (up to 1 year) | Patient Activation Measure has 13 questions, each item is rated on a four-point scale (1 strong disagree to 4 strong agree, with additional 'non-applicable.' Level 1 (less than 47) indicates 'not believing activation is important.' Level 2 (47 to 55.1) indicates 'a lack of knowledge and confidence to take action.' Level 3 (55.2 to 67) indicates 'beginning to take action.' Level 4 (greater than 67) indicates 'taking action.' |
| Emergency Department visits and hospitalizations | Assessed at twice: At time of enrollment and at time of study completion (up to 1 year) | Number of Emergency Department (ED) visits and hospitalizations, length of stay |
| Social Isolation | Assessed twice: At time of enrollment and at time of study completion (up to 1 year) | PROMIS measure |
| Qualitative interviews to assess acceptability | Assessed twice: At time of enrollment and at time of study completion (up to 1 year) | 10 participants will be interviewed using semi-structured approach. The results will be a thematic analysis (that ties in the themes and subthemes with illustrative quotes). |
| Kidney transplantation Questions derived/tailored from two previously published questionnaires. | Assessed twice: At time of enrollment and at time of study completion (up to 1 year) | Kidney transplantation interest in pursuing, placement on list, receipt of transplantation. Questions were derived and tailored from two studies: Ayanian NEJM 1999;341:1661-9 & Bouleware American J of Transplantation 2005;5:1503-1512. Some are yes/no questions and others are on a Likert Scale. |
| Self-Efficacy | Assessed at twice: At time of enrollment and at time of study completion (up to 1 year) | Patient-Reported Outcomes Measurement Information System (PROMIS) measure to assess self-efficacy |
Countries
United States
Outcome results
None listed