Chronic Kidney Diseases
Conditions
Brief summary
The objective of this application is to conduct a pilot study testing the impact of integrated nephrology and palliative care versus standard nephrology care on patient-reported outcomes. This study is a preliminary study designed to determine feasibility of a palliative care study inclusive of kidney disease patients and to look for trends in impact over a 12-week follow-up period. Measurements will be taken at time one (time of enrollment) and time two (12 weeks). Our central hypothesis is that integration of palliative care with standard nephrology care in the ambulatory care of patients with a glomerular filtration rate (eGFR) ≤15ml/min/1.73m2 will trend towards improved symptom control, quality of life, and increased documentation of advance care planning when compared to usual nephrology care. We expect 10-15 patients per arm.
Interventions
OTHERIntegrated ambulatory palliative and nephrology care
Monthly ambulatory care visits with the kidney palliative care team in the intervention group for three months. The intervention in this study is addition of a palliative care team to the care team of the subject. This intervention will not change or impact their regular nephrology care. The subjects in the intervention arm will be seen by the palliative care team three times over the 12-week study period (once per month).The intervention will be delivered by a physician trained in both palliative care and nephrology, the PI of the study.
OTHERStandard nephrology care
Standard nephrology care
Sponsors
NYU Langone Health
Study design
Allocation
RANDOMIZED
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
In order to be eligible to participate in this study, an individual must meet all of the following criteria: 1. Age ≥18 2. Fluent English speaker 3. eGFR≤15 mL/min/1.73m2 (diagnosis of CKD stage V) 4. Able to give consent 5. Must be followed by a faculty group practice nephrologist
Exclusion criteria
An individual who meets any of the following criteria will be excluded from participation in this study: 1. Diagnosis of dementia 2. Non-English speaker 3. Have been seen by a palliative care provider prior to study entry 4. Pregnant women 5. On dialysis or have received a kidney transplant
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Difference between the number of documented advanced care planning between arms | Week 12 | advanced care planning = health care proxy, Medical Order for Life Sustaining Treatment \[MOLST\], or a Do Not Resituate form |
| Change in IPOS-Renal symptom assessment score | Baseline, week 12 | IPOS-Renal is a short measure (11 questions), combining the most common symptoms renal patients experience plus additional items from IPOS on concerns beyond symptoms, such as information needs, practical issues, family anxiety. The total score reflects symptom burden and can range from zero to 68, where 0 is least symptom burden and 68 is highest symptom burden. |
| Change in KDQOL-SF 36 Quality of Life Scores | Baseline, week 12 | The KDQOL-36 has five scales, including two generic HRQOL scales from the SF-12 version 1 (12 items total) and three kidney-specific scales (24 items total). The SF-12 PCS and MCS are scored on a T-score metric (mean=50, SD=10, in the United States general population), with higher scores indicating better HRQOL. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| patient satisfaction as rated on the Press Ganey Survey | 12 weeks | Measure satisfaction on a five point scale where 5 is the Top Score. |
| retention patients at the end of the study | 12 weeks | — |
| percent of returned clinical surveys (IPOS-R and KDQOL-SF 36 | 12 weeks | — |
Other
| Measure | Time frame | Description |
|---|---|---|
| Change in IPOS-Renal symptom assessment score over time in intervention arm | Baseline, 6 weeks, 12 weeks | Exploratory end-points include change in symptom burden over time in the intervention arm. These subjects are expected to have three visits with symptom surveys filled out at each visit. We hypothesize that symptom burden will improve over time. |
Countries
United States
Outcome results
None listed