End-Stage Kidney Disease
Conditions
Keywords
end-stage kidney disease, decision aid, shared decision making
Brief summary
Decision aids are highly recommended for decisions when there is no right treatment choice. The goal is to help patients choose a treatment that is consistent with their preferences and to minimize decisional conflict and regret. A case where there is no right treatment concerns the decision to undergo dialysis or supportive care (i.e., conservative management) for elderly (aged ≥70) patients with end-stage kidney disease. The investigators propose to develop an interactive web-based decision aid and test its effectiveness via a pre-post study design. This research aims to reduce decisional conflict for elderly ESKD patients and caregivers.
Detailed description
For patients aged 75 and above with comorbidities, the benefits of dialysis over kidney supportive care, which focuses on maintaining quality of life as opposed to life extension, are not clear. As there is no clear or right treatment choice, treatment decisions should be informed by patient preferences. However, currently in Singapore most patients choose dialysis and express decisional conflict and regret. Decision aids (DAs) together with values clarification methods (VCMs) can help patients choose a treatment that is concordant with their preferences and treatment goals. To help minimize decisional conflict among elderly ESKD patients, the first aim of this proposal is to adapt the current materials the investigators have developed (booklet and video) for elderly ESKD patients in a prior effort (NMRC/HSRG/0080/2017) into an interactive web-based tool called myKIDNEY. It will provide patients with tailored and relevant information based on their age and medical history, and help them identify and express their preferences via an interactive VCM. The second aim of the proposal is to test the benefits of counselling with myKIDNEY to standard renal counselling via a pre-post study design. The primary hypothesis is that patients and caregivers who receive counselling with myKIDNEY will report less decisional conflict compared to those who receive standard counselling. The investigators also hypothesize that fewer patients in the intervention arm will opt for dialysis, which is the more costly and invasive treatment option. If the proposed study shows evidence that the interactive tool improves decision-making quality in the local setting, this will result in a better patient experience. If fewer patients choose dialysis as per our hypothesis, this will also generate cost savings for the health system while at the same time allowing patients to choose their preferred treatment with lower chances of decisional conflict.
Interventions
OTHERmyKIDNEY decision aid
Patients and caregivers will be counselled using myKIDNEY decision aid which includes a video. Patients will be asked to complete a values clarification exercise (VCE). If a caregiver is recruited without their patient, he/she will be asked to complete the VCE on patient's behalf (i.e., surrogate). At the end of VCE, the participant will be given real-time feedback on which treatment might be the best fit for the patient. With the patient's consent, this information will be shared with the treating physician who can then make recommendations based on the patient's preferences.
Sponsors
Singapore General Hospital
National University Hospital, Singapore
Duke-NUS Graduate Medical School
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE (Subject)
Intervention model description
Pre-post study design
Eligibility
Sex/Gender
ALL
Age
21 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
(patients): * Incident CKD Stage 5 patients with GFR\<15ml/min * Aged 70 years or older- * Have not undergone counselling with a renal counsellor * Cognitively intact as determined by the Abbreviated Mental Test (AMT) * Speak and read English or Mandarin Inclusion Criteria (caregivers): * Primary informal caregiver for an eligible patient (primarily involved in providing care, ensuring provision of care, and/or in making decisions regarding patient's care) * Aged 21 years and older * Direct relative of the patient
Exclusion criteria
\- Patients deemed to be mentally incompetent, and those not aware of their diagnosis will be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Decisional conflict scale (0 to 100; higher scores indicate higher decisional conflict) | 1 hour | Difference in decisional conflict scale between the intervention and comparison arms |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Stated preferred treatment | Assessed after renal counselling (within 2 weeks after renal counselling) | Difference in the percentage of participants who choose a form of dialysis as the preferred treatment between the intervention and comparison arms |
| Actual treatment choice | 6 months after renal counselling | Difference in the percentage of participants who initiate dialysis based on the medical records at 6 months after the counselling between the intervention and comparison arms |
Countries
Singapore
Contacts
Primary ContactSemra Ozdemir, PhD
Backup ContactJia Jia Lee, MPH
Outcome results
None listed