iChoose Kidney Decision Aid for Treatment Options

Kidney transplantation is the preferred treatment for patients with End Stage Renal Disease (ESRD), both because it substantially increases a patient’s survival and it is cost saving compared to a lifetime of dialysis. However, transplantation is not universally chosen by patients with renal failure—a disparity that is especially true among minorities and poor patients. The reasons for this disparity are unclear, but it is hypothesized that patient education and involvement in healthcare decision making may play a role. Technology provides the opportunity to place personalized predictions of treatment outcomes in the hands of the patient and physician as they attempt to engage in joint medical decision making. We developed the iChoose Kidney decision support tool to provide ESRD patients and their providers a simple, standardized, easily accessible, statistically robust, decision support tool for use in the clinic to guide patient education and health care decision making about treatment options of dialysis or kidney transplantation (2KL2TR000455-06). We recently evaluated the feasibility of the iChoose Kidney iPad decision support tool among 21 incident (< 1 year on dialysis) ESRD patients with moderately low health literacy and numeracy in an urban dialysis facility in Atlanta. According to our data, nearly half (42.9%) of patients had never had a physician discuss transplant with them, and only 26.3% reported they knew that transplantation offered a survival benefit over dialysis. Following use of the iChoose Kidney tool, knowledge of this survival benefit doubled (from 23.6% to 52.6%; p=0.0384). We found that limited health literacy and numeracy was associated with lower knowledge about the survival benefits of kidney transplantation at baseline (p<0.05). While our feasibility study demonstrated patient acceptance of iChoose Kidney among a population at high risk for not receiving education about transplantation, our small, non-randomized pilot study did not have a control group and was not powered to detect whether the iChoose Kidney decision aid is effective in improving knowledge and decision-making for treatment options for patients with kidney disease. For this Satellite Healthcare grant, we propose to conduct a two-arm, randomized trial of the iChoose Kidney decision aid among 450 late-stage CKD or ESRD patients who are undergoing evaluation for kidney transplantation at three large, diverse transplant centers across the United States (Emory Transplant Center in Atlanta, Columbia University in New York, and Northwestern in Chicago) to test clinical efficacy of a decision support tool. Conducting this pilot, randomized study will provide us with preliminary data on patient- and provider-centered outcomes to conduct a larger randomized study evaluating clinical outcomes, including transplant access.