TY - JOUR
T1 - Effectiveness of an Intervention to Improve Decision Making for Older Patients with Advanced Chronic Kidney Disease
AU - Ladin, Keren
AU - Tighiouart, Hocine
AU - Bronzi, Olivia
AU - Koch-Weser, Susan
AU - Wong, John B.
AU - Levine, Sarah
AU - Agarwal, Arushi
AU - Ren, Lucy
AU - Degnan, Jack
AU - Sewall, Lexi N.
AU - Kuramitsu, Brianna
AU - Fox, Patrick
AU - Gordon, Elisa J.
AU - Isakova, Tamara
AU - Rifkin, Dena
AU - Rossi, Ana
AU - Weiner, Daniel E.
N1 - Funding Information:
Grant Support: By PCORI award CDR-2017C1-6297 with additional infrastructure support from the Tufts CTSI (NIH National Center for Advancing Translational Sciences grant UL1TR002544).
Funding Information:
Patient-Centered Outcomes Research Institute (PCORI). The team greatly appreciates the participation and input of patients, care partners, and clinicians who participated in this study, as well as the Stakeholder Advisory Board. By PCORI award CDR-2017C1-6297 with additional infrastructure support from the Tufts CTSI (NIH National Center for Advancing Translational Sciences grant UL1TR002544).
Funding Information:
Research reported in this publication was funded through a Patient-Centered Outcomes Research Institute (PCORI) award with additional infrastructure support from the Tufts Clinical and Translational Science Institute (CTSI). The funder had no role in the study's design, conduct, or reporting.
Publisher Copyright:
© 2022 American College of Physicians.
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background: Older patients with advanced chronic kidney disease (CKD) face difficult decisions about managing kidney failure, frequently experiencing decisional conflict, regret, and treatment misaligned with preferences. Objective: To assess whether a decision aid about kidney replacement therapy improved decisional quality compared with usual care. Design: Multicenter, randomized, controlled trial. (ClinicalTrials. gov: NCT03522740) Setting: 8 outpatient nephrology clinics associated with 4 U.S. centers. Participants: English-fluent patients, 70 years and older with nondialysis CKD stages 4 to 5 recruited from 2018 to 2020. Intervention: DART (Decision-Aid for Renal Therapy) is an interactive, web-based decision aid for older adults with CKD. Both groups received written education about treatments. Measurements: Change in the decisional conflict scale (DCS) score from baseline to 3, 6, 12, and 18 months. Secondary outcomes included change in prognostic and treatment knowledge and change in uncertainty. Results: Among 400 participants, 363 were randomly assigned: 180 to usual care, 183 to DART. Decisional quality improved with DART with mean DCS declining compared with control (mean difference, —8.5 [95% CI, —12.0 to —5.0]; P < 0.001), with similar findings at 6 months, attenuating thereafter. At 3 months, knowledge improved with DART versus usual care (mean difference, 7.2 [CI, 3.7 to 10.7]; P < 0.001); similar findings at 6 months were modestly attenuated at 18 months (mean difference, 5.9 [CI, 1.4 to 10.3]; P = 0.010). Treatment preferences changed from 58% “unsure” at baseline to 28%, 20%, 23%, and 14% at 3, 6, 12, and 18 months, respectively, with DART, versus 51% to 38%, 35%, 32%, and 18% with usual care. Limitation: Latinx patients were underrepresented. Conclusion: DART improved decision quality and clarified treatment preferences among older adults with advanced CKD for 6 months after the DART intervention.
AB - Background: Older patients with advanced chronic kidney disease (CKD) face difficult decisions about managing kidney failure, frequently experiencing decisional conflict, regret, and treatment misaligned with preferences. Objective: To assess whether a decision aid about kidney replacement therapy improved decisional quality compared with usual care. Design: Multicenter, randomized, controlled trial. (ClinicalTrials. gov: NCT03522740) Setting: 8 outpatient nephrology clinics associated with 4 U.S. centers. Participants: English-fluent patients, 70 years and older with nondialysis CKD stages 4 to 5 recruited from 2018 to 2020. Intervention: DART (Decision-Aid for Renal Therapy) is an interactive, web-based decision aid for older adults with CKD. Both groups received written education about treatments. Measurements: Change in the decisional conflict scale (DCS) score from baseline to 3, 6, 12, and 18 months. Secondary outcomes included change in prognostic and treatment knowledge and change in uncertainty. Results: Among 400 participants, 363 were randomly assigned: 180 to usual care, 183 to DART. Decisional quality improved with DART with mean DCS declining compared with control (mean difference, —8.5 [95% CI, —12.0 to —5.0]; P < 0.001), with similar findings at 6 months, attenuating thereafter. At 3 months, knowledge improved with DART versus usual care (mean difference, 7.2 [CI, 3.7 to 10.7]; P < 0.001); similar findings at 6 months were modestly attenuated at 18 months (mean difference, 5.9 [CI, 1.4 to 10.3]; P = 0.010). Treatment preferences changed from 58% “unsure” at baseline to 28%, 20%, 23%, and 14% at 3, 6, 12, and 18 months, respectively, with DART, versus 51% to 38%, 35%, 32%, and 18% with usual care. Limitation: Latinx patients were underrepresented. Conclusion: DART improved decision quality and clarified treatment preferences among older adults with advanced CKD for 6 months after the DART intervention.
UR - http://www.scopus.com/inward/record.url?scp=85146365252&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85146365252&partnerID=8YFLogxK
U2 - 10.7326/M22-1543
DO - 10.7326/M22-1543
M3 - Article
C2 - 36534976
AN - SCOPUS:85146365252
SN - 0003-4819
VL - 176
SP - 29
EP - 38
JO - Annals of Internal Medicine
JF - Annals of Internal Medicine
IS - 1
ER -