Conservative kidney management decision aid increases discussion of treatment
Click Here to Manage Email Alerts
Offering a decision aid regarding conservative kidney management to patients with advanced kidney disease and their family led to increased discussion of the treatment option with providers, according to a study.
“Conservative kidney management (CKM) is a planned and comprehensive approach to caring for patients with advanced chronic kidney disease (CKD) who choose not to pursue maintenance dialysis,” Susan P.Y. Wong, MD, MS, from the department of medicine at the University of Washington, and colleagues wrote. They added, “Despite a growing body of evidence and clinical services to support patients who do not wish to pursue dialysis, patients rarely recall discussing conservative options with their providers. A number of decision aids about treatments for advanced CKD exist, however they focus primarily on the benefits and harms of dialysis and include little or no information on CKM. Thus, available decision aids miss critical content needed to support shared decision-making for treatment of advanced CKD.”
In a randomized pilot trial, researchers examined the results of 92 patients who were at least 75 years old with stage 4 or 5 CKD and 56 family members of patients. Patients received care at medical centers in Seattle between December 2021 and August 2022.
Participants completed the first study visit (T1) over the phone, then patients and/or their family members were randomized together in two-patient blocks at a 1:1 ratio to receive either usual care (n=42) or usual care and a CKM decision aid (n=44). The decision aid consisted of a 10-page informational booklet.
Participants attended follow-ups over the phone at 2 weeks (T2) and 3 months (T3). Researchers considered the number of participants who discussed CKM with their health care provider between T1 and T3 the primary outcome of the study. Researchers determined acceptability with attrition rates between T1 and T3.
Overall, attrition rates for the usual care arm vs. the usual care and decision-aid arm were 21% vs. 21%, respectively, for patients and 10% vs. 18%, respectively, for family members. Patients who received a CKM decision aid in addition to usual care were more likely to discuss CKM with a provider (26.4% vs. 3%). Similarly, 26.9% of family members who received the decision aid discussed CKM with providers, as opposed to 0% of family members who did not receive the aid.
“In conclusion, our decision aid about CKM was regarded positively by older patients with advanced CKD and their family members, promoted discussion of CKM with their health care providers and shows promise as a useful addition to currently available educational tools on treatments for advanced CKD,” Wong and colleagues wrote. “A future clinical trial is needed to determine the efficacy of the decision aid among larger, more diverse populations and from the perspective of multiple stakeholders integral to decision-making about treatment of advanced CKD.”
Collapse
Read more about
Click Here to Manage Email Alerts