Automated Digital Counseling Program (ODYSSEE-Kidney Health): A Pilot Study on Health-Related Quality of Life

Abstract

Background: In-person counselling programs promote self-care behaviour and health-related quality of life (HRQoL). ODYSSEE Kidney Health (ODYSSEE-KH) is an automated, scalable, digital counselling program for patients with CKD. This open-label, single-arm pilot study tested the efficacy potential of ODYSSEE-KH to improve HRQoL in patients with CKD. Methods: Adults with categories G3b to 5D CKD were recruited from nephrology clinics in Toronto, Canada. Patients (n=29) received access to ODYSSEE-KH in conjunction with usual care. Generalized linear models and pairwise comparisons of mean change scores were conducted to assess the primary outcome: Mental Component Score (MCS) of the Kidney Disease Quality of Life – Short Form (KDQoL-SF) instrument. Secondary outcomes included: MCS mental health scale, 36-item KDQoL-SF, Generalized Anxiety Disorder scale (GAD-7), Patient Health Questionnaire for depression (PHQ-9), Enhancing Recovery in Coronary Heart Disease Social Support Instrument (ESSI), and 3-item Revised UCLA Loneliness (RULS-3) scale. Results: Mean age was 53.5 years (SD=18.3); 35% women; 56% White; 93% completed ≥ post-secondary education; patients came from the Multi-Care Kidney Clinic (n=9), the Home Peritoneal Dialysis Unit (n=12), and the Home Hemodialysis Unit (n=8); and 24 participants completed the 4-month end of study questionnaires. Outcomes were assessed according to tertiles of program logon minutes: median (range) = 67 (62-108), 212 (119-355), and 500 (359-1573) minutes. Patients in the highest tertile of engagement showed significant improvements on the MCS vs. the moderate tertile group (p = 0.01). Significant dose-response associations were observed for MCS Mental Health (p<0.05), KDQoL Burden on Kidney Disease (p<0.01), KDQoL Effect of Kidney Disease on Everyday Life (p<0.01), aggregated KDQoL summary (p<0.05), GAD-7 (p<0.01), PHQ-9 (p<0.05), ENRICHD-SSI (p<0.01), and RULS-3 (p<0.01). Conclusion: ODYSSEE-KH demonstrated feasibility as an automated, scalable, digital self-care program for patients with CKD. There is evidence of efficacy potential to improve HRQoL. Further evaluation with a larger sample is warranted.