Effect of a Mobile Web App on Kidney Transplant Candidates' Knowledge About Increased Risk Donor Kidneys

Abstract

Background Kidney transplant candidates (KTCs) must provide informed consent to accept kidneys from increased risk donors (IRD), but poorly understand them. We conducted a multisite, randomized controlled trial to evaluate the efficacy of a mobile web application, Inform Me, for increasing knowledge about IRDs. Methods KTCs undergoing transplant evaluation at 2 transplant centers were randomized to use Inform Me after routine transplant education (intervention) or routine transplant education alone (control). Computer adaptive learning method reinforced learning by embedding educational material, and initial (Test 1) and additional test questions (Test 2) into each chapter. Knowledge (primary outcome) was assessed in person after education (Tests 1 and 2), and 1-week later by telephone (Test 3). Controls did not receive Test 2. Willingness to accept an IRD kidney (secondary outcome) was assessed after Tests 1 and 3. Linear regression Test 1 knowledge scores were used to test the significance of Inform Me exposure after controlling for covariates. Multiple imputation was used for intention-to-treat analysis. Results Two hundred-eighty-eight KTCs participated. Intervention participants had higher Test 1 knowledge scores (mean difference=6.61; 95% CI, 5.37–7.86) than control participants, representing a 44% higher score than control participants’ scores. Intervention participants’ knowledge scores increased with educational reinforcement (Test 2) compared to control arm Test 1 scores (mean difference=9.50; 95% CI, 8.27–10.73). After 1 week, intervention participants’ knowledge remained greater than controls’ (mean difference=3.63; 95% CI, 2.49–4.78) (Test 3). Willingness to accept an IRD kidney did not differ between study arms at Tests 1 and 3. Conclusion Inform Me use was associated with greater KTC knowledge about IRD kidneys above routine transplant education alone.

Effect of the iChoose Kidney decision aid in improving knowledge about treatment options among transplant candidates: A randomized controlled trial

“…In a study evaluating the ef-ficacy of a mobile web application for increasing knowledge about increased risk donor kidneys, intervention participants using the app had higher knowledge scores (mean difference: 6.61; 95% CI: 5.37–7.86) than control participants where the knowledge scale ranged from 0 to 31. 34 In another, patients who received intensive education about living donor transplant had higher knowledge (scaled from 0 to than patients who received usual care (12.7 vs. 11.7; P = .0008) one week after evaluation. 35 A systematic review concluded that decision aids were effective in improving treatment option knowledge and clearer expectations of treatment risks and benefits.…”

Cultural competency of a mobile, customized patient education tool for improving potential kidney transplant recipients’ knowledge and decision-making

“…This may reflect either the construction of the survey question, which asked if the recipient would "try to get a PHS high risk donor" or the need to improve the MTC presentation itself. The MTC's failure to encourage acceptance of increased risk deceased donor kidneys mirrors that of another mobile app-based decision-aid, the Inform Me app, which also seeks to increase ESRD patients' knowledge of the risks and benefits of increased risk deceased donor kidney options [30]. Using a randomized controlled trial design, a recently published evaluation of "Inform Me" found that while it was associated with a 44% higher increased risk kidney knowledge score than a control group, but was actually associated with a trend toward lower willingness to accept increased risk kidneys.…”

Attitudes of Liver Transplant Candidates Toward Organs From Increased‐Risk Donors

“…A previous study in liver transplant candidates and recipients showed that more than half the patients preferred being informed about donor‐related risks at the time of organ offer . Interventions such as decision aids and mobile apps have also been studied to assist patients in making decisions regarding transplant quality and appear to increase knowledge . The theoretical acceptance response collected via a survey in some of the quoted studies may be different than the actual acceptance response at the time of offer.…”