Use of a Decision Aid for Patients Considering Peritoneal Dialysis and In-Center Hemodialysis: A Randomized Controlled Trial

Abstract

US patients face the difficult choice between the most common dialysis types, in-center hemodialysis and peritoneal dialysis. This study evaluated the value of a new decision aid to assist in the choice of dialysis modality. Study Design: A parallel-group randomized controlled trial to test the efficacy of the decision aid on decision-making outcomes. Setting & Participants: English-speaking US adults with advanced chronic kidney disease and internet access enrolled in 2015. Intervention: Participants randomly assigned to the decision aid intervention received information about chronic kidney disease, peritoneal dialysis, and hemodialysis and a value clarification exercise through the study website using their own electronic devices. Participants in the control arm were only required to complete the control questionnaire. Questionnaire responses were used to assess differences across arms in decision-making outcomes. Outcomes: Treatment preference, decisional conflict, decision self-efficacy, knowledge, and preparation for decision making. Results: Of 234 consented participants, 94 (40.2%) were lost to follow-up before starting the study. Among the 140 (70 in each arm) who started the study, 7 were subsequently lost to follow-up. Decision aid users had lower decisional conflict scores (42.5 vs 29.1; P < 0.001) and higher average knowledge scores (90.3 vs 76.5; P < 0.001). Both arms had high decisional self-efficacy scores independent of decision aid use. Uncertainty about choice of dialysis treatment declined from 46% to 16% after using the decision aid. Almost all (>90%) users of the decision aid reported that it helped in decision making. Limitations: Limited generalizability from the study of self-selected study participants who had to have internet access, speak English, and have computer literacy. High postrandomization loss to follow-up. Evaluation of only short-term outcomes. Conclusions: The decision aid improves decision-making outcomes immediately after use. Implementation of the decision aid in clinical practice may allow further assessment of its effects on patient engagement and empowerment in choosing a dialysis modality.

Challenges to Shared Decision Making About Treatment of Advanced CKD: A Qualitative Study of Patients and Clinicians

“…41 Patient decision aids can also better prepare patients to select a treatment option that they believe is best for them. 42 Additionally, engaging specialty palliative care and ethics consultation services in the care of complex patients can be helpful to patients, families and clinicians and reduce the use of burdensome or unnecessary treatments. 43,44 Taken together, our findings call for more innovation to support shared decisionmaking for treatment of advanced CKD.…”

Good practices for dialysis education, treatment, and eHealth: A scoping review

“…However, the review includes no decision aids specifically for nephrological care. A randomized study among 133 CKD patients concludes that an online decision aid can improve knowledge and decrease decisional conflict and uncertainty about choice of dialysis treatment [ 54 ]. So, decision aids are important for use during dialysis education.…”

Use of a Supportive Kidney Care Video Decision Aid in Older Patients: A Randomized Controlled Trial

“…DOI: 10.1159/000509711 Shared decision-making for ESRD treatments should encompass conversations between clinicians, patients, and caregivers about the risk and benefits of both dialytic and non-dialytic treatments in the context of a patient's goals and values [39]. However, despite long-standing advocacy for supportive kidney care delivery among national and international nephrology organizations, educational tools that inform patients and their loved ones are limited and fewer have established efficacy on objective knowledge [14,17,19,40,41]. We demonstrated that a supportive kidney video decision aid was well received among our study cohort-which counters historic beliefs among clinicians that speaking about non-dialytic treatments may cause unintended psychological harm toward patients [42].…”

“…Patients with advanced CKD and their caregivers desire patient-centered information regarding their ESRD treatment options but supportive kidney care is often not discussed [11][12][13]. Also, there is limited evidence about how best to inform patients about non-dialytic treatments and pre-dialysis education program processes vary widely [14][15][16][17][18][19]. Educational video decision aids have been studied in randomized controlled trials (RCT) to better promote informed decision-making among patients with kidney disease, dementia, heart failure, and cancer; however, none have included supportive kidney care [20][21][22][23].…”