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

Abstract

Background: There are few studies of patient-facing decision aids that include supportive kidney care as an option. We tested the efficacy of a video decision aid on knowledge of supportive kidney care among older patients with advanced CKD. Methods: Participants (age ≥ 65 years with advanced CKD) were randomized to receive verbal or video education. Primary outcome was knowledge of supportive kidney care (score range 0-3). Secondary outcomes included preference for supportive kidney care, and satisfaction and acceptability of the video. Results: Among all participants (n = 100), knowledge of supportive kidney care increased significantly after receiving education (p < 0.01); however, there was no difference between study arms (p = 0.68). There was no difference in preference for supportive kidney care between study arms (p = 0.49). In adjusted analyses, total health literacy score (aOR 1.08 [95% CI: 1.003-1.165]) and nephrologists' answer of "No" to the Surprise Question (aOR 4.87 [95% CI: 1.22-19.43]) were associated with preference for supportive kidney care. Most felt comfortable watching the video (96%), felt the content was helpful (96%), and would recommend the video to others (96%). Conclusions: Among older patients with advanced CKD, we did not detect Randomized Clinical Trial 737

Video Images about Decisions for Ethical Outcomes in Kidney Disease (VIDEO-KD): the study protocol for a multi-centre randomised controlled trial

“…As such, experts and guidelines have called for increased efforts to improve on shared advance care planning and decision-making for older adults around initiation of dialysis and CPR preferences 30–32. Further, medical treatments, such as dialysis, are often presented as necessary rather than a matter of personal preference while the option of medical management of kidney disease without dialysis is poorly described to patients, if at all 33–38. As a result, there is a call for research to develop and test tools to improve ACP and treatment decision-making among older adults with advanced CKD 33…”

“…Patients often look to video media for information on CPR,42 however, fictional video representations in popular media can sensationalise and misrepresent outcomes 14 43–46. To address these shortcomings, we developed and tested a video decision aid to improve knowledge of kidney failure treatment options (including medical management without dialysis) among older patients with advanced CKD 38. The tool, which is available in both English and Spanish, significantly improved knowledge of medical management without dialysis and participants also reported high satisfaction and acceptability ratings 38.…”

“…To address these shortcomings, we developed and tested a video decision aid to improve knowledge of kidney failure treatment options (including medical management without dialysis) among older patients with advanced CKD 38. The tool, which is available in both English and Spanish, significantly improved knowledge of medical management without dialysis and participants also reported high satisfaction and acceptability ratings 38. Video-based tools can improve decision making by providing visual information to capture complex medical and emotional scenarios and lead to increased ACP documentation 47 48.…”

“…Video-based tools can improve decision making by providing visual information to capture complex medical and emotional scenarios and lead to increased ACP documentation 47 48. Additionally, a growing body of evidence supports the effectiveness and feasibility of decision aids on decision-making outcomes among patients with various serious illnesses, including in kidney disease 38 43 44 47–59. In this paper, we present the rationale, methodology and design of the Video Images about Decisions for Ethical Outcomes in Kidney Disease (VIDEO-KD) trial.…”

Co-Creation of a Multi-Component Health Literacy Intervention Targeting Both Patients with Mild to Severe Chronic Kidney Disease and Health Care Professionals

“…The long-term effect of existing HL interventions, targeting self-management behaviors of CKD patients with LHL, often with digital strategies, is unknown [17]. These interventions do not aim to increase competences of HCPs and target groups often were not consulted during development [18][19][20][21][22][23][24][25].…”