Patients with End-Stage Kidney Disease (ESKD) wishing to choose Peritoneal Dialysis (PD) may not be able to perform this modality due to advanced age, physical function/dexterity, vision, cognition, mobility, or psychosocial issues. This intervention will seek to test the feasibility of a clinical support model to address these barriers. Patients identified by their nephrologist as wishing to choose Peritoneal Dialysis (PD), but needing assistance, are referred to the research staff for discussion and consent. Based on the assessment of the subject's nephrologist, PD staff, and researchers, the subject will receive assistance beyond the standard PD care offered in US dialysis centers. Such assistance will be provided for up to one visit/day, seven days/week, for up to three months. At the end of that time period, the subject will be able to perform PD independently, have identified a care provider, or have planned with his/her nephrologist for an alternative dialysis modality.
A patient identified by his/her nephrologist or the WellBound dialysis staff as a candidate for Peritoneal Dialysis (PD) who meets the inclusion criteria will be referred to the research staff for a discussion of the study and consent. A referral to this program can come from any physician referring to participating centers. * Each subject consented into the study receives the standard of care education and training for home PD, in addition to the usual insertion of a PD catheter. * The subject is then transferred to home PD with an individualized assistance plan and research follow-up. * The subject receives the assistance of up to one visit per day depending on the subject's needs, as assessed by the interdisciplinary team, the nephrologist, and the primary investigator or delegate. * The assistance will be provided by a research associate who has undergone full training in the PD techniques required to assist the PD subject at home. * Every 4 weeks the PI or delegate reviews the subject's progress with the nephrologist and nephrology nurse to assess further assistance needs. * Total assistance of up to 3 months is provided after which the subject is either independent, has a care provider, or has developed a plan with his/her nephrologist for future dialysis care.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
20
The patient receives assistance of up to one visit per day for three months depending on the patient's needs, as assessed by the interdisciplinary team, the nephrologist, and the primary investigator or delegate.
Satellite WellBound Emeryville
Emeryville, California, United States
RECRUITINGSatellite WellBound Fremont
Fremont, California, United States
RECRUITINGSatellite WellBound Milpitas
Milpitas, California, United States
RECRUITINGSatellite WellBound Mountain View
Mountain View, California, United States
RECRUITINGSatellite WellBound San Jose
San Jose, California, United States
RECRUITINGSatellite WellBound San Mateo
San Mateo, California, United States
RECRUITINGTo explore the feasibility of an assisted PD program by assessing the need.
Number and proportion of patients needing the service (out of total new starts of PD).
Time frame: Throughout the study, an average of two years
To explore the feasibility of an assisted PD program by assessing the types of need.
Categorize types of assisted tasks and length of assistance needed by participants in the program.
Time frame: Throughout the study, an average of two years
To explore the feasibility of an assisted PD program by assessing acceptance.
Measure the number and rate of patients recruited.
Time frame: Throughout the study, an average of two years
To explore the feasibility of an assisted PD program by measuring adherence.
Measure the number and rate of participants' adherence to and completion of the program.
Time frame: Throughout the study, an average of two years
To explore the feasibility of an assisted PD program by assessing the outcome of participant Peritoneal Dialysis independence.
Measure the number of patients able to independently continue Peritoneal Dialysis out of all patients referred to the program.
Time frame: Throughout the study, average of two years
To explore the feasibility of an assisted PD program by assessing any and all adverse events.
Collect all adverse events during the study.
Time frame: Throughout the study, average of two years
To explore the feasibility of an assisted PD program by measuring the effect on the program on the participant's ability to maintain PD as the treatment modality.
Change in the number of patients who remain on Peritoneal dialysis after assistance as reflected in the dialysis unit records from 1 month to 12 months.
Time frame: At 1, 2, 3, 6, and 12 months
To provide data to estimate the personnel costs of a US assisted PD program.
Measurement of the time and, thus, costs of personnel to conduct the assisted PD program.
Time frame: Aggregated from the start to end of the study (estimated as two years)
To provide data to estimate the resources costs of a US assisted PD program.
Measurement of all non-personal costs to complete the study.
Time frame: Aggregated from the start to end of the study (estimated as two years)
To identify the demographics of the population in need of assisted PD support.
Assessment of the baseline demographics of the patient as routinely collected in the dialysis record.
Time frame: On referral into the study.
To identify the medical history of the population in need of assisted PD support.
Assessment of the medical history of the patient as routinely collected in the dialysis record.
Time frame: Day one on the study
To identify the frailty level of the population in need of assisted PD support.
Measured by the clinical frailty scale. This ranges from 1 (very fit) to 9 (terminally ill).
Time frame: Change from day 1 of home dialysis to 3 months (end of the intervention) .
To identify the patient activation level of the population in need of assisted PD support.
Measured by the Patient Activation Measure: PAM-13 survey. This is a 100 point scale with lower scores designating an individual with less ability to manage his/her health and healthcare.
Time frame: Change from month 1 through month 3 (end of the intervention).
To identify the patient symptom level of the population in need of assisted PD support.
Measured by the Renal Patient Outcome Scale: IPOS-Renal survey which is composed of 11 questions on renal symptoms and patient issues with higher scores indicating greater distress.
Time frame: Change from week 1 to month 3 (end of study).
To identify the patient satisfaction with an assisted PD program.
Measured by a simple LIkert Patient Satisfaction Scale ranging from 1 - 5 with higher results indicating greater satisfaction.
Time frame: Change from 1 month to the end of the patient's participation in the study (up to 1 year).
To identify the staff's satisfaction with an assisted PD program.
Assessed by open ended questions at a staff focus group.
Time frame: One time at the end of the program (approximately two years).
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