The investigators are conducting a study to see which program better helps older patients with kidney disease choose their treatment. Investigators are also investigating if either program can reduce the number of hospital or emergency room visits in the first 6 months of the study, as well as potentially improve end-of-life care for older adults. Half of the participants will receive Program A, while the other half will receive Program B. Investigators will compare the two groups to see which participants feel better prepared about their kidney therapy decisions, experience improved end-of-life care, and have fewer emergency room visits and hospital admissions. Participants in Program A will receive information from the National Kidney Foundation and meet with a kidney therapy educator. Participants in Program B will get information about kidney disease treatment and meet with a decision-support specialist who's an expert in decision-making.
Older adults ≥75 years represent the fastest-growing population to initiate dialysis in the US; despite the life-altering effects of dialysis on quality of life, dialysis is often presented as a default without considering patient preferences, prognosis, and alternative options such as conservative kidney management. This study will test the first palliative care intervention for older patients with advanced chronic kidney disease to improve the kidney therapy decision-making process. This research not only has the potential to help thousands of older patients with advanced chronic kidney disease who often have unanswered questions, unmet information needs, and restricted opportunities to share personal treatment preferences with their nephrologists but also has the possibility of creating new models of collaborative care by integrating palliative care into routine nephrology care.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
326
Subjects in the Control group will receive 1) National Kidney Foundation information, and 2) support from a kidney therapy educator.
Subjects in the intervention group will receive 1) a video and paper decision aid, and 2) coaching from a decision support specialist. The visits will be aimed at supporting patients with kidney therapy decision-making.
UR Medicine Nephrology - Strong West
Brockport, New York, United States
RECRUITINGNephrology Clinic - Thompson Professional Building
Canandaigua, New York, United States
RECRUITINGNephrology Clinic - St. James Medical Office Building
Hornell, New York, United States
RECRUITINGHighland Hospital
Rochester, New York, United States
RECRUITINGUniversity of Rochester Medical Center
Rochester, New York, United States
RECRUITINGChanges in Kidney Therapy Decision-Making Process using the Decisional Conflict Scale at 12 weeks
Determine whether the intervention improves kidney therapy decision-making at 12 weeks by using the Decisional Conflict Scale. Score ranges from 0-100. Lower scores indicate better outcomes.
Time frame: Baseline, 4-6 weeks, and 12 weeks
Changes in patients' well-being at 6 months using the Burden of Kidney Disease Subscale
Determine whether the intervention improves patient well-being at 6 months using the Burden of Kidney Disease Subscale, a 4-question scale with response options ranging from 'definitely true (0)' to 'definitely false (3)'. Higher scores indicate better outcomes.
Time frame: Base line 6 months
Changes in number of hospital admissions, intensive care admissions, and emergency room visits
Review electronic health records to determine whether the intervention reduces the number of hospital admissions, intensive care admissions, and emergency room visits between study entry and 6 months.
Time frame: Baseline, 6 months
Differences in end-of-life care between intervention and control arm
Review patients' medical charts to determine whether the intervention improves end-of-life care treatment during the last 30 days of life, as measured by the rates of aggressive procedures such as cardiopulmonary resuscitation (CPR), dialysis, intubation, gastrostomy (G-tube), etc.
Time frame: Baseline to 6 months
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