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Use of a Decision Aid for Patients Considering Peritoneal Dialysis and In-Center Hemodialysis: A Randomized
Lalita Subramanian1, Junhui Zhao1, Jarcy Zee1
1Arbor Research Collaborative for Health, Ann Arbor, MI.
Insights
A new decision aid significantly reduced decisional conflict and improved knowledge for patients choosing between hemodialysis and peritoneal dialysis. This tool enhances patient understanding and confidence in selecting the right dialysis modality.
Area of Science:
- Nephrology
- Medical Decision Making
- Health Informatics
Background:
- Approximately 100,000 US patients annually must choose between in-center hemodialysis and peritoneal dialysis.
- Selecting the appropriate dialysis modality is a critical decision for patients with advanced chronic kidney disease.
Purpose of the Study:
- To evaluate the effectiveness of a novel decision aid in improving patient decision-making outcomes for dialysis modality selection.
- To assess the impact of the decision aid on decisional conflict, self-efficacy, knowledge, and preparation for making a dialysis choice.
Main Methods:
- A parallel-group randomized controlled trial was conducted with English-speaking US adults with advanced chronic kidney disease and internet access.
- Participants were randomized to receive a web-based decision aid intervention or a control questionnaire.
- Outcomes including treatment preference, decisional conflict, and knowledge were assessed.
Main Results:
- Decision aid users reported significantly lower decisional conflict (29.1 vs 42.5) and higher average knowledge scores (76.5 vs 90.3) compared to the control group.
- Uncertainty regarding dialysis choice decreased from 46% to 16% after using the decision aid.
- Over 90% of decision aid users found it helpful for their decision-making process.
Conclusions:
- The tested decision aid effectively improves immediate decision-making outcomes for patients choosing a dialysis modality.
- Further clinical implementation could explore its potential to enhance patient engagement and empowerment in dialysis selection.
Rationale & Objective:
Annually, about 100,000 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.
Funding:
This study was funded through a Patient Centered Outcomes Research Institute (PCORI) award (#1109).
Trial Registration:
Registered at ClinicalTrials.gov with study number NCT02488317.
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