A randomized controlled trial testing a decision support intervention for older patients with advanced kidney disease

Area of Science:

• Nephrology
• Geriatrics
• Health Decision Science

Background:

• Older adults with advanced kidney disease (eGFR ≤20 ml/min/1.73m²) face complex treatment decisions.
• Facilitating shared decision-making is crucial for patient autonomy in this population.
• The OPTIONS intervention was developed to support treatment choices in this demographic.

Purpose of the Study:

• To evaluate the effectiveness of the OPTIONS decision support intervention.
• To assess its role in facilitating treatment choices for older individuals with advanced kidney disease.

Main Methods:

• A pragmatic randomized controlled trial was conducted.
• Participants (≥70 years, eGFR ≤20 ml/min/1.73m²) received either OPTIONS or standard care.
• Primary outcomes included decision conflict and regret; secondary outcomes assessed knowledge and quality of life.

Main Results:

• The OPTIONS intervention significantly improved participants' knowledge of dialysis risks and benefits.
• Lower decisional conflict was observed in the intervention group at T2.
• No significant differences were found in decision conflict, regret, or quality of life scores between groups.

Conclusions:

• The OPTIONS intervention effectively increases knowledge regarding dialysis treatment options for older adults.
• It serves as a structured, evidence-based approach to support shared decision-making in advanced kidney disease.
• Enhanced patient knowledge can facilitate greater autonomy and informed treatment choices.