Identifying Adaptation Needs of a Decision Aid for Older Latino Adults With Advanced CKD: A Qualitative Study

Latino adults aged 65 years and older comprise the fastest growing minoritized group in the United States and experience a disproportionate burden of kidney failure. Decision aids improve decisional quality and goal-concordant care among older patients with chronic kidney disease (CKD). However, decision aids for kidney replacement therapy have yet to be adapted for the older Latino adult population with advanced CKD. This study assessed the acceptability, accessibility and adaptions needed to facilitate use of a Spanish version of the Decision-Aid for Renal Therapy (DART-S) for older Latino adults with advanced CKD.

Qualitative study applying the Cultural Targeting and Tailoring of Shared Decision-Making Technology Framework in focus groups and structured interviews. Suggested adaptations were grouped into recommendations and analyzed qualitatively.

Five focus groups (N = 17) and interviews (N = 15) with Spanish-speaking patients and care partners were conducted.

Thematic analysis.

Among patient participants, 55% were male, and the mean age was 68 ± 9 years. Overall, the participants found DART-S to be acceptable and accessible. Thematic analysis revealed the importance of incorporating lived experiences, including patient and family testimonials, to illustrate the mental health impact of CKD, self-care strategies, and home dialysis adaptations. Some found the delivery of prognostic information distressing, highlighting the need for more sensitive communication. The tailoring recommendations included information about financial barriers, nutrition, and lifestyle. Participants preferred that DART-S be disseminated via kidney clinicians upon CKD diagnosis and recommended leveraging social media for broader reach.

Findings are not generalizable beyond the Latino subgroups in this study. Legal status was not ascertained.

Targeting and tailoring decision aids is a necessary step in providing goal-concordant and person-centered care for older Latino adults with advanced CKD. Future research should examine the comparative efficacy of DART-S in increasing knowledge and decisional quality among Latino patients.