My Heart and CKD: Pathway to Implementing a Decision Aid for Patients With CKD and Coronary Artery Disease

Patients with chronic kidney disease (CKD) at times must decide whether to take an invasive approach to management of coronary artery disease (CAD), which involves procedures such as angiography, angioplasty, and surgery, versus attempt management with medications alone. My Heart and CKD is a decision aid to support shared decision-making (SDM) between patients and their care providers in these situations. This report describes the pathway to implement My Heart and CKD , and key learnings that have emerged through this process.

Human-centered design was used to develop the decision aid while concurrently identifying design features that could facilitate its incorporation within patient-physician clinical encounters. Interviews exploring use of the decision aid with patients and care providers were qualitatively analyzed according to the theoretical domains framework to identify barriers and facilitators to implementation. Simulated encounters between patient and physicians were used for pre-clinical testing and to identify additional training and resources that could support effective implementation.

Implementation insights overlapped with decision-aid design input and influenced key design elements of My Heart and CKD as well as the development of implementation strategies to facilitate its clinical use. An overarching theme that influenced development and implementation was the concept that the decision aid be designed for use by patients and physicians together, to support the bidirectional communication and relationship building intended with SDM. This influenced design features to support varying use preferences and contexts, encompassing both digital and paper-based forms for use. Implementation considerations also influenced order and arrangement of content in My Heart and CKD to enhance integration of all stages of SDM into varying clinical environments. Additional training and implementation resources, including an accredited continuous medical education program for care providers, were identified as additional facilitators necessary to support implementation.

Clinical evaluation has not yet been completed.

My Heart and CKD is intended to support personalized, patient-centered care by providing patients with CKD and CAD and their care providers with tools to engage in SDM. Further research will evaluate the effectiveness of its implementation and impact on the quality of decision-making.