Evaluation of a Decision Aid in Kidney Care Counseling for Older Adults

We evaluated the effectiveness of a web-based patient decision aid (PDA) developed for older adults with end-stage kidney disease (ESKD) and their caregivers, integrated into kidney care counseling.

A pragmatic pre- and post-trial with a comparison group was conducted in Singapore with patients aged ≥ 70 years with ESKD and their caregivers. Usual care participants received standard counseling, whereas intervention arm received counseling using the PDA. The primary outcome was change in decisional conflict from pre- to post-counseling between arms. Secondary outcomes were conservative management (CM) awareness, stated treatment preference at postcounseling, and real-life treatment choice at 6 months. Analyses used a generalized linear mixed model for the primary outcome and logistic regressions for secondary outcomes.

A total of 143 participants were enrolled (75 patients and 68 caregivers). Caregivers in the intervention arm experienced significantly greater reductions in decisional conflict compared with usual care (β = -4.48; P < 0.001), whereas reductions did not differ between arms for the patients (β = 0.05; P = 0.97). Postcounseling, patient CM awareness increased more in the intervention arm (82.6% vs. 69.2%; odds ratio (OR) = 7.24; P < 0.01). Patients receiving the PDA were less likely to prefer dialysis postcounseling (OR = 0.33; P = 0.12) and were less likely to initiate dialysis within 6 months (OR = 0.21; P = 0.049).

Although future studies are needed to confirm these results, this study provides preliminary, suggestive evidence that integrating a web-based PDA into kidney care counseling may reduce caregiver decisional conflict, improve patient awareness of CM, and shift both stated and actual treatment choices away from dialysis.