Decision-Aid for Renal Therapy Pilot Trial

Study Overview
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Brief Summary
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Successful communication between patients, caregivers, and physicians can improve how patients feel about their treatment. Our recent studies of older dialysis patients find, however, that many patients do not engage in this type of communication about treatment options. This study aims to determine whether the Decision-Aid for Renal Therapy (DART), a web-based program, can improve shared decision-making (decisions where patients are actively engaged) among patients, caregivers, and physicians, and improve certainty and satisfaction in treatment decisions.

Detailed Description
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Successful end-of-life communication between patients, caregivers, and physicians is associated with superior psychosocial outcomes, less intensive treatment, greater satisfaction, and higher likelihood of death at home. The Decision-Aid for Renal Therapy (DART) is an interactive web-based decision-aid that can empower patients and caregivers to select the treatment choice for chronic kidney disease that best suits them. DART was developed using a rigorous, validated, patient-engaged process and helps clarify decision-points and tradeoffs by providing individualized information about outcomes that matter most to patients. DART is designed to promote shared decision-making between patients, caregivers, and physicians and align preferences with treatment received. Although proven effective and in current use in the general population, DART's effectiveness in an older population is unclear. The purpose of this project is to conduct a pilot study of DART's feasibility and effectiveness to improve end-of-life planning and shared decision-making among older end-stage renal disease patients.

Official Title
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Decision-Aid for Renal Therapy Pilot Trial (DART Pilot Trial)

Conditions
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Renal Insufficiency, Chronic, Kidney Failure, Chronic

Intervention / Treatment
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* Behavioral: DART
* Behavioral: Choosing a Treatment for Kidney Failure


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Chronic kidney disease stages 4 or 5, not currently on dialysis Age >=70 English-speaking Willingness to be randomized to DART Able to sign informed consent 5-year kidney failure risk probability > 15% using [www.kidneyfailurerisk.com] Glomerular filtration rate (GFR) < 30 Exclusion Criteria: Non-English speaking

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Participants (patient-caregiver dyads) will be randomized to receive either usual care education (a pamphlet published by the National Kidney Foundation, Choosing a Treatment for Kidney Failure, or usual care education plus DART.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Usual care<br>Participants receive an educational pamphlet from the National Kidney Foundation, Choosing a Treatment for Kidney Failure. | Behavioral: Choosing a Treatment for Kidney Failure<br>* This is an educational pamphlet published by the National Kidney Foundation.<br>|
| Experimental: DART<br>Participants receive an educational pamphlet from the National Kidney Foundation, Choosing a Treatment for Kidney Failure. They also receive a link to access the web-based decision-aid program, Decision-Aid for Renal Therapy (DART). Participants may access this program using a computer at home throughout the duration of the trial. Those who do not have a computer with web access at home are assisted in watching the program in the clinic. | Behavioral: DART<br>* A one-hour long web-based decision-aid program that explains treatment options for end-stage renal disease, including the benefits and risks of each treatment option.<br>Behavioral: Choosing a Treatment for Kidney Failure<br>* This is an educational pamphlet published by the National Kidney Foundation.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Completion of advance directives at 3 months. | Participants will be asked if they have completed an advance directive. | Assessed at 3 months | 
| Change in baseline Decisional Conflict Scale score at 3 months. | Measures personal perceptions of: a) uncertainty in choosing options; b) modifiable factors contributing to uncertainty such as feeling uninformed, unclear about personal values and unsupported in decision making; and c) effective decision making such as feeling the choice is informed, values-based, likely to be implemented and expressing satisfaction with the choice. Scores range from 0 (no decisional conflict) to 100 (extremely high decisional conflict). | Assessed in patients at 3 months. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Congruence in patient-caregiver goals of care | Patients and caregivers are each administered a questionnaire to determine what the patient's goals of care are at the end of life. The congruence (agreement) between the stated preferences of the patient and caregiver will be assessed at 6 months. | Assessed in patients and caregivers at 6 months. | 
| Change in baseline overall patient satisfaction score from the Canadian Health Care Evaluation Project (CANHELP) questionnaire at 3 months. | A survey instrument that evaluates satisfaction with care for older patients with life threatening illnesses, and their family members. The overall CANHELP Lite satisfaction score is calculated as the unweighted average of all answered questions. The score is then rescaled to range between 0 (worst possible value) to 100 (best possible value). | Assessed in patients at 3 months. | 
| Change in baseline overall caregiver satisfaction score from the Canadian Health Care Evaluation Project (CANHELP) questionnaire at 3 months. | A survey instrument that evaluates satisfaction with care for older patients with life threatening illnesses, and their family members. The overall CANHELP Lite satisfaction score is calculated as the unweighted average of all answered questions. All scores are rescaled to range between 0 (worst possible value) to 100 (best possible value). | Assessed in caregivers at 3 months. |