Clinical trial NCT06030206: Lung Transplant READY CF 2: A Multi-site RCT
Official title: Preparation for Lung Transplant Discussions and Decisions Among People With Cystic Fibrosis
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Cystic Fibrosis
Keywords: Cystic Fibrosis
Lung Transplantation
Advanced Lung Disease
Decision Support Tool
Lead sponsor: University of Washington
Sponsor class: OTHER
Collaborators: name: National Institute of Nursing Research (NINR)
First posted: 2023-09-08
Enrollment: 132
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: CROSSOVER
Primary purpose: OTHER

Brief summary: Lung transplant is an option for treating end-stage lung disease in cystic fibrosis (CF). In the United States, more people with CF and low lung function die each year than undergo lung transplant. More than half of people with CF who die without a lung transplant were never referred for consideration. Patient preference not to undergo lung transplant may account for 25-40% of decisions to defer referral. Rates of death without transplant are higher for people with CF who are members of marginalized communities, including those with Black race, Hispanic ethnicity, or low socioeconomic status. Increasing awareness of lung transplant among people with CF, and promoting understanding of the risks and benefits of transplant, can potentially reduce the number of people with CF who die without a lung transplant.

The CF Foundation (CFF) lung transplant referral guidelines were developed to optimize the timing of referral for lung transplant. These guidelines recommend annual conversations with people with CF once their forced expiratory volume in one second (FEV1) is \<50% predicted. Considering lung transplant as a treatment option before it is medically needed will allow more time to learn about lung transplant and address any barriers to lung transplant that may exist.

Investigators are interested in understanding how people with CF use lung transplant educational resources and how one prepares for having discussions and/or making decisions about lung transplant as a treatment option for advanced CF. The purpose of this study is to test whether a research website improves patient preparedness for discussions about lung transplant. Investigators also aim to understand whether there are unique factors that affect people with CF from communities with decreased access to transplant ("communities of concern").

Study involvement will span 6 months and study activities will involve the following:

* Four Zoom research sessions (15-30 minutes each)
* Survey assessments
* Access to a research website that contains educational resources about lung transplant
* Audio recording of a routine CF clinic visit to determine if and how lung transplant is discussed between a participant and his/her/their CF doctor

Detailed description: Lung transplant is an option for treating end-stage lung disease in cystic fibrosis (CF). In the United States, more people with CF with forced expiratory volume in 1 second (FEV1) less than 30% of predicted die each year than undergo lung transplant. More than half of people with CF who die without lung transplant were never referred for consideration, with patients of lower socioeconomic status, Black race, or Hispanic ethnicity disproportionately impacted by limited access to lung transplant. Patient preference not to undergo lung transplant may account for 25-40% of decisions to defer referral. The CF Foundation established lung transplant referral guidelines that recommend people with CF have annual conversations about lung transplant with their CF doctor once their FEV1 is less than 50% of predicted. Considering lung transplant as a treatment option before it is medically needed will allow more time to learn about lung transplant and address any barriers to lung transplant that may exist. By introducing an educational resource that can increase awareness of lung transplant among patients, and promote understanding of the risks and benefits of lung transplant, investigators aim to empower people with CF to take part in shared decision-making with their CF providers, which could reduce the number of people with CF who die without lung transplant.

Based on prior research, investigators developed a novel lung transplant educational resource that addresses patient-identified knowledge gaps and provides personalized educational content to help people with CF prepare for lung transplant discussions and decisions. The web-based educational resource couples real-life CF patient experiences of lung transplant in the form of personal narratives with up-to-date, CF-specific, and guideline-based medical information about lung transplant.

The overall research objectives for this study are to test the efficacy of the investigator-designed educational resource to improve patient preparedness for shared decision making about lung transplant and knowledge about lung transplant, and to evaluate the impact on mental health outcomes (depression and anxiety). The investigator-designed website will be compared to an attention control website to better understand how people with CF use and rank different educational resources' utility. The central hypothesis is that use of the new investigator-designed website that incorporates disease severity data (FEV1 % predicted, supplemental oxygen use, exacerbations) to identify relevant personal narratives and guideline-based educational content will increase a patient's preparedness to engage in discussions about lung transplant beyond the standard information presented on the attention control website.

The study will be a randomized controlled trial. Participants will be randomly assigned 1:1 to one of two educational resources, described above, stratified by FEV1 category (FEV1 30-50% or FEV1 \<30% of predicted), CF Center, and whether they are members of the "communities of concern"). The communities of concern include people with Medicaid insurance, high school education or less, Hispanic ethnicity, or Black/Asian/Other race (not White race). Baseline surveys will evaluate knowledge about lung transplant, a Likert scale rating of preparedness for lung transplant discussions, decisional conflict about lung transplant, and mental health. For three months, participants will have access to one of two educational resources via a login to a secure research website. At 2 weeks, there will be a study visit that includes repeated surveys from baseline and the Preparedness for Shared Decision Making (PrepDM) Scale. At 2 to 3 months after randomization, participants will have a routine CF clinic visit, which may be audio-recorded for evaluation of lung transplant discussion. At 3 months after randomization, there will be a study visit that includes repeated surveys from baseline and the PrepDM Scale. After the 3-month study visit, participants will have access to both educational resources via individual login to the secure research website. At 6-months, there will be a study visit to repeat the surveys. Throughout the 6-months and for a long-term follow up period of 4 years, web analytics will be captured at the individual level to determine usage patterns for both educational resources.

Eligibility criteria: Inclusion Criteria:

* Diagnosis of cystic fibrosis
* FEV1 less than 50% of predicted

Exclusion Criteria:

* People who are unable to provide informed consent
* People who are lung transplant recipients
* Unable to read or understand English or Spanish to complete surveys or access the website (currently only available in English and Spanish)

Primary outcomes:
measure: Preparedness for Shared Decision Making (PrepDM) Scale
timeFrame: Measured at the 3-month study visit
Secondary outcomes:
measure: Confidence-weighted true false knowledge about lung transplant (14-question investigator-designed survey)
timeFrame: Measured at 3-month study visit
measure: Decisional Conflict Scale
timeFrame: Baseline to 3-month study visit
measure: Likert-scale rating of preparedness to discuss lung transplant (0-4)
timeFrame: Measured at 3-month study visit
measure: Patient Health Questionnaire (PHQ-9)
timeFrame: Measured at 3-month study visit
measure: Generalized Anxiety Disorder 7-item (GAD-7) Scale
timeFrame: Measured at 3-month study visit
Other outcomes:
measure: 6-month assessment of Preparedness for Shared Decision Making (PrepDM) Scale
timeFrame: Measured at 6-month study visit
measure: 6-month assessment for confidence-weighted true false knowledge about lung transplant (14-question investigator-designed survey)
timeFrame: Measured at 6-month study visit
measure: 6-month assessment for Decisional Conflict Scale
timeFrame: Measured at 6-months study visit
measure: 6-month assessment for Likert-scale rating of preparedness to discuss lung transplant
timeFrame: Measured at baseline, 3-month and 6-month study visits
measure: Time spent using the research website
timeFrame: Baseline to 3-month study visit
measure: Between-arm comparisons of Shared Decision Making Questionnaire (SDM-Q-9)
timeFrame: Routine CF Clinic visit during the trial
measure: Between-arm comparisons of Shared Decision Making Questionnaire for physicians (SDM-Q-doc)
timeFrame: Routine CF Clinic visit during the trial
measure: Preparedness for Shared Decision Making (PrepDM) Scale among members of communities of concern.
timeFrame: Measured at 3-month study visit
measure: Decisional Conflict Scale among members of communities of concern.
timeFrame: Baseline to 3-month study visit
measure: Confidence-weighted true false knowledge about lung transplant (14-question investigator-designed survey) among members of communities of concern.
timeFrame: Baseline to 3-month study visit
measure: Likert rating of preparedness to discuss lung transplant among members of communities of concern.
timeFrame: Baseline to 3-month study visit
measure: Evaluation of CF Clinic audio-recordings and transcripts
timeFrame: Routine CF Clinic visit (at least 6 weeks after randomization/until 3-Month Session) during the trial
Locations:
city: Los Angeles
country: United States
facility: University of California at Los Angeles (UCLA)
state: California
city: Denver
country: United States
facility: National Jewish Health
state: Colorado
city: New Haven
country: United States
facility: Yale University
state: Connecticut
city: Kansas City
country: United States
facility: University of Kansas
state: Kansas
city: Portland
country: United States
facility: Maine Health
state: Maine
city: Baltimore
country: United States
facility: Johns Hopkins University
state: Maryland
city: Minneapolis
country: United States
facility: University of Minnesota
state: Minnesota
city: Cincinnati
country: United States
facility: University of Cincinnati
state: Ohio
city: Pittsburgh
country: United States
facility: University of Pittsburgh
state: Pennsylvania
city: Houston
country: United States
facility: Baylor College of Medicine
state: Texas
city: Seattle
country: United States
facility: University of Washington Medical Center - Montlake
state: Washington
Study officials:
affiliation: University of Washington
name: Kathleen Ramos, MD, MSc
role: PRINCIPAL_INVESTIGATOR
References:
citation: Ramos KJ, Smith PJ, McKone EF, Pilewski JM, Lucy A, Hempstead SE, Tallarico E, Faro A, Rosenbluth DB, Gray AL, Dunitz JM; CF Lung Transplant Referral Guidelines Committee. Lung transplant referral for individuals with cystic fibrosis: Cystic Fibrosis Foundation consensus guidelines. J Cyst Fibros. 2019 May;18(3):321-333. doi: 10.1016/j.jcf.2019.03.002. Epub 2019 Mar 27.
citation: Hartzler AL, Bartlett LE, Hobler MR, Reid N, Pryor JB, Kapnadak SG, Berry DL, Lober WB, Goss CH, Ramos KJ; Take on Transplant Study Group. Take on transplant: human-centered design of a patient education tool to facilitate informed discussions about lung transplant among people with cystic fibrosis. J Am Med Inform Assoc. 2022 Dec 13;30(1):26-37. doi: 10.1093/jamia/ocac176.