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

TL;DR

A web-based tool for kidney care counseling reduced caregivers' decisional conflict and improved patient awareness of conservative management.

Contribution

This study provides preliminary evidence that a web-based decision aid improves kidney care counseling for older adults.

Findings

Caregivers using the PDA had significantly lower decisional conflict compared to usual care.

Patients using the PDA showed increased awareness of conservative management.

Patients using the PDA were less likely to choose dialysis in the short and long term.

Abstract

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.

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