Abstract
Background: There are few studies of patient-facing decision aids that include supportive kidney care as an option. We tested the efficacy of a video decision aid on knowledge of supportive kidney care among older patients with advanced CKD. Methods: Participants (age ≥ 65 years with advanced CKD) were randomized to receive verbal or video education. Primary outcome was knowledge of supportive kidney care (score range 0–3). Secondary outcomes included preference for supportive kidney care, and satisfaction and acceptability of the video. Results: Among all participants (n = 100), knowledge of supportive kidney care increased significantly after receiving education (p < 0.01); however, there was no difference between study arms (p = 0.68). There was no difference in preference for supportive kidney care between study arms (p = 0.49). In adjusted analyses, total health literacy score (aOR 1.08 [95% CI: 1.003–1.165]) and nephrologists’ answer of “No” to the Surprise Question (aOR 4.87 [95% CI: 1.22–19.43]) were associated with preference for supportive kidney care. Most felt comfortable watching the video (96%), felt the content was helpful (96%), and would recommend the video to others (96%). Conclusions: Among older patients with advanced CKD, we did not detect a significant difference between an educational verbal script and a video decision aid in improving knowledge of supportive kidney care or preferences. However, patients who received video education reported high satisfaction and acceptability ratings. Future research will determine the effectiveness of a supportive kidney care video decision aid on real-world patient outcomes. Trial Registration: NCT02698722 (ClinicalTrials.gov).
References
1.
Saran
R
, Robinson
B
, Abbott
KC
, Agodoa
LY
, Albertus
P
, Ayanian
J
, et al. US Renal Data System 2016 Annual Data Report: epidemiology of kidney disease in the United States
. Am J Kidney Dis
. 2020 Jan
;69
(3 Suppl 1
):A7
. 2.
Saran
R
, Li
Y
, Robinson
B
, Ayanian
J
, Balkrishnan
R
, Bragg-Gresham
J
, et al. US Renal Data System 2014 Annual Data Report: epidemiology of kidney disease in the United States
. Am J Kidney Dis
. 2019 Mar
;66
(1 Suppl 1
):Svii
–305
. 3.
Rouveure
AC
, Bonnefoy
M
, Laville
M
. [Conservative treatment, hemodialysis or peritoneal dialysis for elderly patients: The choice of treatment does not influence the survival]
. Nephrol Ther
. 2016 Feb
;12
(1
):32
–7
. 4.
Verberne
WR
, Geers
AB
, Jellema
WT
, Vincent
HH
, van Delden
JJ
, Bos
WJ
. Comparative survival among older adults with advanced kidney disease managed conservatively versus with dialysis
. Clin J Am Soc Nephrol
. 2016 Apr 7
;11
(4
):633
–40
. 5.
Raman
M
, Middleton
RJ
, Kalra
PA
, Green
D
. Outcomes in dialysis versus conservative care for older patients: a prospective cohort analysis of stage 5 chronic kidney disease
. PLoS One
. 2018
;13
(10
):e0206469
. 6.
van Loon
IN
, Goto
NA
, Boereboom
FTJ
, Verhaar
MC
, Bots
ML
, Hamaker
ME
. Quality of life after the initiation of dialysis or maximal conservative management in elderly patients: a longitudinal analysis of the Geriatric assessment in OLder patients starting Dialysis (GOLD) study
. BMC Nephrol
. 2019 Mar 29
;20
(1
):108
. 7.
O’Connor
NR
, Kumar
P
. Conservative management of end-stage renal disease without dialysis: a systematic review
. J Palliat Med
. 2012 Feb
;15
(2
):228
–35
.8.
Wong
SPY
, Yu
MK
, Green
PK
, Liu
CF
, Hebert
PL
, O’Hare
AM
. End-of-life care for patients with advanced kidney disease in the US veterans affairs health care system, 2000–2011
. Am J Kidney Dis
. 2018 Jul
;72
(1
):42
–9
.9.
Rubio Rubio
MV
, Lou Arnal
LM
, Gimeno Orna
JA
, Munguía Navarro
P
, Gutiérrez-Dalmau
A
, Lambán Ibor
E
, et al. Supervivencia y calidad de vida en pacientes ancianos en tratamiento renal conservador
. Nefrología
. 2019 Mar-Apr
;39
(2
):141
–50
. 10.
Saeed
F
, Adams
H
, Epstein
RM
. Matters of life and death: why do older patients choose conservative management?
Am J Nephrol
. 2020
;51
(1
):35
–42
. 11.
Tonkin-Crine
S
, Okamoto
I
, Leydon
GM
, Murtagh
FE
, Farrington
K
, Caskey
F
, et al. Understanding by older patients of dialysis and conservative management for chronic kidney failure
. Am J Kidney Dis
. 2015 Mar
;65
(3
):443
–50
. 12.
Karlin
J
, Chesla
CA
, Grubbs
V
. Dialysis or death: a qualitative study of older patients’ and their families’ understanding of kidney failure treatment options in a US public hospital setting
. Kidney Med
. 2019
;1
(3
):124
–30
. 13.
Selman
LE
, Bristowe
K
, Higginson
IJ
, Murtagh
FEM
. The views and experiences of older people with conservatively managed renal failure: a qualitative study of communication, information and decision-making
. BMC Nephrol
. 2019 Feb 4
;20
(1
):38
. 14.
Fortnum
D
, Grennan
K
, Smolonogov
T
. End-stage kidney disease patient evaluation of the Australian “My Kidneys, My Choice” decision aid
. Clin Kidney J
. 2015 Aug
;8
(4
):469
–75
. 15.
Isnard Bagnis
C
, Crepaldi
C
, Dean
J
, Goovaerts
T
, Melander
S
, Nilsson
EL
, et al. Quality standards for predialysis education: results from a consensus conference
. Nephrol Dial Transplant
. 2015 Jul
;30
(7
):1058
–66
. 16.
Roderick
P
, Rayner
H
, Tonkin-Crine
S
, Okamoto
I
, Eyles
C
, Leydon
G
, et al. A national study of practice patterns in UK renal units in the use of dialysis and conservative kidney management to treat people aged 75 years and over with chronic kidney failure
. Health Services and Delivery Research
. Southampton (UK)
: NIHR Journals Library
; 2015
. Copyright (c) Queen’s Printer and Controller of HMSO 2015. This work was produced by Roderick et al. under the terms of a commissioning contract issued by the Secretary of State for Health. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
.17.
Winterbottom
AE
, Gavaruzzi
T
, Mooney
A
, Wilkie
M
, Davies
SJ
, Crane
D
, et al. Patient acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) booklet: a prospective non-randomized comparison study across 6 predialysis services
. Perit Dial Int
. 2016 Jul-Aug
;36
(4
):374
–81
. 18.
Davis
JL
, Davison
SN
. Hard choices, better outcomes: a review of shared decision-making and patient decision aids around dialysis initiation and conservative kidney management
. Curr Opin Nephrol Hypertens
. 2017 May
;26
(3
):205
–13
. 19.
Subramanian
L
, Zhao
J
, Zee
J
, Knaus
M
, Fagerlin
A
, Perry
E
, et al. Use of a decision aid for patients considering peritoneal dialysis and in-center hemodialysis: a randomized controlled trial
. Am J Kidney Dis
. 2019 Sep
;74
(3
):351
–60
. 20.
Stacey
D
, Bennett
CL
, Barry
MJ
, Col
NF
, Eden
KB
, Holmes-Rovner
M
, et al. Decision aids for people facing health treatment or screening decisions
. Cochrane Database Syst Rev
. 2014
;1
(10
):Cd001431
. 21.
El-Jawahri
A
, Mitchell
SL
, Paasche-Orlow
MK
, Temel
JS
, Jackson
VA
, Rutledge
RR
, et al. A randomized controlled trial of a CPR and intubation video decision support tool for hospitalized patients
. J Gen Intern Med
. 2015 Aug
;30
(8
):1071
–80
. 22.
Mitchell
SL
, Shaffer
ML
, Cohen
S
, Hanson
LC
, Habtemariam
D
, Volandes
AE
. An advance care planning video decision support tool for nursing home residents with advanced dementia: a cluster randomized clinical trial
. JAMA Intern Med
. 2018 Jul 1
;178
(7
):961
–9
. 23.
Waterman
AD
, Peipert
JD
, McSorley
A-M
, Goalby
CJ
, Beaumont
JL
, Peace
L
. Direct delivery of kidney transplant education to black and low-income patients receiving dialysis: a randomized controlled trial
. Am J Kidney Dis
. 2019 Nov
;74
(5
):640
–9
. 24.
Norman
GR
, Sloan
JA
, Wyrwich
KW
. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation
. Med Care
. 2003 May
;41
(5
):582
–92
. 25.
Prakash
S
, McGrail
A
, Lewis
SA
, Schold
J
, Lawless
ME
, Sehgal
AR
, et al. Behavioral stage of change and dialysis decision-making
. Clin J Am Soc Nephrol
. 2015 Feb 6
;10
(2
):197
–204
. 26.
Schulz
KF
, Altman
DG
, Moher
D
. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials
. PLoS Med
. 2010 Mar 23
;7
(3
):e1000251
. 27.
Levey
AS
, Stevens
LA
, Schmid
CH
, Zhang
YL
, Castro
AF
3rd, Feldman
HI
, et al. A new equation to estimate glomerular filtration rate
. Ann Intern Med
. 2009 May 5
;150
(9
):604
–12
. 28.
Levey
AS
, Bosch
JP
, Lewis
JB
, Greene
T
, Rogers
N
, Roth
D
. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group
. Ann Intern Med
. 1999
;130
(6
):461
–470
. .
[PubMed]
.29.
Pfeiffer
E
. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients
. J Am Geriatr Soc
. 1975 Oct
;23
(10
):433
–41
. 30.
Grant
BKSJ
. Documenting the documentary: close readings of documentary film and video
. Detroit (MI)
: Wayne Stage University Press
; 1998
.31.
Volandes
AE
, Barry
MJ
, Wood
F
, Elwyn
G
. Audio-video decision support for patients: the documentary genré as a basis for decision aids
. Health Expect
. 2013 Sep
;16
(3
):e80
–8
. 32.
Epstein
AS
, Volandes
AE
, Chen
LY
, Gary
KA
, Li
Y
, Agre
P
, et al. A randomized controlled trial of a cardiopulmonary resuscitation video in advance care planning for progressive pancreas and hepatobiliary cancer patients
. J Palliat Med
. 2013 Jun
;16
(6
):623
–31
. 33.
Davis
TC
, Long
SW
, Jackson
RH
, Mayeaux
EJ
, George
RB
, Murphy
PW
, et al. Rapid estimate of adult literacy in medicine: a shortened screening instrument
. Fam Med
. 1993 Jun
;25
(6
):391
–5
.34.
Cavanaugh
KL
, Wingard
RL
, Hakim
RM
, Eden
S
, Shintani
A
, Wallston
KA
, et al. Low health literacy associates with increased mortality in ESRD
. J Am Soc Nephrol
. 2010 Nov
;21
(11
):1979
–85
. 35.
Wright
JA
, Wallston
KA
, Elasy
TA
, Ikizler
TA
, Cavanaugh
KL
. Development and results of a kidney disease knowledge survey given to patients with CKD
. Am J Kidney Dis
. 2011 Mar
;57
(3
):387
–95
. 36.
Cavanaugh
KL
, Osborn
CY
, Tentori
F
, Rothman
RL
, Ikizler
TA
, Wallston
KA
. Performance of a brief survey to assess health literacy in patients receiving hemodialysis
. Clin Kidney J
. 2015 Aug
;8
(4
):462
–8
. 37.
Charlson
ME
, Pompei
P
, Ales
KL
, MacKenzie
CR
. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation
. J Chronic Dis
. 1987
;40
(5
):373
–83
. 38.
Baddour
NA
, Robinson-Cohen
C
, Lipworth
L
, Bian
A
, Stewart
TG
, Jhamb
M
, et al. The surprise question and self-rated health are useful screens for frailty and disability in older adults with chronic kidney disease
. J Palliat Med
. 2019 Dec
;22
(12
):1522
–9
. 39.
Li
KC
, Brown
MA
. Consenting for dialysis or its alternative: systematic process is needed
. Clin J Am Soc Nephrol
. 2020 Feb 4
;15
(4
):560
–2
.40.
Moss
AH
. Revised dialysis clinical practice guideline promotes more informed decision-making
. Clin J Am Soc Nephrol
. 2010 Dec
;5
(12
):2380
–3
. 41.
Davison
SN
, Levin
A
, Moss
AH
, Jha
V
, Brown
EA
, Brennan
F
, et al. Executive summary of the KDIGO Controversies Conference on Supportive Care in Chronic Kidney Disease: developing a roadmap to improving quality care
. Kidney Int
. 2015 Sep
;88
(3
):447
–59
. 42.
Ladin
K
, Pandya
R
, Kannam
A
, Loke
R
, Oskoui
T
, Perrone
RD
, et al. Discussing conservative management with older patients with CKD: an interview study of nephrologists
. Am J Kidney Dis
. 2018 May
;71
(5
):627
–35
. 43.
Wachterman
MW
, Marcantonio
ER
, Davis
RB
, Cohen
RA
, Waikar
SS
, Phillips
RS
, et al. Relationship between the prognostic expectations of seriously ill patients undergoing hemodialysis and their nephrologists
. JAMA Intern Med
. 2013 Jul 8
;173
(13
):1206
–14
. 44.
Salat
H
, Javier
A
, Siew
ED
, Figueroa
R
, Lipworth
L
, Kabagambe
E
, et al. Nephrology provider prognostic perceptions and care delivered to older adults with advanced kidney disease
. Clin J Am Soc Nephrol
. 2017 Nov 7
;12
(11
):1762
–70
. 45.
Schmidt
RJ
, Landry
DL
, Cohen
L
, Moss
AH
, Dalton
C
, Nathanson
BH
, et al. Derivation and validation of a prognostic model to predict mortality in patients with advanced chronic kidney disease
. Nephrol Dial Transplant
. 2019 Sep 1
;34
(9
):1517
–25
. 46.
Cassidy
BP
, Harwood
L
, Getchell
LE
, Smith
M
, Sibbald
SL
, Moist
LM
. Educational support around dialysis modality decision making in patients with chronic kidney disease: qualitative study
. Can J Kidney Health Dis
. 2018
;5
:2054358118803323
. 47.
Waite
KR
, Federman
AD
, McCarthy
DM
, Sudore
R
, Curtis
LM
, Baker
DW
, et al. Literacy and race as risk factors for low rates of advance directives in older adults
. J Am Geriatr Soc
. 2013 Mar
;61
(3
):403
–6
. 48.
Ladin
K
, Buttafarro
K
, Hahn
E
, Koch-Weser
S
, Weiner
DE
. “End-of-Life Care? I’m not Going to Worry About That Yet.” Health literacy gaps and end-of-life planning among elderly dialysis patients
. Gerontologist
. 2018 Mar 19
;58
(2
):290
–9
. 49.
Nouri
SS
, Barnes
DE
, Volow
AM
, McMahan
RD
, Kushel
M
, Jin
C
, et al. Health literacy matters more than experience for advance care planning knowledge among older adults
. J Am Geriatr Soc
. 2019 Oct
;67
(10
):2151
–6
. 50.
O’Hare
AM
, Richards
C
, Szarka
J
, McFarland
LV
, Showalter
W
, Vig
EK
, et al. Emotional impact of illness and care on patients with advanced kidney disease
. Clin J Am Soc Nephrol
. 2018 Jul 6
;13
(7
):1022
–9
.51.
Wong
SPY
, McFarland
LV
, Liu
CF
, Laundry
RJ
, Hebert
PL
, O’Hare
AM
. Care practices for patients with advanced kidney disease who forgo maintenance dialysis
. JAMA Intern Med
. 2019 Jan 22
;179
(3
):305
.52.
Wong
SPY
, Boyapati
S
, Engelberg
RA
, Thorsteinsdottir
B
, Taylor
JS
, O’Hare
AM
. Experiences of US nephrologists in the delivery of conservative care to patients with advanced kidney disease: a national qualitative study
. Am J Kidney Dis
. 2020 Feb
;75
(2
):167
–76
. 
