Web-based Advance Care Planning Intervention for Patients With Kidney Failure on Dialysis: Pilot Testing of 'My Voice'

'My Voice' is a website intervention developed to enable advance care planning (ACP) conversations for patients with kidney disease on dialysis, educate patients on their illness, help identify their goals and preferences for EOL care, and coaches them on how to speak with their HCPs and loved ones. This study aims to evaluate if 'My Voice' intervention improves quality of ACP conversations between patients and providers, and patients and family carers; improves patient's knowledge about kidney failure, engagement in ACP and preparedness for future end of life care compared to usual practices for ACP in dialysis centres.

Study Overview

• Status: Recruiting
• Conditions: Kidney Failure, Chronic Therapy; Hemodialysis
• Intervention / Treatment: Other: My Voice website intervention with patient and caregiver modules

• Study Type: Interventional
• Enrollment (Estimated): 100
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Chandrika Ramakrishnan, MBBS; MPH; Phone Number: +6566011253; Email: chandrika.ramky@duke-nus.edu.sg

Study Locations

• Singapore
  • Singapore, Singapore
    • Recruiting
    • Duke NUS Medical School
    • Contact: Chandrika Ramakrishnan, MBBS; MPH; Phone Number: +6566011253; Email: chandrika.ramky@duke-nus.edu.sg

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria: For patients

• Singapore citizens or permanent residents; aged 21 years (age of majority) or older
• CKD stage 5; receiving dialysis

• Identified as eligible for SIC by NKF HCPs based on one or more of the following:

  1. clinical deterioration with a terminal condition or
  2. intolerability to dialysis or
  3. having two or more unplanned hospitalizations for renal complications in the past 6 months (from medical records); or
  4. known to palliative care or under conservative care as indicated in the discharge summary or
  5. poor functional status indicated by the Fragility Assessment for Elders (FIFE) score >4
• Normal cognitive function as indicated by Mini Mental Scale Examination (MMSE) score of 24 or more (based on medical record)
• Able to speak and read English, Mandarin or Malay
• Agreeable to be audio-recorded

Inclusion Criteria: For caregivers

• Aged 21 years old and above
• Family caregivers of the patients recruited i.e. Caregiver primarily involved in providing care, ensuring provision of care, and/or in making decisions regarding patient's care, with no expectation of financial compensation
• Able to speak and read English, Mandarin or Malay
• Have a phone and/or an electronic device with internet access.
• Agreeable to be audio-recorded

Exclusion Criteria: For Patients

• Patients with cognitive impairment or serious mental illness will be excluded
• Patients who had prior serious illness conversations (SIC) will be excluded
• Are not easily contactable via mobile phone or landline

Exclusion Criteria: For Caregivers

• Those who are foreign domestic workers/maids
• Are not easily contactable via mobile phone or landline

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention group; Patients will view My Voice website intervention and complete patient module. They will also receive standard of care for advance care planning [namely serious illness conversation (SIC)] with the health care provider at the dialysis centers. Caregivers will view My Voice website intervention and complete caregiver module.	Other: My Voice website intervention with patient and caregiver modules; 'My Voice' is an interactive web-based ACP intervention tailored for patients with kidney failure on dialysis, and their caregivers, and includes patient and caregiver modules. Patient module has 6 steps consisting of a series of videos, value-clarification exercise (VCE) identifying goals and values for care, and knowledge quiz, and a summary My Voice document that is generated shared with patients, designated surrogates and HCPs. Automated reminders are sent to revisit My Voice. Caregiver module has 4 steps with videos and quiz, with access to their loved one's summary My Voice document containing goals of care and values.
No Intervention: Usual care group; Patients will receive standard of care for advance care planning -namely the serious illness conversation (SIC) with the health care provider at the dialysis centres. Caregivers will receive no intervention.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Quality of ACP conversations (serious illness conversations) between patients and physicians/health care providers	Quality of ACP conversations will be measured using a scoring sheet developed for the study. One point will be given for every SICG topic discussed with score min to max of 0 to 13. Higher scores indicate higher quality.	Post baseline and within 8 weeks

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in kidney disease and dialysis knowledge scores	Collected using knowledge questions designed by the research team. Higher scores indicate higher knowledge	Baseline to 8 weeks
Change in ACP engagement	Using the 9-item Advance care planning engagement scale. 9 to 45 (Min to Max) value, with higher value indicating higher engagement	Baseline to 8 weeks
Change in patient preparedness	Assessed using Preparedness for end-of-life decision-making scale. 20 to 80 (min to max) scores, with higher scores indicating better preparedness	Baseline to 8 weeks
Change in proportion of patients who had ACP conversations with family caregivers/spokesperson	Based on self-reported number of ACP conversations collected in the survey	Baseline and 8 weeks

Collaborators and Investigators

• Sponsor: Duke-NUS Graduate Medical School
• Collaborators: National Kidney Foundation, Singapore

Study record dates

Study Major Dates

• Study Start (Actual): October 2, 2025
• Primary Completion (Estimated): September 30, 2026
• Study Completion (Estimated): December 30, 2026

Study Registration Dates

• First Submitted: September 23, 2025
• First Submitted That Met QC Criteria: December 15, 2025
• First Posted (Actual): December 30, 2025

Study Record Updates

• Last Update Posted (Actual): December 30, 2025
• Last Update Submitted That Met QC Criteria: December 15, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Advance care planning; Web intervention; Dialysis withdrawal
• Additional Relevant MeSH Terms: Urogenital Diseases; Male Urogenital Diseases; Kidney Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Renal Insufficiency
• Other Study ID Numbers: NUS-IRB-2024-713

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No