Use of a Supportive Kidney Care Video Decision Aid in Older Patients: A Randomized Controlled Trial

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).

Keywords: Chronic kidney disease; Dialysis decision-making; Palliative nephrology; Supportive kidney care.

Conflict of interest statement

Disclosure Statement: Dr. Volandes has a financial interest in the nonprofit foundation Nous Foundation (d/b/a ACP Decisions, 501c3). The nonprofit organization develops advanced care planning video decision aids and support tools. Dr. Volandes’ interests were reviewed and are managed by Massachusetts General Hospital and Partners HealthCare in accordance with their conflict of interest policies. All other authors declare that they have no relevant conflict of interests.

© 2020 S. Karger AG, Basel.

Figures

Figure 1.

Study Schema

Figure 2.. Factors Associated with Correct Supportive Care Knowledge*

*Patients of Asian or Other race (n=3) removed from analyses due to cells with no preference for supportive kidney care. Variables: Sex = Male vs. Female; Race = White vs. Black; Ethnicity = Non-Hispanic vs Hispanic; High school = Greater than 12th grade education vs. Less than 12th grade education; Income = Income ≤ 30k vs. > 30k; REALM score = REALM score; CCI score = Charlson Comorbidity Index Score; Pre-ed referral =Have you referred your patient for pre-dialysis education? (yes vs. no);Surprise ques = Would you be surprised if your patient died in the next one year? (no vs. yes); SKC (Supportive kidney care) education = Verbal script vs. Video.

Figure 3.. Factors Associated with Preference for Supportive Kidney Care*

*Patients of Asian or Other race (n=3) removed from analyses due to cells with no preference for supportive kidney care. Variables: Sex = Male vs. Female; Race = White vs. Black; Ethnicity = Non-Hispanic vs Hispanic; High school = Greater than 12th grade education vs. Less than 12th grade education; Income = Income ≤ 30k vs. > 30k; REALM score = REALM score; CCI score = Charlson Comorbidity Index Score; Pre-ed referral =Have you referred your patient for pre-dialysis education? (yes vs. no);Surprise ques = Would you be surprised if your patient died in the next one year? (no vs. yes); SKC (Supportive kidney care) education = Verbal script vs. Video.