Effect of the iChoose Kidney decision aid in improving knowledge about treatment options among transplant candidates: A randomized controlled trial

Abstract

We previously developed a mobile- and web-based decision aid (iChoose Kidney) that displays individualized risk estimates of survival and mortality, for the treatment modalities of dialysis versus kidney transplantation. We examined the effect of iChoose Kidney on change in transplant knowledge and access to transplant in a randomized controlled trial among patients presenting for evaluation in three transplant centers. A total of 470 patients were randomized to standard transplantation education (control) or standard education plus iChoose Kidney (intervention). Change in transplant knowledge (primary outcome) among intervention versus control patients was assessed using nine items in pre- and postevaluation surveys. Access to transplant (secondary outcome) was defined as a composite of waitlisting, living donor inquiries, or transplantation. Among 443 patients (n = 226 intervention; n = 216 control), the mean knowledge scores were 5.1 ± 2.1 pre- and 5.8 ± 1.9 postevaluation. Change in knowledge was greater among intervention (1.1 ± 2.0) versus control (0.4 ± 1.8) patients (P < .0001). Access to transplantation was similar among intervention (n = 168; 74.3%) versus control patients (n = 153; 70.5%; P = .37). The iChoose Kidney decision aid improved patient knowledge at evaluation, but did not impact transplant access. Future studies should examine whether combining iChoose Kidney with other interventions can increase transplantation. (Clinicaltrials.gov NCT02235571).

Keywords: clinical research/practice; dialysis; education; health services and outcomes research; kidney disease; kidney transplantation/nephrology; patient education; patient survival.

Conflict of interest statement

DISCLOSURE

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

FIGURE 1

Screenshots of the iChoose Kidney Decision Aid (iPad version) outlining the varying message frames used to enter patient’s clinical information (gender, age, race, ethnicity, time on dialysis, various comorbidities) into the risk prediction calculator for individualized 1- and 3-year mortality (not shown) and survival estimates of dialysis versus kidney transplant and deceased versus living donor transplant

FIGURE 2

Study schema of the iChoose Kidney randomized controlled trial depicting the study process and points of data collection for both control and intervention patients, and providers (transplant nephrologists or surgeons), 2014–2015

FIGURE 3

Flow diagram of recruitment into the iChoose Kidney randomized controlled trial among ESRD patients evaluated for a kidney transplant at three US transplant centers, 2014–2015