A Digital Modality Decision Program for Patients With Advanced Chronic Kidney Disease

Abstract

Background: Patient education regarding end-stage renal disease (ESRD) has the potential to reduce adverse outcomes and increase the use of in-home renal replacement therapies.

Objective: This study aimed to investigate whether an online, easily scalable education program can improve patient knowledge and facilitate decision making regarding renal replacement therapy options.

Methods: We developed a 4-week online, digital educational program that included written information, short videos, and social networking features. Topics included kidney transplant, conservative management, peritoneal dialysis, in-home hemodialysis, and in-center hemodialysis. We recruited patients with advanced chronic kidney disease (stage IV and V) to enroll in the online program, and we evaluated the feasibility and potential impact of the digital program by conducting pre- and postintervention surveys in areas of knowledge, self-efficacy, and choice of ESRD care.

Results: Of the 98 individuals found to be eligible for the study, 28 enrolled and signed the consent form and 25 completed the study. The average age of participants was 65 (SD 15) years, and the average estimated glomerular filtration rate was 21 (SD 6) ml/min/1.73 m2. Before the intervention, 32% of patients (8/25) were unable to make an ESRD treatment choice; after the intervention, all 25 participants made a choice. The proportion of persons who selected kidney transplant as the first choice increased from 48% (12/25) at intake to 84% (21/25) after program completion (P=.01). Among modality options, peritoneal dialysis increased as the first choice for 4/25 (16%) patients at intake to 13/25 (52%) after program completion (P=.004). We also observed significant increases in knowledge score (from 65 [SD 56] to 83 [SD 14]; P<.001) and self-efficacy score (from 3.7 [SD 0.7] to 4.3 [SD 0.5]; P<.001).

Conclusions: Implementation of a digital ESRD education program is feasible and may facilitate patients' decisions about renal replacement therapies. Larger studies are necessary to understand whether the program affects clinical outcomes.

Trial registration: ClinicalTrials.gov NCT02976220; https://ichgcp.net/clinical-trials-registry/NCT02976220.

Keywords: chronic kidney disease; end-stage renal disease; online social networking; patient education; renal dialysis.

Conflict of interest statement

Conflicts of Interest: Cricket Health Inc contributed to the conception and design and collected limited data on study engagement and enrollment, but was not involved in the analysis or interpretation of survey results. Cricket Health Inc approved the manuscript, but the final content was determined by the authors. The views and opinions expressed in this paper are those of the authors and should not be construed to represent the views of the sponsoring organizations, agencies, or the US Government.

©Ruth Dubin, Anna Rubinsky. Originally published in JMIR Formative Research (http://formative.jmir.org), 06.02.2019.

Figures

Figure 1

Recruitment and enrollment. A total of 2617 patients who had been seen at the University of California, San Francisco and San Francisco Veterans Affairs Medical Center renal clinics were either sent letters to notify them of the study or screened via the electronic medical record for eligibility. A total of 156 patients were potentially eligible based on initial screening; of these, we found 98 of those that responded to be eligible after the phone interview. Moreover, 27 of these enrolled into the study and 25 completed the study.