Leanne Brown1, Glenn Gardner1, Ann Bonner1,2,3. 1. School of Nursing and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Qld, Australia. 2. Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Qld, Australia. 3. Visiting Research Fellow, Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Qld, Australia.
Abstract
AIM: To evaluate the effectiveness of a decision support intervention (OPTIONS) in facilitating the older person with advanced kidney disease to make a treatment choice. DESIGN: Pragmatic randomized controlled trial. METHODS:People aged ≥70 years with advanced kidney disease (eGFR≤20 ml/min/1.73m2 ) who had not made a decision about treatment options and who were not eligible for a kidney transplant were recruited between March 2015 and March 2016. Participants were randomly allocated to receive the OPTIONS (N = 16) or standard care (N = 21). OPTIONS is a 4-week nurse-delivered intervention. Primary outcomes were decision conflict and decision regret, the secondary outcomes were knowledge of risk and benefits of dialysis and health-related quality of life. The usefulness of OPTIONS was also evaluated. RESULTS: There were no differences between the intervention and standard care groups at baseline. At T1, there were no significant differences in decision conflict and decision regret although the intervention group had lower decisional conflict at T2. The decision support intervention was able to significantly improve the participants' knowledge score in the intervention group. There were no observable differences between groups for health-related quality of life physical and mental health component summary scores. OPTIONS was helpful in preparing participants in making a treatment decision. CONCLUSION: OPTIONS, a decision support intervention, increased a person's knowledge of the benefits and risks of dialysis and can be used to facilitate shared decision-making with older adults with advanced stages of kidney disease. IMPACT: Strategies to improve shared decision-making between older people with advanced stages of kidney disease and their clinicians are crucial for patient autonomy in a population where this may not be common practice. The decision support intervention- OPTIONS demonstrated significant improvement in patient knowledge about different treatment pathways. OPTIONS provides a structured and evidence-based approach to support shared decision-making for this population. TRIAL REGISTRATION: ACTRN 12614001090606 Registered 14/10/2014.
RCT Entities:
AIM: To evaluate the effectiveness of a decision support intervention (OPTIONS) in facilitating the older person with advanced kidney disease to make a treatment choice. DESIGN: Pragmatic randomized controlled trial. METHODS:People aged ≥70 years with advanced kidney disease (eGFR ≤20 ml/min/1.73m2 ) who had not made a decision about treatment options and who were not eligible for a kidney transplant were recruited between March 2015 and March 2016. Participants were randomly allocated to receive the OPTIONS (N = 16) or standard care (N = 21). OPTIONS is a 4-week nurse-delivered intervention. Primary outcomes were decision conflict and decision regret, the secondary outcomes were knowledge of risk and benefits of dialysis and health-related quality of life. The usefulness of OPTIONS was also evaluated. RESULTS: There were no differences between the intervention and standard care groups at baseline. At T1, there were no significant differences in decision conflict and decision regret although the intervention group had lower decisional conflict at T2. The decision support intervention was able to significantly improve the participants' knowledge score in the intervention group. There were no observable differences between groups for health-related quality of life physical and mental health component summary scores. OPTIONS was helpful in preparing participants in making a treatment decision. CONCLUSION: OPTIONS, a decision support intervention, increased a person's knowledge of the benefits and risks of dialysis and can be used to facilitate shared decision-making with older adults with advanced stages of kidney disease. IMPACT: Strategies to improve shared decision-making between older people with advanced stages of kidney disease and their clinicians are crucial for patient autonomy in a population where this may not be common practice. The decision support intervention- OPTIONS demonstrated significant improvement in patient knowledge about different treatment pathways. OPTIONS provides a structured and evidence-based approach to support shared decision-making for this population. TRIAL REGISTRATION: ACTRN 12614001090606 Registered 14/10/2014.
Authors: Noel Engels; Gretchen N de Graav; Paul van der Nat; Marinus van den Dorpel; Anne M Stiggelbout; Willem Jan Bos Journal: BMJ Open Date: 2022-09-21 Impact factor: 3.006
Authors: Janet Jull; Sascha Köpke; Maureen Smith; Meg Carley; Jeanette Finderup; Anne C Rahn; Laura Boland; Sandra Dunn; Andrew A Dwyer; Jürgen Kasper; Simone Maria Kienlin; France Légaré; Krystina B Lewis; Anne Lyddiatt; Claudia Rutherford; Junqiang Zhao; Tamara Rader; Ian D Graham; Dawn Stacey Journal: Cochrane Database Syst Rev Date: 2021-11-08