A Randomized Controlled Trial of a Mobile Clinical Decision Aid to Improve Access to Kidney Transplantation: iChoose Kidney

Abstract

Kidney transplantation is the preferred treatment for patients with end-stage renal disease, as it substantially increases a patient's survival and is cost saving compared to a lifetime of dialysis. However, transplantation is not universally chosen by patients with renal failure, and limited knowledge about the survival benefit of transplantation vs. dialysis may play a role. We created a mobile application clinical decision aid called iChoose Kidney to improve access to individualized prognosis information comparing dialysis and transplantation outcomes. We describe the iChoose Kidney study, a randomized controlled trial designed to test the clinical efficacy of a mobile health decision aid among end-stage renal disease patients referred for kidney transplantation at three large, diverse transplant centers across the U.S. Approximately 450 patients will be randomized to receive either: (1) standard of care or “usual” transplantation education, or (2) standard of care plus iChoose Kidney. The primary outcome is change in knowledge about the survival benefit of kidney transplantation vs. dialysis from baseline to immediate follow-up; secondary outcomes include change in treatment preferences, improved decisional conflict, and increased access to kidney transplantation. Analyses are also planned to examine effectiveness across subgroups of race, socioeconomic status, health literacy and health numeracy. Engaging patients in health care choices can increase patient empowerment and improve knowledge and understanding of treatment choices. If the effectiveness of iChoose Kidney has a greater impact on patients with low health literacy, lower socioeconomic status, and minority race, this decision aid could help reduce disparities in access to kidney transplantation.

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

“…The randomized clinical trial was registered on clinicaltrials.gov (NCT02235571) as “iChoose Decision Kidney Aid for End- Stage Renal Disease Patients.” The full trial protocol is available in the journal Kidney International Reports . 19 …”

Strategies for Increasing Knowledge, Communication, and Access to Living Donor Transplantation: an Evidence Review to Inform Patient Education

“…A randomized trial to assess knowledge, treatment preferences and access to transplant including LDKT is underway. 34 …”

“…“ iChoose Kidney .” 34 “iChoose Kidney” was developed by a multi-disciplinary team as a shared decision aid for clinicians to present individualized risk predictions of short-term patient survival with kidney transplantation versus dialysis to patients. It is available through the Internet (http://ichoosekidney.emory.edu/) or a mobile (iOS) app.…”

Decision Aids to Increase Living Donor Kidney Transplantation

“…Four of these aids have completed evaluation and demonstrated effectiveness [45–48]. Six are undergoing effectiveness testing [49–54] (Table 2). …”

“…iChoose Kidney followed the IPDAS guidelines [30] for decision aid development, and best practices were used to ensure access for patients with low health literacy and numeracy [29, 81]. The effectiveness of iChoose Kidney (clinicaltrials.gov protocol #NCT022355571) to increase knowledge regarding the transplant survival benefit compared to dialysis is currently being evaluated in a multicenter, randomized control trial among transplant candidates (n=450) presenting at transplant evaluation [49]. …”