Decisional Conflict About Kidney Failure Treatment Modalities Among Adults With Advanced CKD

DePasquale, Nicole; Green, Jamie A.; Ephraim, Patti L.; Morton, Sarah U.; Peskoe, Sarah B.; Davenport, Clemontina A.; Mohottige, Dinushika; McElroy, Lisa M.; Strigo, Tara S.; Hill‐Briggs, Felicia; Browne, Teri; Wilson, Jonathan M.; Lewis-Boyér, LaPricia; Cabacungan, Ashley; Boulware, L. Ebony

doi:10.1016/j.xkme.2022.100521

Cited by 10 publications

(5 citation statements)

References 45 publications

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“…Our findings that nearly two-thirds of Veterans with advanced CKD are unable to select any KRT modality demonstrates a highly suboptimal state of KRT-related discussions in advanced CKD care and identifies a major modifiable risk factor affecting home dialysis use. These findings are also congruent with the recently published data by Ladin et al 27 and DePasquale et al 28 that suggest that most US patients with advanced CKD, including those under nephrology care, are ill-prepared to make an informed KRT selection. Overall, we show a highly suboptimal state of informed KRT selection among patients with advanced CKD, with only a quarter (26.2%) being confident in selecting any KRT, and a minority (13.1%) preferring home dialysis.…”

Section: Discussionsupporting

confidence: 91%

“…Unfortunately, only about a quarter of the approached population participated in the trial, limiting its generalizability, and the study did not assess patient interest in specific forms of dialysis modalities. Similarly, among the PREPARE-NOW study participants, DePasquale et al 28 showed that over three-quarters of CKD participants with ongoing nephrology care have significant KRT-related decisional conflict, with only 18% showing preferences for home dialysis. Unfortunately, only a minority of the study population had advanced CKD, with results showing lower decisional conflicts among those with advanced CKD.…”

Section: Discussionmentioning

confidence: 95%

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Informed Dialysis Modality Selection Among Veterans With Advanced CKD: A Community-Level Needs Assessment

Chamarthi,

Orozco,

Hale-Gallardo

et al. 2024

Kidney Medicine

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 95%

Informed Dialysis Modality Selection Among Veterans With Advanced CKD: A Community-Level Needs Assessment

Chamarthi,

Orozco,

Hale-Gallardo

et al. 2024

Kidney Medicine

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“…Recent studies have found that nearly 70% of Americans with advanced CKD, even under nephrology care, have poor KRT awareness and are unable to select any dialysis modality. [32][33][34] In keeping with this, our study found significant deficits in awareness of KRT-related knowledge. Even for the least complex General domain, which primarily includes descriptive and definitional terms-essential for any informed decision making-the ease index was 0.28, low.…”

Section: Discussionsupporting

confidence: 89%

Development and Validation of KRT Knowledge Instrument

Shukla,

Visconti,

Pearce

et al. 2024

CJASN

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Introduction: Awareness of kidney replacement therapies (KRT) is associated with greater home dialysis use. However, validated instruments evaluating patient knowledge and awareness of various KRTs are currently lacking and are critical for informed decision-making. Methods: We developed a 24-item KRT knowledge instrument (Know-KRT) encompassing three domains of General, Technical, and Correlative information critical for informed dialysis decision-making. We conducted a cross-sectional study among Veterans with advanced chronic kidney disease (CKD) to determine its reliability, dimensionality, and validity. Results: The Know-KRT instrument dimensionality was acceptable with a root mean squared error of approximation of 0.095 for the conceptual three-domain model fit (χ2=824.6, P < .001). Corrected Item-Total Correlation indices were excellent (>0.4) for all individual items. Internal consistency was excellent for the full instrument, Cronbach’s alpha, α=0.95, with α=0.86, 0.91, and 0.79 for the General, Technical, and Correlative domains, respectively. The Know-KRT score correlated strongly with the CKD knowledge score (r=0.68, P<.001). KRT awareness was low, with an ease index of 0.181 for the full instrument. The General, Technical, and Correlative domains scores demonstrated strong correlations with the Know-KRT total score (r=0.68, 0.61, and 0.48, respectively, p<.001) and CKD instrument score (r=0.95, 0.93, and 0.77, respectively, P < .001). KRT and CKD awareness correlated negatively with age and positively with health literacy, employment status, hypertension, and quality of nephrology care. Conclusion: We report a newly developed KRT knowledge instrument with three domains having acceptable internal consistency, reliability, and validity. We show that patients with advanced CKD have low awareness of KRTs, even for items related to basic descriptions of modalities, highlighting the need for targeted patient education efforts.

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“…5 Patients with CKD have limited disease awareness and high levels of decisional conflict, defined as the degree of uncertainty about choosing the most suitable among the available KRT options with differing pros and cons. 33 Nearly all studies to date show that when provided with CoPE, patients with advanced CKD choose and use home dialysis at substantially higher rates (approximately 45%-50%) compared with contemporaneous population statistics (Figure 1). 48 Together, available evidence and guidelines suggest that the principles of ethical medicine and the health care system's goal of increasing home dialysis are aligned and achievable through the implementation of CoPE.…”

Section: Why Is Cope Necessary?mentioning

confidence: 99%

Needs and Considerations for Standardization of Kidney Disease Education in Patients with Advanced CKD

Shukla

Cavanaugh

Jia

et al. 2023

CJASN

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Kidney health advocacy organizations and leaders in the nephrology community have repeatedly emphasized the need to increase home dialysis utilization in the United States. Limited awareness and understanding of options for the management of kidney failure among patients living with advanced CKD is a significant barrier to increasing the selection and use of home dialysis. Studies have shown that providing targeted comprehensive patient education before the onset of kidney failure can improve patients' awareness of kidney disease and substantially increase the informed utilization of home dialysis. Unfortunately, in the absence of validated evidence-based education protocols, outcomes associated with home dialysis use vary widely among published studies, potentially affecting the routine implementation and reporting of these services among patients with advanced CKD. This review provides pragmatic guidance on establishing effective patient-centered education programs to empower patients to make informed decisions about their KRT and, in turn, increase home dialysis use.

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Decisional Conflict About Kidney Failure Treatment Modalities Among Adults With Advanced CKD

Cited by 10 publications

References 45 publications

Informed Dialysis Modality Selection Among Veterans With Advanced CKD: A Community-Level Needs Assessment

Informed Dialysis Modality Selection Among Veterans With Advanced CKD: A Community-Level Needs Assessment

Development and Validation of KRT Knowledge Instrument

Needs and Considerations for Standardization of Kidney Disease Education in Patients with Advanced CKD

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