A Communication Tool to Assist Older Adults Facing Dialysis Choices

Summary

The purpose of this study is to test the effect of the "Best Case/Worse Case" (BC/WC) communication tool on receipt of palliative care and intensity of treatment at the end of life, quality of life, and quality of communication for older patients with end-stage renal disease (ESRD) receiving outpatient care at ten nephrology clinics. The intervention was developed and tested with acute care surgical patients at the University of Wisconsin (UW) and is now being testing to see if the intervention will work in a different setting.

The intervention will be tested with 320 older adults who have end-stage renal disease (ESRD) and are receiving care from a nephrologist enrolled in the study. Randomly assigned nephrologists within each site will receive the intervention (training to use the BC/WC tool) or to be in the waitlist control, meaning that they will not be offered BC/WC training until the end of the study, when all participants have been enrolled. Participants will be on follow up with surveys and chart review for up to two years after study enrollment. Caregivers will also be invited to participate and complete surveys.

Conditions

• Palliative Care
• Kidney Failure, Chronic
• Decision Making
• Decision Support Techniques
• Renal Dialysis
• Dialysis
• Kidney Diseases
• Nephrologists
• Decision Aid
• End of Life
• End-Stage Renal Disease
• Late-Stage Renal Disease
• Communication
• Life-Supporting Treatments

Interventions

OTHER

Best Case/Worst Case communication tool training

The communication tool promotes dialogue and patient deliberation, and supports shared decision making in the context of kidney disease. Building on a conceptual model of shared decision-making proposed and the practice of scenario planning the intervention is designed to lead to a discussion of participants preferences and consideration of outcomes. The nephrologist verbally describes the "best case," "worst case," and "most likely" outcomes for each treatment option-incorporating rich narrative from clinical experience and translation of probabilistic information-while drawing a diagram of those options. The nephrologist also writes details about each option on the diagram. The narrative and graphic help family and patients formulate and express preferences.

Sponsors & Collaborators

• National Institute on Aging (NIA)

  collaborator NIH

• University of Pittsburgh

  collaborator OTHER

• University of Vermont

  collaborator OTHER

• Johns Hopkins University

  collaborator OTHER

• University of Colorado, Denver

  collaborator OTHER

• Icahn School of Medicine at Mount Sinai

  collaborator OTHER

• University of Washington

  collaborator OTHER

• West Virginia University

  collaborator OTHER

• Columbia University

  collaborator OTHER

• Medical College of Wisconsin

  collaborator OTHER

• The Palliative Care Research Cooperative Group

  collaborator UNKNOWN

• Northwestern University

  collaborator OTHER

• University of Wisconsin, Madison

  lead OTHER

Principal Investigators

• Margaret L Schwarze, MD, MPP, FACS · University of Wisconsin, Madison

• Amar Bansal, MD · University of Pittsburgh

• Katharine Cheung, MD, PhD · University of Vermont

• Deidra Crews, MD · Johns Hopkins University

• Katie Colborn, PhD · University of Colorado, Denver

• Holly Koncicki, MD · Icahn School of Medicine at Mount Sinai

• Jean Kutner, MD · University of Colorado, Denver

• Daniel Lam, MD · University of Washington

• Alvin Moss, MD · West Virginia University

• Maya Rao, MD · Columbia University

• Dawn Wolfgram, MD · Medical College of Wisconsin

• Jeniann Yi, MD · University of Colorado, Denver

• Tamara Isakova, MD, MMSc · Northwestern University

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

DOUBLE

Model

PARALLEL

Eligibility

Min Age

60 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2020-11-02

Primary Completion

2025-11-10

Completion

2026-02-28

Countries

• United States

Study Locations