Pilot Testing of a Communication Intervention to Promote Shared Dialysis Decision Making in Older Patients with Chronic Kidney Disease (DIAL-SDM Trial)

小结 65岁以上的慢性肾病患者≥面临着围绕透析的决策挑战 入会仪式。这些患者报告说，医生几乎没有努力去引起治疗偏好，讨论预后或 解释透析选项的负担/好处，包括保守治疗。老年慢性肾脏病患者 与延长生命相比，他们往往更喜欢保持生活质量，许多人后悔自己开始透析的决定： 每年有近四分之一的人退出透析。共享透析决策需要积极主动 肾脏科医生和患者之间的接触，以使患者、护理者和医生之间的沟通保持一致 共同的目标。拟议的研究是一项共享透析决定的试点随机群实用试验- 肾病专科医生(n=20)及其65岁≥患者(n=60)的Dial-SDM干预 估计肾小球滤过率(≤)为20ml/min//1.73m2。干预组的肾科医生将 接受3个远程在线沟通培训课程，由标准化患者导师(SPI)授课 通过Zoom技术，谁将制定临床方案并提供反馈。同时，患者(和照顾者，如果 将接受由健康教练提供的2次辅导课程，健康教练将探索每位患者的相关 背景信息(价值观、偏好和目标)，并帮助他们识别和实践重要问题 给他们的肾病科医生。对照组的肾科医生将为他们的患者提供常规护理。这项研究 结果将在两次肾内科办公室访问期间和6个月时进行评估。 具体来说，我们的目标是： 目标1(主要)：评估DIAL-SDM干预的可行性、可接受性和保真度。 目标2(次级)：测试干预的初步效果：(A)患者积极参与 透析决策，通过来自录音的活跃的患者参与编码分数来衡量 办公室访问；(B)共享透析决策，以录音中的选项量表分数衡量 和患者报告的共享决策问卷；(C)患者最初选择 透析选项(家庭透析与中心内透析与保守治疗)。

Brief Summary Older patients ≥65 years with chronic kidney disease (CKD) face challenges in decision making around dialysis initiation. These patients report little effort by physicians to elicit treatment preferences, discuss prognoses or explain the burdens/benefits of dialysis options including conservative management. Older patients with CKD often prefer maintaining the quality of life over prolonging life, and many regret their decision to start dialysis: nearly one quarter withdraw from dialysis each year. Shared dialysis decision-making requires active engagement between nephrologists and patients to align patient, caregiver and physician communication around common goals. The proposed study is a pilot randomized cluster pragmatic trial of a shared dialysis decision- making (DIAL-SDM) intervention for nephrologists (n=20) and their patients ≥65 years old (n=60) with an estimated glomerular filtration rate (eGFR) of ≤ 20 ml/min/ /1.73 m2. Nephrologists in the Intervention Group will receive 3 remote online communication training sessions, delivered by a standardized patient instructor (SPI) via Zoom technology who will enact clinical scenarios and offer feedback. In parallel, patients (and caregivers, if available) will receive 2 coaching sessions provided by a health coach, who will explore each patient's relevant contextual information (values, preferences, and goals), and help them identify and practice important questions for their nephrologist. Nephrologists in the Control Group will provide their patients with usual care. The study outcomes will be assessed during two nephrology office visits and at 6 months. Specifically, we aim to: Aim 1 (primary): Assess the feasibility, acceptability, and fidelity of the DIAL-SDM intervention. Aim 2 (secondary): Test the preliminary effectiveness of the intervention on (a) active patient participation in dialysis decision-making, as measured by the Active Patient Participation Coding scores from audio-recordings of office visits; (b) shared dialysis decision-making, as measured by OPTION scale scores from audio-recordings of the office visits, and patient-reported Shared Decision-Making Questionnaire; (c) patients' initial choice of dialysis options (home vs. in-center dialysis vs. conservative management).