Strengthening Shared Decision-Making for Older Adults with Kidney Failure Considering Kidney Transplant

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PROJECT SUMMARY / ABSTRACT The goals of this K23 application are to support shared decision-making for older adults considering kidney transplant evaluation and to facilitate Dr. Catherine Butler's transition to independence as a physician scientist whose research focuses on making the transplant evaluation process more person-centered and equitable. Kidney transplant can be a valuable treatment option for the growing number of older adults with kidney failure, but because of their limited life expectancy and high burden of comorbidity, most will not receive a kidney. Further, the transplant evaluation itself can be time-consuming, burdensome, and risky, especially for older adults who are particularly vulnerable to the complications of aggressive screening and treatments. Our preliminary work suggests that patients often have little understanding of what to expect from the transplant evaluation and limited opportunity to shape their involvement. A process of shared decision-making could help older adults to navigate the complex trade-offs and uncertainties involved in the kidney transplant evaluation. We propose an integrated research agenda intended to strengthen shared decision-making around referral for kidney transplant among older adults. First, we will conduct an interview-based qualitative study to elicit the experiences and perspectives of older adults with kidney failure related to the transplant evaluation process along with their family members and clinicians (Aim 1). Second, we will describe the duration and likelihood of completing discrete steps in the transplant process for a large national cohort of patients with kidney failure (Aim 2). Finally, informed by these first two aims, we will adapt and pilot-test a communication tool to support shared decision-making around referral for transplant among older adults with kidney failure (Aim 3). During the award period, Dr. Butler will build upon her background in bioethics and early experience in qualitative and epidemiologic research to acquire new expertise in the use of applied qualitative methods, design and conduct of cohort studies, and development and testing of communication tools. This career development plan will be supported by the exceptional research environment at the University of Washington, including the Kidney Research Institute and the Seattle-Denver VA Center of Innovation. Dr. Butler's primary mentor, Dr. Ann O'Hare, is an internationally recognized physician scientist whose research focuses on complex care processes for older adults with kidney disease. Dr. Butler's co-mentors have complementary expertise in transplant epidemiology (Dr. Peter Reese) and communication tool development and testing (Dr. Margaret “Gretchen” Schwarze). The work proposed here will lay the foundation for a future trial to test the communication tool developed during the award period and, more broadly, will identify multiple avenues to improve upon the transplant evaluation process at both the individual- and systems-levels. Collectively, this work will position Dr. Butler to become a successful independent physician scientist whose research focuses on fostering a more person-centered and equitable approach to the kidney transplant evaluation process.