integrating conservative kidney management options and advance care planning into a pre-dialysis educational program

项目总结/摘要 透析前教育计划是晚期慢性肾脏病患者的标准护理 (CKD)了解他们对终末期肾病（ESRD）的治疗选择。然而，这些方案 通常不包括关于保守肾脏管理（CKM）或提前护理计划的教育。 对于年老体弱的患者来说，透析治疗的知情决策变得尤为重要 晚期CKD患者，因为他们可能会经历频繁的住院治疗，生活质量差， 他们开始透析。在透析知识、预先护理计划和 晚期CKD黑人和白色患者之间的寿命终了（EOL）偏好， 黑人对他们的治疗方案了解较少。提前护理规划教育已成为 用于改善不同队列的慢性血液透析患者的决策， 将CKM和高级护理计划教育整合到透析前教育计划中， 在减少种族差异同时，改善对护理选择的了解和沟通情况并不理想 研究了该科学计划有三个研究目标：（1）进行一项开放的试点研究， 教育干预（保守肾脏管理选项和预先护理计划教育- 科普），将其整合到体弱和老年晚期肾病患者的标准透析前教育中 CKD，以评估其可行性和可接受性，（2）在一项初步随机对照试验中， 科普对提高CKM知识和提前护理计划以及增加沟通的有效性 关于晚期CKD体弱和老年患者的ESRD治疗和终末期护理偏好，以及（3） 探讨科普是否减少了CKM中的种族差异，并提高了护理计划知识， 黑人和白色体弱和老年患者之间ESRD和EOL护理偏好的沟通 晚期CKD。Eneanya博士提出了一个职业发展计划，其中包括方法培训 和高级教师的指导，以开发和评估知识评估工具，有效地与 重症患者人群，并试行干预措施，以检测治疗知识的种族差异 和临终交流这个职业发展奖的长期目标是发展博士。 Eneanya成为一个独立的卫生服务研究员，具有调查研究方法的专业知识， 决策模式的护理，和临床试验中的少数民族和肾人口。

PROJECT SUMMARY/ABSTRACT Pre-dialysis education programs are the standard of care for patients with advanced chronic kidney disease (CKD) to learn about their options for treatment of end-stage renal disease (ESRD). However, these programs do not usually include education about conservative kidney management (CKM) or advance care planning. Informed decision-making about dialysis treatments becomes especially important for elderly and frail patients with advanced CKD as they may experience frequent hospitalizations, poor quality of life, and early death once they are initiated on dialysis. There are also racial disparities in dialysis knowledge, advance care planning and end-of-life (EOL) preferences between Black and White patients with advanced CKD that have been attributed to Blacks having less understanding of their treatment options. Advance care planning education has been used to improve decision-making among diverse cohorts of chronic hemodialysis patients however the integration of CKM and advance care planning education into pre-dialysis education programs in order to improve knowledge and communication of care options while also reducing racial disparities has not been well studied. The proposed scientific program has three research aims: (1) To conduct an open pilot study of an educational intervention (Conservative Kidney Management Options and Advance Care Planning Education – COPE) that is integrated into standard pre-dialysis education among frail and elderly patients with advanced CKD to assess its feasibility and acceptability, (2) To test, in a pilot randomized controlled trial, the preliminary efficacy of COPE on improving knowledge of CKM and advance care planning and increasing communication about ESRD treatment and EOL care preferences among frail and elderly patients with advanced CKD, and (3) To explore whether COPE reduces racial disparities in CKM and advance care planning knowledge as well as communication of ESRD and EOL care preferences among Black and White frail and elderly patients with advanced CKD. Dr. Eneanya proposes a career development program that includes methodological training and mentorship by senior faculty to develop and evaluate knowledge assessment tools, engage effectively with seriously ill patient populations, and pilot an intervention to detect racial differences in treatment knowledge and end-of-life communication. The long-term goal of this career development award is to develop Dr. Eneanya into an independent health services researcher with expertise in survey research methods, informed decision-making models of care, and clinical trials among minority and renal populations.