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

项目摘要/摘要 透析前教育计划是对晚期慢性肾脏疾病患者的标准护理 (CKD)了解他们治疗终末期肾病(ESRD)的选择。然而，这些节目 通常不包括关于保守肾脏管理(CKM)或高级护理计划的教育。 对于年老体弱的患者来说，关于透析治疗的知情决策变得尤为重要 患有晚期CKD，因为他们可能会经历频繁的住院，较差的生活质量，以及一次过早的死亡 它们是在透析时开始的。在透析知识、高级护理计划和 已被归因于晚期CKD的黑人和白人患者的临终(EOL)偏好 对黑人来说，他们对自己的治疗方案了解较少。高级护理计划教育一直是 用于改善不同队列的慢性血液透析患者的决策，然而 将慢性知识管理和高级护理计划教育整合到透析前教育计划中，以便 改善护理选择的知识和沟通，同时也减少种族差异一直不是很好 学习。拟议的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(保守性肾脏管理选项和高级护理计划教育- COPE)，整合到老年晚期患者的标准透析前教育中 CKD评估其可行性和可接受性，(2)在试点随机对照试验中测试，初步 COPE在提高慢性知识管理知识水平、提前制定护理计划和增加沟通方面的效果 中老年晚期CKD患者的ESRD治疗和EOL护理偏好，以及(3) 探讨COPE是否能减少CKM中的种族差异，并提高护理规划知识以及 老年和黑白体弱患者对ESRD和EOL护理偏好的沟通 高级CKD。Eneanya博士提出了一项职业发展计划，其中包括方法学培训 以及资深教员的指导，以开发和评估知识评估工具，有效地参与 重病患者群体，并试行干预措施，以检测治疗知识中的种族差异 和生命末期的沟通。这一职业发展奖的长期目标是培养博士。 Eneanya成为一家独立的卫生服务研究员，在调查研究方法方面具有专长，知情 少数族裔和肾脏人群中的护理决策模式和临床试验。

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.