晚期肾病中关于保守性肾脏管理的患者决策辅助工具：一项随机试验性研究。

A Patient Decision Aid About Conservative Kidney Management in Advanced Kidney Disease: A Randomized Pilot Trial.

机构信息

Department of Medicine, University of Washington, Seattle, Washington.

出版信息

Am J Kidney Dis. 2023 Aug;82(2):179-188. doi: 10.1053/j.ajkd.2022.12.007. Epub 2023 Feb 4.

DOI:10.1053/j.ajkd.2022.12.007

Abstract

RATIONALE & OBJECTIVE: Available decision aids for patients about treatment of advanced chronic kidney disease (CKD) often lack information on conservative kidney management (CKM). We assessed the feasibility and acceptability of a decision aid on CKM among patients with advanced CKD and their family members.

STUDY DESIGN

Randomized pilot trial.

SETTING & PARTICIPANTS: Patients aged≥75 years with stage 4 or 5 CKD and their family members at 4 medical centers in the greater Seattle area between August 2020 and December 2021.

INTERVENTIONS

Usual care with or without a decision aid on CKM.

OUTCOME

Acceptability was assessed by attrition rates between the initial study visit (T1) and the 3-month follow-up evaluation (T3). The primary outcome and measure of feasibility was the proportion of participants who discussed CKM with a health care provider between T1 and T3.

RESULTS

We randomized 92 patients of whom 86 (55.8% male; age 82±6 years; 82.6% White) completed T1-42 in the usual care arm and 44 in the usual care plus decision aid arm-and 56 family members of whom 53 (18.9% male; age 71±11 years; 86.8% White) completed T1-20 in usual care arm and 33 in the usual care plus decisions aid arm. The attrition rates were 21% versus 21% (P=1.0) for patients, and 10% versus 18% (P=0.46) for family members in the usual care versus usual care plus decisions aid arms. Receipt of the decision aid significantly increased discussion of CKM with a health care provider for patients (26.4% vs 3.0%, P=0.007) and family members (26.9% vs 0, P=0.02).

LIMITATIONS

Possible limited generalizability because participants were a relatively homogenous group. The decision aid focuses on CKM and may be less applicable to those with limited knowledge of kidney replacement therapies.

CONCLUSIONS

A CKM decision aid was feasible and acceptable, and increased discussion of this treatment option with health care providers. This aid may serve as a useful adjunct to the currently available educational tools on treatments for advanced CKD.

FUNDING

Grant from a not-for-profit entity (National Palliative Care Research Center).

TRIAL REGISTRATION

Registered at ClinicalTrials.gov with study number NCT04919941.

摘要

背景与目的

现有的关于晚期慢性肾脏病（CKD）治疗的患者决策辅助工具通常缺乏关于保守性肾脏管理（CKM）的信息。我们评估了一种关于 CKM 的决策辅助工具在晚期 CKD 患者及其家属中的可行性和可接受性。

研究设计

随机试点试验。

设置与参与者

2020 年 8 月至 2021 年 12 月期间，西雅图大都市区的 4 家医疗中心的年龄≥75 岁、处于 4 期或 5 期 CKD 的患者及其家属。

干预措施

常规护理加或不加 CKM 决策辅助工具。

主要结果和可行性的衡量标准

接受性通过初始研究访视（T1）和 3 个月随访评估（T3）之间的流失率来评估。主要结果和可行性的衡量标准是在 T1 和 T3 之间与医疗保健提供者讨论 CKM 的参与者比例。

结果

我们随机分配了 92 名患者，其中 86 名（55.8%为男性；年龄 82±6 岁；82.6%为白人）在常规护理组完成了 T1-42，44 名在常规护理加决策辅助工具组完成了 T1-42；56 名家属，其中 53 名（18.9%为男性；年龄 71±11 岁；86.8%为白人）在常规护理组完成了 T1-20，33 名在常规护理加决策辅助工具组完成了 T1-20。患者的流失率为 21%对 21%（P=1.0），家属的流失率为 10%对 18%（P=0.46），常规护理组与常规护理加决策辅助工具组。接受决策辅助工具显著增加了患者（26.4%比 3.0%，P=0.007）和家属（26.9%比 0%，P=0.02）与医疗保健提供者讨论 CKM。