Advance Care Planning Coaching in CKD Clinics: A Pragmatic Randomized Clinical Trial.
Citation: American Journal of Kidney Diseases. 79(5):699-708.e1, 2022 May.PMID: 34648897Institution: MedStar Washington Hospital CenterDepartment: Medicine/Nephrology | Medicine/Palliative CareForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Advance Care Planning | *Mentoring | *Renal Insufficiency, Chronic | Advance Directives | Female | Humans | Male | Patient Participation | Renal Insufficiency, Chronic/th [Therapy]Year: 2022Local holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006Abstract: CONCLUSIONS: Individualized coaching may be effective in enhancing ACP, but its impact may be influenced by the health care environment where it is delivered.FUNDING: The Patrick and Catherine Weldon Donaghue Medical Research Foundation, via the Greater Value Portfolio.INTERVENTION: Nurses or social workers with experience in nephrology or palliative care delivered individualized in-person ACP sessions. The enhanced control group was given Make Your Wishes About You (MY WAY) education materials and was verbally encouraged to bring their completed advance directives to the clinic.LIMITATIONS: Small number of study sites and possible unrepresentativeness of the broader CKD population by study participants.OUTCOME: Primary outcome measures were scores on a 45-point ACP engagement scale at 14 weeks and a documented advance directive or portable medical order at 16 weeks after enrollment.RATIONALE & OBJECTIVE: Although guidelines recommend more and earlier advance care planning (ACP) for patients with chronic kidney disease (CKD), scant evidence exists to guide incorporation of ACP into clinical practice for patients with stages of CKD prior to kidney failure. Involving nephrology team members in addition to primary care providers in this important patient-centered process may increase its accessibility. Our study examined the effect of coaching implemented in CKD clinics on patient engagement with ACP.RESULTS: Among 254 participants analyzed, 46.5% were 65-74 years of age, and 54% had CKD stage 3. The coached patients scored 1.9 points higher at 14 weeks on the ACP engagement scale (beta = 1.87 [95% CI, 0.13-3.64]) adjusted for baseline score and site. Overall, 32.8% of intervention patients (41 of 125) had an advance directive compared with 17.8% (23 of 129) of patients in the control group. In a site-adjusted multivariable model, coached patients were 79% more likely to have a documented advance directive or portable medical order (adjusted risk ratio, 1.79 [95% CI, 1.18-2.72]), with the impact principally evident at only 1 study site.SETTING & PARTICIPANTS: Three CKD clinics in different states participated: 273 patients consented to participate, 254 were included in analysis. Eligible patients were 55 years or older, had stage 3-5 CKD, and were English speaking.STUDY DESIGN: Multicenter, pragmatic randomized controlled trial.TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT03506087. Copyright (c) 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.Originally published: American Journal of Kidney Diseases. 2021 Oct 12Fiscal year: FY2022Digital Object Identifier: Date added to catalog: 2022-02-22| Item type | Current library | Collection | Call number | Status | Date due | Barcode |
|---|---|---|---|---|---|---|
| Journal Article | MedStar Authors Catalog | Article | 34648897 | Available | 34648897 |
Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006
CONCLUSIONS: Individualized coaching may be effective in enhancing ACP, but its impact may be influenced by the health care environment where it is delivered.
FUNDING: The Patrick and Catherine Weldon Donaghue Medical Research Foundation, via the Greater Value Portfolio.
INTERVENTION: Nurses or social workers with experience in nephrology or palliative care delivered individualized in-person ACP sessions. The enhanced control group was given Make Your Wishes About You (MY WAY) education materials and was verbally encouraged to bring their completed advance directives to the clinic.
LIMITATIONS: Small number of study sites and possible unrepresentativeness of the broader CKD population by study participants.
OUTCOME: Primary outcome measures were scores on a 45-point ACP engagement scale at 14 weeks and a documented advance directive or portable medical order at 16 weeks after enrollment.
RATIONALE & OBJECTIVE: Although guidelines recommend more and earlier advance care planning (ACP) for patients with chronic kidney disease (CKD), scant evidence exists to guide incorporation of ACP into clinical practice for patients with stages of CKD prior to kidney failure. Involving nephrology team members in addition to primary care providers in this important patient-centered process may increase its accessibility. Our study examined the effect of coaching implemented in CKD clinics on patient engagement with ACP.
RESULTS: Among 254 participants analyzed, 46.5% were 65-74 years of age, and 54% had CKD stage 3. The coached patients scored 1.9 points higher at 14 weeks on the ACP engagement scale (beta = 1.87 [95% CI, 0.13-3.64]) adjusted for baseline score and site. Overall, 32.8% of intervention patients (41 of 125) had an advance directive compared with 17.8% (23 of 129) of patients in the control group. In a site-adjusted multivariable model, coached patients were 79% more likely to have a documented advance directive or portable medical order (adjusted risk ratio, 1.79 [95% CI, 1.18-2.72]), with the impact principally evident at only 1 study site.
SETTING & PARTICIPANTS: Three CKD clinics in different states participated: 273 patients consented to participate, 254 were included in analysis. Eligible patients were 55 years or older, had stage 3-5 CKD, and were English speaking.
STUDY DESIGN: Multicenter, pragmatic randomized controlled trial.
TRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT03506087. Copyright (c) 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
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