000			04491nam a22005897a 4500
008			220222s20212021 xxu||||| |||| 00| 0 eng d
024			_a10.1053/j.ajkd.2021.08.019 [doi]
024			_aS0272-6386(21)00896-9 [pii]
040			_aOvid MEDLINE(R)
099			_a34648897
245			_aAdvance Care Planning Coaching in CKD Clinics: A Pragmatic Randomized Clinical Trial.
251			_aAmerican Journal of Kidney Diseases. 79(5):699-708.e1, 2022 May.
252			_aAm J Kidney Dis. 79(5):699-708.e1, 2022 May.
252			_zAm J Kidney Dis. 2021 Oct 12
253			_aAmerican journal of kidney diseases : the official journal of the National Kidney Foundation
260			_c2022
260			_fFY2022
260			_p2021 Oct 12
265			_sppublish
266			_d2022-02-22
268			_aAmerican Journal of Kidney Diseases. 2021 Oct 12
501			_aAvailable online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006
520			_aCONCLUSIONS: Individualized coaching may be effective in enhancing ACP, but its impact may be influenced by the health care environment where it is delivered.
520			_aFUNDING: The Patrick and Catherine Weldon Donaghue Medical Research Foundation, via the Greater Value Portfolio.
520			_aINTERVENTION: 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.
520			_aLIMITATIONS: Small number of study sites and possible unrepresentativeness of the broader CKD population by study participants.
520			_aOUTCOME: 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.
520			_aRATIONALE & 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.
520			_aRESULTS: 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.
520			_aSETTING & 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.
520			_aSTUDY DESIGN: Multicenter, pragmatic randomized controlled trial.
520			_aTRIAL REGISTRATION: Registered at ClinicalTrials.gov with study number NCT03506087. Copyright (c) 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.
546			_aEnglish
650			_a*Advance Care Planning
650			_a*Mentoring
650			_a*Renal Insufficiency, Chronic
650			_aAdvance Directives
650			_aFemale
650			_aHumans
650			_aMale
650			_aPatient Participation
650			_aRenal Insufficiency, Chronic/th [Therapy]
651			_aMedStar Washington Hospital Center
656			_aMedicine/Nephrology
656			_aMedicine/Palliative Care
657			_aJournal Article
700			_aGroninger, Hunter
700			_aSherman, Michael J
790			_aAiello JR, Aldous A, Anderson E, Groninger H, Lupu DE, Schell JO, Sherman MJ, Simmens SJ
856			_uhttps://dx.doi.org/10.1053/j.ajkd.2021.08.019 _zhttps://dx.doi.org/10.1053/j.ajkd.2021.08.019
942			_cART _dArticle
999			_c754 _d754