A randomized controlled trial testing a decision support intervention for older patients with advanced kidney disease

Aim To evaluate the effectiveness of a decision support intervention (OPTIONS) in facilitating the older person with advanced kidney disease to make a treatment choice. Design Pragmatic randomized controlled trial. Methods People aged ≥70 years with advanced kidney disease (eGFR ≤20 ml/min/1.73m2) who had not made a decision about treatment options and who were not eligible for a kidney transplant were recruited between March 2015 and March 2016. Participants were randomly allocated to receive the OPTIONS (N = 16) or standard care (N = 21). OPTIONS is a 4‐week nurse‐delivered intervention. Primary outcomes were decision conflict and decision regret, the secondary outcomes were knowledge of risk and benefits of dialysis and health‐related quality of life. The usefulness of OPTIONS was also evaluated. Results There were no differences between the intervention and standard care groups at baseline. At T1, there were no significant differences in decision conflict and decision regret although the intervention group had lower decisional conflict at T2. The decision support intervention was able to significantly improve the participants’ knowledge score in the intervention group. There were no observable differences between groups for health‐related quality of life physical and mental health component summary scores. OPTIONS was helpful in preparing participants in making a treatment decision. Conclusion OPTIONS, a decision support intervention, increased a person's knowledge of the benefits and risks of dialysis and can be used to facilitate shared decision‐making with older adults with advanced stages of kidney disease. Impact Strategies to improve shared decision‐making between older people with advanced stages of kidney disease and their clinicians are crucial for patient autonomy in a population where this may not be common practice. The decision support intervention– OPTIONS demonstrated significant improvement in patient knowledge about different treatment pathways. OPTIONS provides a structured and evidence‐based approach to support shared decision‐making for this population. Trial Registration ACTRN 12614001090606 Registered 14/10/2014. 目的 评估决策支持干预(备选项)在帮助晚期肾病患者做出治疗选择方面的有效性。 研究设计 实用随机对照试验。 方法 2015年三月至2016年三月之间,招募年龄≥70岁未决定治疗方案且不符合肾移植条件的晚期肾病患者(表皮生长因子受体(eGFR)≤20 ml/min/1.73m2)。随机分配实验对象接受备选项(N = 16)或标准护理(N = 21)。备选项是一个4周的护理干预。主要结果是决策冲突和决策后悔,次要结果则是透析和健康相关的生活质量的风险和益处的知识,还评估了备选项的有用性。 结果 就干预和标准护理组而言基线两者并没有太大区别。尽管干预组T2决策冲突较低,T1干预组的决策冲突和决策后悔仍然没有显著差异。决策支持干预显著提高了干预组