Decision-Aid for Renal Therapy improves treatment quality among elderly with CKD

The study by Keren Ladin and peers found the decision aid called DART (Decision-Aid for Renal Therapy) improved decisional quality compared to usual care in older patients with advanced chronic kidney disease (CKD). The findings of this study were published in the Annals of Internal Medicine.

A total of 400 participants were recruited, with 363 of them being randomly assigned to either the usual care group or the DART group. The DART group received an interactive, web-based decision aid and written education about treatments, while the usual care group only received written education. The primary outcome was the change in decisional conflict scale (DCS) score from baseline to 3, 6, 12, and 18 months. Secondary outcomes included change in prognostic and treatment knowledge and change in uncertainty.

The highlights of this study were:

The decisional quality improved with DART, as the mean DCS score decreased compared to the control group. This result was consistent at the 6 month mark, but attenuated thereafter.

The DART group also showed improvements in knowledge and treatment preferences, with a decrease in the number of participants who were unsure about their treatment preferences.

The study found that the use of DART improved decision quality and clarified treatment preferences among older adults with advanced CKD for 6 months after the DART intervention. The use of decision aids like DART can be beneficial in helping older patients with advanced CKD navigate the difficult decisions regarding managing kidney failure, and reducing decisional conflict and regret.

Reference:

Ladin, K., Tighiouart, H., Bronzi, O., Koch-Weser, S., Wong, J. B., Levine, S., Agarwal, A., Ren, L., Degnan, J., Sewall, L. N., Kuramitsu, B., Fox, P., Gordon, E. J., Isakova, T., Rifkin, D., Rossi, A., & Weiner, D. E. (2022). Effectiveness of an Intervention to Improve Decision Making for Older Patients With Advanced Chronic Kidney Disease. In Annals of Internal Medicine. American College of Physicians. https://doi.org/10.7326/m22-1543