Outcomes of a Palliative Care Intervention to Improve Kidney Therapy-Decision Making for Older People with Advanced CKD - PROJECT SUMMARY Older adults ≥75 years represent the fastest-growing population to initiate dialysis in the US. These people face challenges in decision-making around dialysis initiation. They have reported that clinicians seldom elicit treatment preferences, discuss prognoses, or explain the tradeoffs of kidney therapy (KT) options. Older patients often prioritize the quality of life over life prolongation. However, dialysis is still commonly presented as the sole KT option without any discussion of conservative kidney management or the effects of dialysis on the future quality of life. Subsequently, many of these patients experience deterioration in quality of life, experience high healthcare utilization rates, and undergo intensive end-of-life (EOL) treatments. Indeed, KT decision- making requires the engagement of patients and physicians alike—incorporation of patients' goals, discussion of alternatives to dialysis such as conservative kidney management (CKM), conversation about prognosis and exploration of patients' emotional needs. The proposed study is a type-1 hybrid effectiveness-implementation trial of a palliative care (CKD-EDU) intervention for patients ≥75 years old (n=326) with an estimated glomerular filtration rate (eGFR) of ≤ 30 ml/min/1.73 m2. Patients in the intervention group will receive 1) a multicomponent video and paper KT decision aid including a question prompt list, and 2) coaching from a palliative care clinician. The visits will be used to explore patients' goals, address KT information needs including prognosis, and attend to their emotions to aid them with KT and EOL decision-making. Patients in the Control Group will receive the usual care from their nephrologist and a dialysis educator. Aim 1: To determine whether CKD-EDU improves the kidney therapy decision-making process (primary) as measured by the Decisional Conflict Scale at month 1 and enhances patient well-being (secondary) as measured by the Burden of Kidney Disease Subscale at month 6. Aim 2 (secondary): To determine whether the intervention reduces six-month health services utilization and improves end-of-life care course during the last 30 days of life. Aim 3 (exploratory): Identify barriers and facilitators to the dissemination and implementation of CKD-EDU using rapid qualitative inquiry with key stakeholders (e.g., patients, caregivers, nephrologists and palliative care clinicians).
