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).
