Decision aid improves decision quality for seniors with chronic kidney disease

For older adults with chronic kidney disease (CKD), a decision aid about kidney replacement therapy improves decision quality and clarifies treatment preferences, according to a study published online Dec. 20 in the Annals of Internal Medicine.

Keren Ladin, Ph.D., from Tufts University in Boston, and colleagues examined whether the Decision-Aid for Renal Therapy (DART) improved decisional quality versus usual care in a multicenter trial conducted at eight outpatient nephrology clinics. Overall, 363 older adults were randomly assigned to usual care or DART (180 and 183, respectively). Change in the decisional conflict scale (DCS) score was examined from baseline to three, six, 12, and 18 months.

The researchers observed an improvement in decisional quality with DART, with the mean DCS score decreasing relative to control (mean difference, −7.9 and −8.5 at three and six months, respectively); results decreased after six months. Knowledge improved with DART versus usual care at three months (mean difference, 7.2); findings were similar at six months then decreased at 18 months (mean difference, 5.9).

There was a change in treatment preferences observed from 58 percent unsure at baseline to 28, 20, 23, and 14 percent at three, six, 12, and 18 months, respectively, with DART; the corresponding changes were 51 to 38, 35, 32, and 18 percent with usual care.

"DART presents a consistent and accessible decision support tool that expedites higher-quality patient-centered decisions by reducing decisional conflict and improving knowledge in the short-term," the authors write. "Effects may be attenuated by 12 months, and patients may benefit from reengagement with DART annually."