Accepted for/Published in: JMIR Formative Research
Date Submitted: Oct 17, 2018
Open Peer Review Period: Oct 24, 2018 - Oct 27, 2018
Date Accepted: Dec 14, 2018
(closed for review but you can still tweet)
Feasibility and Effectiveness of a Digital Modality Decision Program for Patients with Advanced Chronic Kidney Disease
ABSTRACT
Background:
Patient education regarding end-stage renal disease (ESRD) has the potential to reduce adverse outcomes and increase use of home renal replacement therapies.
Objective:
We sought to investigate whether an online, easily scalable education program can improve patient knowledge and facilitate decision-making regarding renal replacement therapy options.
Methods:
We developed a 4-week online, digital educational program that included written information, short videos and social networking features. Topics included kidney transplant, conservative management, peritoneal dialysis, home hemodialysis, and in-center hemodialysis. We recruited patients with advanced CKD (stage IV and V) to enroll in the online program, and we evaluated the feasibility and preliminary effectiveness of the digital program by conducting pre-and post-intervention surveys in areas of knowledge, self-efficacy, and choice of ESRD care.
Results:
Of 98 individuals found to be eligible for the study, 28 enrolled and signed consent and 25 completed the study. The average age of participants was 65 (±15) years and the average estimated glomerular filtration rate was 21 ml/min/1.73m2. Prior to intervention, 8 (32%) patients were unable to make an ESRD treatment choice; after the intervention, 100% of patients made a choice. The proportion of persons who selected kidney transplant as first choice increased from 48% at intake to 84% after program completion (p=0.012). Among modality options, peritoneal dialysis as first choice increased from 16% of patients at intake to 52% after program completion (p=0.004). We also observed significant increases in knowledge and self-efficacy scores (p<0.001).
Conclusions:
Implementation of a digital ESRD education program is feasible, and may be effective in facilitating patients’ decisions about renal replacement therapies. Larger studies are necessary to understand whether the program affects clinical outcomes. Clinical Trial: NCT02976220, ClinicalTrials.gov (Registered 11/29/2016)
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