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“A randomized controlled trial protocol testing a decision support intervention for older patients with advanced kidney disease.”

 

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Authors: Leanne Brown, Glenn Gardner & Ann Bonner

Brown_et_al-2016-Journal_of_Advanced_Nursing

Aim:  To assess the effectiveness of a decision support intervention using a pragmatic single blind Randomized Controlled Trial.

Background: Worldwide the proportion of older people (aged 65 years and over) is rising. This population is known to have a higher prevalence of chronic diseases including chronic kidney disease. The resultant effect of the changing health landscape is seen in the increase in older patients (aged ≥65 years)
commencing on dialysis. Emerging evidence suggests that for some older patients dialysis may provide minimal benefit. In a majority of renal units non-dialysis management is offered as an alternative to undertaking dialysis. Research regarding decision-making support that is required to assist this population in choosing between dialysis or non-dialysis management is limited.

Design: A multisite single blinded pragmatic randomized controlled trial is proposed.

Methods:  Patients will be recruited from four Queensland public hospitals and randomizd into either the control or intervention group. The decision support intervention is multimodal and includes counselling provided by a trained nurse. The comparator is standard decision-making support. The primary outcomes are decisional regret and decisional conflict. Secondary outcomes are improved knowledge and quality of life. Ethics approval obtained November 2014.

Conclusion: This is one of the first randomized controlled trials assessing a decision support intervention in older people with advance chronic kidney disease. The results may provide guidance for clinicians in future approaches to assist this population in decision-making to ensure reduced decisional regret and decisional conflict.

Correspondence to L. Brown: e-mail  l47.brown@student.qut.edu.au