Evaluation of a Decision Aid in Kidney Care Counseling for Older Adults

Abstract Introduction We evaluated the effectiveness of a web-based patient decision aid (PDA) developed for older adults with end-stage kidney disease (ESKD) and their caregivers, integrated into kidney care counseling. Methods A pragmatic pre-post trial with a comparison group was conducted in Singapore with patients aged ≥70 years with ESKD and their caregivers. Usual care participants received standard counseling, while intervention arm received counseling using the PDA. The primary outcome was change in decisional conflict from pre- to post-counseling between arms. Secondary outcomes were conservative management (CM) awareness, stated treatment preference at post-counseling, and real-life treatment choice at six months. Analyses used a generalized linear mixed model for the primary outcome and logistic regressions for secondary outcomes. Results A total of 143 participants were enrolled (75 patients, 68 caregivers). Caregivers in the intervention arm experienced significantly greater reductions in decisional conflict compared to usual care (β =–4.48; p<0.001) while reductions did not differ between arms for the patients (β=0.05; p=0.97). Post-counseling, patient CM awareness increased more in the intervention arm (82.6% vs 69.2%; odds ratio (OR)=7.24; p<0.01). Patients receiving the PDA were less likely to prefer dialysis post-counseling (OR=0.33; p=0.12) and were less likely to initiate dialysis within six months (OR=0.21; p=0.049). Conclusions Although future studies are needed to confirm these results, this study provides preliminary, suggestive evidence that integrating a web-based PDA into kidney care counseling may reduce caregiver decisional conflict, improve patient awareness of CM, and shift both stated and actual treatment choices away from dialysis.