AbstractIntroduction 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; pConclusions 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.
Ozdemir et al. (Sun,) studied this question.