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

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Brown, Leanne
Gardner, Glenn
Bonner, Ann
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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.

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Journal of Advanced Nursing
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Science & Technology
Life Sciences & Biomedicine
chronic kidney disease
conservative kidney management
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Brown, L; Gardner, G; Bonner, A, A randomized controlled trial protocol testing a decision support intervention for older patients with advanced kidney disease, Journal of Advanced Nursing, 2016, 72 (5), pp. 1191-1202