The National Palliative Care Research Center

Curing suffering through palliative care research.


Margaret Schwarze, MD, MPP

Associate Professor

University of Wisconsin-Madison

Grant Year
Grant Term
Grant Type

Project Description
A Communication Tool to Assist Frail Older Adults in Decision Making about Dialysis

Each year, more than 100,000 adults over age 75 with end-stage renal disease receive dialysis, a therapy with considerable treatment burden and often limited ability to prolong life. Because these patients experience significant morbidity, a decision to start dialysis needs to be contextualized with information about the patient’s overall health status so patients can make values-concordant treatment decisions and recognize the value of early access to palliative care. This proposal serves the long-term goal of improving treatment decision making for frail older adults with life-limiting illnesses so that treatment choices reflect personal preferences and goals.

“A communication tool to assist frail older adults with end-stage renal disease” is a two-year NPCRC proposal to support a pilot study of a communication tool designed to help older patients make decisions about dialysis and receive earlier access to palliative care. This project has three aims: Aim 1, to demonstrate that nephrologists can learn to use the communication tool; Aim 2, to assess the feasibility of study procedures for later use in a large-scale efficacy study; and Aim 3, to evaluate measured effects in order to estimate sample size and ensure future study outcomes are clinically meaningful.

This award will produce data and procedures necessary to submit a competitive application for a larger-scale efficacy trial. The research is innovative because it will test a novel, theoretically grounded intervention in a well-defined outpatient setting. The research is significant because if it is ultimately found effective, it offers a low-cost, scalable strategy to improve physician engagement with frail older patients during treatment decision making and promote earlier access to outpatient palliative care. The research is feasible because it has been carefully designed to fit the time frame and budget and will be conducted by investigators with a strong track record in decision-making, aging-related, health services research.


Gretchen Schwarze MD, MPP is an Associate Professor in the Division Vascular of Surgery at the University of Wisconsin. She received her medical degree from Harvard Medical School and master’s degree in public policy from the John F. Kennedy School of Government.  She completed residency at the Massachusetts General Hospital in Boston. Her fellowship training in vascular surgery and clinical ethics was done at the University of Chicago Hospital and Clinics.  Her research interests are in patient-doctor decision making for high risk operations and end-of-life care for surgical patients. She is an alumna of the Greenwall Faculty Scholars program and currently holds a KL2 award via the University of Wisconsin CTSA and a GEMSSTAR (R03 NIA)/Jahnigen Award from the American Geriatrics Society and the Society for Vascular Surgery to test a communication intervention for older, frail surgical patients.   She was recently awarded funding from PCORI to test a patient-designed and patient-mediated intervention to improve engagement during high-stakes surgical decisions. Dr. Schwarze has two daughters, ages 8 and 10.