A Decision Aid for the Conservative Management of Advanced Kidney Disease
Conservative care is palliative approach to caring for patients with advanced
chronic kidney disease (CKD) who choose not to initiate maintenance dialysis.
Despite calls for greater efforts to support shared decision-making for
treatment of advanced CKD, available decision aids intended to assist patients
with navigating these decisions focus primarily on of the benefits and harms of
dialysis and include little or no information on conservative care.
Aim 1: To conduct a qualitative study using cognitive interviews with 20-25
patients with advanced CKD and their close persons to ascertain how they
process information about conservative care and uncover unmet needs and
preferences for information on conservative care to inform a decision aid on
conservative care; and Aim 2: To conduct a pilot study of the decision aid with
108 patients with advanced CKD and their close persons to evaluate its
feasibility and acceptability and explore knowledge, confidence with
decision-making and concordance between treatment decisions for advanced CKD
with healthcare priorities gained with the aid.
The work will provide: 1) new insights on what information on conservative care
patients and their close persons would like to receive and how it should be
framed to better support decision-making for treatment of advanced CKD; and, 2)
the first dedicated decision aid on conservative care for the US population.
Susan Wong is an early investigator and mentored by experts in geriatric nephrology
(Ann O’Hare) and interventional trials in palliative care (J. Randall Curtis).
The work will be situated at the Seattle VA Health Services Research and
Development Center, which has been a leader in the evaluation of healthcare
delivery and implementation science.
Directions: The findings will inform R-level proposals to enhance and test the
effectiveness of the decision aid in supporting shared decision-making for
treatment of advanced CKD.
Susan P. Y. Wong, M.D., M.S. is an Assistant Professor of Medicine
in the Division of Nephrology at the University of Washington, an Investigator
at the Kidney Research Institute, and a nephrologist and Core Investigator at
the VA Health Services Research and Development Center at the VA Puget Sound
Health Care System in Seattle, WA. She received her medical degree from the
University of Pittsburgh, and her internal medicine and nephrology training,
master of science in epidemiology, and graduate certificates in palliative care
and clinical ethics from the University of Washington. Dr. Wong conducts
patient-oriented health services research on dialysis practices and end-of-life
care among patients with advanced kidney disease.. Her goal is to create more
patient-centered models of care for patients with kidney disease.