Communication Tool Training for Kidney Failure

Recruiting in Palo Alto (17 mi)

+10 other locations

Overseen byMargaret L Schwarze, MD, MPP, FACS

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: University of Wisconsin, Madison

No Placebo Group

Trial Summary

What is the purpose of this trial?

The purpose of this study is to test the effect of the "Best Case/Worse Case" (BC/WC) communication tool on receipt of palliative care and intensity of treatment at the end of life, quality of life, and quality of communication for older patients with end-stage renal disease (ESRD) receiving outpatient care at ten nephrology clinics. The intervention was developed and tested with acute care surgical patients at the University of Wisconsin (UW) and is now being testing to see if the intervention will work in a different setting. The intervention will be tested with 320 older adults who have end-stage renal disease (ESRD) and are receiving care from a nephrologist enrolled in the study. Randomly assigned nephrologists within each site will receive the intervention (training to use the BC/WC tool) or to be in the waitlist control, meaning that they will not be offered BC/WC training until the end of the study, when all participants have been enrolled. Participants will be on follow up with surveys and chart review for up to two years after study enrollment. Caregivers will also be invited to participate and complete surveys.

Eligibility Criteria

This trial is for older adults with severe kidney disease (eGFR ≤ 24) who are not on dialysis but may have had it before or have the access in place. They must be over 80, have other serious illnesses, or their doctor wouldn't be surprised if they passed away within a year. Participants should speak English and be able to make decisions.

Inclusion Criteria

Your kidney function, as measured by eGFR, is very low.

I am over 80, have a serious health condition, or my doctor wouldn't be surprised if I passed away within a year.

I am not currently undergoing dialysis.

Exclusion Criteria

I am currently receiving dialysis.

I do not speak English.

I am unable to make my own medical decisions.

Treatment Details

Interventions

Best Case/Worst Case communication tool training (Behavioural Intervention)

Trial OverviewThe study tests a 'Best Case/Worst Case' communication tool training for doctors at nephrology clinics. It aims to see if this improves end-of-life care quality and decision-making for patients with end-stage renal disease by comparing trained doctors to those waiting for training.

Participant Groups

2Treatment groups

Experimental Treatment

Active Control

Group I: Best Case/Worst Case communication toolExperimental Treatment1 Intervention

The participant's enrolled nephrologist will have completed training on the Best Case/Worst Case communication tool and will be encouraged to use it with the participant.

Group II: Usual CareActive Control1 Intervention

Usual care conversations are typically focused on mode and timing of dialysis, management of electrolytes and scheduling of laboratory testing. Conservative management or a treatment option of "no dialysis" is rarely mentioned.