Work

Feasibility and Acceptability of a Palliative Care Intervention among Older Adults with Advanced CKD and Their Caregivers

Year: 2024

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Key Points In the current pilot trial, palliative care (PC) consultation for older adults with advanced CKD was both feasible and acceptable. PC consultation was associated with significant improvements in the decision-making process for kidney therapy and in quality of life. A large-scale PC-based decision-support intervention for older adults with CKD aimed at examining person-centered outcomes is warranted. Background In non-nephrology settings, specialty palliative care (PC) improves decision making, patient's quality of life (QoL), advance care planning, and certain indicators of the quality of end-of-life (EoL) care. This pilot randomized control trial (RCT) explored the feasibility and acceptability of a PC intervention, CKD-EDU, for adults aged 75 years and older with eGFR ≤25 ml/min and their caregivers. Methods Participants randomized to the control group received standard nephrology care and routine kidney therapy education, whereas those randomized to CKD-EDU received a decision aid and met with a PC clinician up to three times to discuss kidney therapy decisions and EoL planning. Patients were assessed at baseline, 4–6, 12–14, and 24–26 weeks. Main outcomes included intervention feasibility and acceptability, decision conflict, and patient QoL. The mediating effects of reduced decision conflict on improved QoL were explored, as were the effects of CKD-EDU on advance care planning, EoL treatment intensity, and 6-month hospitalization. Statistical analyses encompassed descriptive analyses, adjusted repeated-measure models, mediation analyses, and logistic regression models. Results Among the 127 eligible patients screened, 58 (46%) consented: 30 were randomized to CKD-EDU and 28 to the control arm. All patients completed baseline assessments and 89% completed at least 1 intervention session ( n =26/29), underscoring intervention adherence and feasibility. Similarly, assessment completion rates at 4 (83%, n =45/54), 12 (93%, n =42/45), and 24 (95%, n =40/42) weeks were high. The intervention received over 85% acceptability ratings for all questions. Patients exposed to CKD-EDU exhibited significant improvement in Decisional Conflict Scale scores ( P = 0.003) at 4–6 weeks and improvements in QoL at 24–26 weeks ( P = 0.02). Exploratory analyses were not statistically significant in this pilot study, but all effect sizes were in the predicted direction. Conclusions This study demonstrates the feasibility and acceptability of CKD-EDU. A larger scale trial is warranted to assess its effectiveness in improving key outcomes important to patients and families. Clinical trial registry name and registration number: NCT03465449.

Source: Kidney360

DOI: 10.34067/kid.0000000622