Pre-dialysis education programs are the standard of care for patients with advanced chronic kidney disease (CKD) to learn about their options for treatment of end-stage renal disease (ESRD). However, these programs do not usually include education about conservative kidney management (CKM) or advance care planning. Informed decision-making about dialysis treatments becomes especially important for elderly and frail patients with advanced CKD as they may experience frequent hospitalizations, poor quality of life, and early death once they are initiated on dialysis. There are also racial disparities in dialysis knowledge, advance care planning and end-of-life (EOL) preferences between Black and White patients with advanced CKD that have been attributed to Blacks having less understanding of their treatment options. Advance care planning education has been used to improve decision-making among diverse cohorts of chronic hemodialysis patients however the integration of CKM and advance care planning education into pre-dialysis education programs in order to improve knowledge and communication of care options while also reducing racial disparities has not been well studied. The proposed scientific program has three research aims: (1) To conduct an open pilot study of an educational intervention (Conservative Kidney Management Options and Advance Care Planning Education ? COPE) that is integrated into standard pre-dialysis education among frail and elderly patients with advanced CKD to assess its feasibility and acceptability, (2) To test, in a pilot randomized controlled trial, the preliminary efficacy of COPE on improving knowledge of CKM and advance care planning and increasing communication about ESRD treatment and EOL care preferences among frail and elderly patients with advanced CKD, and (3) To explore whether COPE reduces racial disparities in CKM and advance care planning knowledge as well as communication of ESRD and EOL care preferences among Black and White frail and elderly patients with advanced CKD. Dr. Eneanya proposes a career development program that includes methodological training and mentorship by senior faculty to develop and evaluate knowledge assessment tools, engage effectively with seriously ill patient populations, and pilot an intervention to detect racial differences in treatment knowledge and end-of-life communication. The long-term goal of this career development award is to develop Dr. Eneanya into an independent health services researcher with expertise in survey research methods, informed decision-making models of care, and clinical trials among minority and renal populations.
In the United States, elderly and frail patients with advanced chronic kidney disease (CKD) are increasingly initiated on dialytic treatments despite the unclear effects on mortality and quality of life for this population. Furthermore, racial minority patients are diagnosed more frequently with advanced CKD but experience barriers to informed dialysis decision-making and quality end-of-life care. The proposed study seeks to test a pre-dialysis educational intervention to promote informed treatment decision-making, improve advance care planning, and decrease racial disparities in treatment knowledge and communication of care preferences among Black and White frail and elderly patients with advanced CKD.
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