Advance Care Planning Coaching for Patients With Chronic Kidney Disease
| Status: | Enrolling by invitation |
|---|---|
| Conditions: | Renal Impairment / Chronic Kidney Disease |
| Therapuetic Areas: | Nephrology / Urology |
| Healthy: | No |
| Age Range: | 55 - Any |
| Updated: | 3/1/2019 |
| Start Date: | May 15, 2018 |
| End Date: | December 2019 |
Impact of Advance Care Planning Coaching for Patients With Chronic Kidney Disease
This project will develop and test a model intervention for Advance Care Planning (ACP) for
patients with advanced chronic kidney disease (CKD) cared for in nephrology clinics that have
the capacity to consult with or refer to palliative care. Specifically, we will compare the
effectiveness of having a trained ACP coach meet in person with patients to discuss their
goals and preferences vs. providing patients with a packet of material to review on their own
and then discuss with their nephrologist at their initiation.
Hypothesis: In patients aged 55 or older with stage 3-5 Chronic Kidney Disease cared for in a
CKD outpatient clinic, an advance care planning process that involves in-person meetings with
a trained ACP coach will be more effective than providing patients with printed educational
materials alone.
patients with advanced chronic kidney disease (CKD) cared for in nephrology clinics that have
the capacity to consult with or refer to palliative care. Specifically, we will compare the
effectiveness of having a trained ACP coach meet in person with patients to discuss their
goals and preferences vs. providing patients with a packet of material to review on their own
and then discuss with their nephrologist at their initiation.
Hypothesis: In patients aged 55 or older with stage 3-5 Chronic Kidney Disease cared for in a
CKD outpatient clinic, an advance care planning process that involves in-person meetings with
a trained ACP coach will be more effective than providing patients with printed educational
materials alone.
BASELINE VISIT: After obtaining written informed consent, research staff will administer a
baseline survey to assess ACP readiness as well as participant physical and emotional health.
The participant will then be randomized to one of the study arms: intervention or control.
Research staff will provide participants in both study arms with the advance care planning
educational materials and instruct them that they are encouraged to discuss their thoughts
and questions with the nephrologist, at their own initiation. Participants will be further
encouraged to bring their advance directives (ADs) to the clinic to be scanned into the
electronic health record (EHR) if they currently have ADs or complete them in the future.
ADVANCE CARE PLANNING COACHING SESSION (intervention arm only): Participants in the
intervention arm will receive a 60-minute in-person coaching session. The advance care
planning coach, trained in motivational interviewing, will use a flexible script and
checklist to assess the participant's readiness to engage in advance care planning and guide
the participant forward in the process, proceeding at the participant's pace. Some
participants may complete advance directives while others will not get that far. The coach
will document the clinical aspects of the discussion in the participant's medical chart
according to clinic protocol and the research aspects in the participant tracking
instruments. The ACP coach may arrange for one or more follow-up sessions as needed,
typically conducted by telephone.
FOLLOW-UP ASSESSMENT SURVEY (both study arms): Approximately 14 weeks after the baseline
visit, research staff will contact the participant to administer a follow-up assessment
survey.
FOLLOW-UP CHART REVIEW: Approximately 16 weeks after the baseline visit, research staff will
review the participant's medical chart to assess documentation of advance care planning
activities, medical and health outcomes, and use of medical and palliative care services.
baseline survey to assess ACP readiness as well as participant physical and emotional health.
The participant will then be randomized to one of the study arms: intervention or control.
Research staff will provide participants in both study arms with the advance care planning
educational materials and instruct them that they are encouraged to discuss their thoughts
and questions with the nephrologist, at their own initiation. Participants will be further
encouraged to bring their advance directives (ADs) to the clinic to be scanned into the
electronic health record (EHR) if they currently have ADs or complete them in the future.
ADVANCE CARE PLANNING COACHING SESSION (intervention arm only): Participants in the
intervention arm will receive a 60-minute in-person coaching session. The advance care
planning coach, trained in motivational interviewing, will use a flexible script and
checklist to assess the participant's readiness to engage in advance care planning and guide
the participant forward in the process, proceeding at the participant's pace. Some
participants may complete advance directives while others will not get that far. The coach
will document the clinical aspects of the discussion in the participant's medical chart
according to clinic protocol and the research aspects in the participant tracking
instruments. The ACP coach may arrange for one or more follow-up sessions as needed,
typically conducted by telephone.
FOLLOW-UP ASSESSMENT SURVEY (both study arms): Approximately 14 weeks after the baseline
visit, research staff will contact the participant to administer a follow-up assessment
survey.
FOLLOW-UP CHART REVIEW: Approximately 16 weeks after the baseline visit, research staff will
review the participant's medical chart to assess documentation of advance care planning
activities, medical and health outcomes, and use of medical and palliative care services.
Inclusion Criteria:
- Chronic Kidney Disease (CKD) Stage 3-5
- Age 55 or older
- English speaking
- Patient at participating CKD clinic
Exclusion Criteria:
- Receiving dialysis
- Kidney transplant recipient
- Cognitively impaired or otherwise not competent to participate (as deemed by treating
nephrologist and research staff)
- Participation contra-indicated for patient's health (as deemed by treating
nephrologist)
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