Patient Acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) Booklet: A Prospective Non-Randomized Comparison Study Across 6 Predialysis Services

Anna E Winterbottom; Teresa Gavaruzzi; Andrew Mooney; Martin Wilkie; Simon J Davies; Dennis Crane; Ken Tupling; Paul D Baxter; David M Meads; Nigel Mathers; Hilary L Bekker

doi:10.3747/pdi.2014.00274

Patient Acceptability of the Yorkshire Dialysis Decision Aid (YoDDA) Booklet: A Prospective Non-Randomized Comparison Study Across 6 Predialysis Services

Perit Dial Int. 2016 Jul-Aug;36(4):374-81. doi: 10.3747/pdi.2014.00274. Epub 2015 Oct 1.

Authors

Affiliations

¹ Leeds Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK.
² St. James University Hospital, Leeds, UK.
³ Sheffield Kidney Institute, Sheffield, UK.
⁴ Institute for Science & Technology in Medicine, Guy Hilton Research Centre, Stoke-on-Trent, UK.
⁵ National Kidney Federation Advocacy Officer, Manchester, UK.
⁶ Kidney Patient Association, Sheffield Area Kidney Association, Northern General Hospital, Sheffield, UK.
⁷ Division of Epidemiology & Biostatistics LIGHT - School of Medicine, University of Leeds, Leeds, UK.
⁸ Academic Unit of Primary Medical Care, Northern General Hospital, Herries Road, Sheffield, UK.
⁹ Leeds Institute of Health Sciences - School of Medicine, University of Leeds, Leeds, UK h.l.bekker@leeds.ac.uk.

Abstract

♦

Background: Patients are satisfied with their kidney care but want more support in making dialysis choices. Predialysis leaflets vary across services, with few being sufficient to enable patients' informed decision making. We describe the acceptability of a patient decision aid and feasibility of evaluating its effectiveness within usual predialysis practice. ♦

Methods: Prospective non-randomized comparison design, Usual Care or Usual Care Plus Yorkshire Dialysis Decision Aid Booklet (+YoDDA), in 6 referral centers (Yorkshire-Humber, UK) for patients with sustained deterioration of kidney function. Consenting (C) patients completed questionnaires after predialysis consultation (T1), and 6 weeks later (T2). Measures assessed YoDDA's utility to support patients' decisions and integration within usual care. ♦

Results: Usual Care (n = 105) and +YoDDA (n = 84) participant characteristics were similar: male (62%), white (94%), age (mean = 62.6; standard deviation [SD] 14.4), kidney disease severity (glomerular filtration rate [eGFR] mean = 14.7; SD 3.7); decisional conflict was < 25; choice-preference for home versus hospital dialysis approximately 50:50. Patients valued receiving YoDDA, reading it on their own (96%), and sharing it with family (72%). The +YoDDA participants had higher scores for understanding kidney disease, reasoning about options, feeling in control, sharing their decision with family. Study engagement varied by center (estimated range 14 - 49%; mean 45%); participants varied in completion of decision quality measures. ♦

Conclusions: Receiving YoDDA as part of predialysis education was valued and useful to patients with worsening kidney disease. Integrating YoDDA actively within predialysis programs will meet clinical guidelines and patient need to support dialysis decision making in the context of patients' lifestyle.

Keywords: Patient decision aid; conservative care; dialysis; implementation science; renal replacement therapy; shared decision making.

Publication types

Comparative Study

MeSH terms

Aged
Choice Behavior
Decision Making
Decision Support Techniques*
Female
Humans
Kidney Failure, Chronic / psychology
Kidney Failure, Chronic / therapy*
Male
Middle Aged
Pamphlets
Patient Acceptance of Health Care*
Patient Education as Topic*
Prospective Studies
Referral and Consultation
Renal Dialysis*
Surveys and Questionnaires