A Patient Decision Support Tool for Hepatitis C Virus and CKD Treatment

Nerissa George; AnnMarie Liapakis; Kevin M Korenblat; Tingting Li; David Roth; Jerry Yee; Kevin J Fowler; Lehman Howard; Jingxia Liu; Mary C Politi

doi:10.1016/j.xkme.2019.06.003

A Patient Decision Support Tool for Hepatitis C Virus and CKD Treatment

Kidney Med. 2019 Jul 11;1(4):200-206. doi: 10.1016/j.xkme.2019.06.003. eCollection 2019 Jul-Aug.

Authors

Affiliations

¹ Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO.
² Section of Digestive Disease, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.
³ Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO.
⁴ Division of Nephrology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO.
⁵ Katz Family Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL.
⁶ Division of Nephrology, Hypertension & Transplant, Henry Ford Hospital and Medical Center, Detroit, MI.
⁷ The Voice of the Patient Inc, Elmhurst, IL.
⁸ National Kidney Foundation, Inc, Hamden, CT.

Abstract

Rationale & objective: Patient education and decision support tools could facilitate decisions around the timing of antiviral therapy in patients living with both hepatitis C virus (HCV) infection and chronic kidney disease (CKD). We previously developed a tool through the HELP (Helping Empower Liver and Kidney Patients) study. This article evaluates the preliminary efficacy and usability of the tool among participants with both HCV infection and CKD.

Study design: Pre-post study pilot evaluation.

Setting & participants: Participants were at least 18 years old, were English speaking, and had a diagnosis of chronic HCV infection and CKD; they were seen in CKD clinics, dialysis units, and/or hepatology and liver transplantation clinics.

Intervention: Electronic patient decision support tool.

Outcomes: Participants' change in knowledge, certainty about choice, decision self-efficacy, patients' treatment preferences, and tool usability.

Results: 70 participants were recruited; 56 of 70 (80.0%) completed study procedures. Nearly all (51/56; 91.1%) requested paper-based study procedures despite the electronic design of the tool. Participants reported that they were most worried about the following treatment factors: (1) cost of drugs to treat HCV infection, (2) how their HCV infection affected their CKD, and (3) wait times for a kidney transplant. After using the decision tool, participants had significantly higher HCV infection and CKD knowledge (mean posttest percent of questions answered correctly = 65.74% vs pretest percent of questions answered correctly = 53.44%; P < 0.001) and more certainty about choice (mean posttest = 3.13 vs pretest = 2.65; P = 0.05). There were no significant changes in decision self-efficacy (mean posttest = 86.62 vs pretest = 84.68; P = 0.48).

Limitations: Single-site pilot study to explore preliminary tool efficacy and usability.

Conclusions: This study suggests that a decision tool may support informed patient-centered choices among patients with HCV infection and CKD. Future studies should evaluate ways to improve care decisions in a larger sample using both paper-based and electronic materials.

Funding: Merck & Co, Inc, Kenilworth, NJ.

Trial registration: Registered at clinicaltrials.gov with study number NCT03426787.

Keywords: chronic kidney disease; decision aid; decision support; hepatitis C virus; patient education.

Associated data

ClinicalTrials.gov/NCT03426787