Chronic Kidney Disease Clinical Trial
Official title:
Patient and Provider Education for Patients With Severe Chronic Kidney Disease: Assessing the Impact on Barriers and Use of Home Dialysis
Patients with severe kidney failure require dialysis or transplantation to survive. For those in whom a transplant is not an option, there are two main dialysis options: hemodialysis (either incenter or at home) or home peritoneal dialysis. Home-based therapies (peritoneal and home hemodialysis) are under-utilized in many Canadian jurisdictions with the proportion of home-based therapies varying between 10 and 40% across centres. Studies show that the low use of home dialysis is due to a variety of factors, though patient and provider awareness and knowledge of home dialysis are major factors. In this cluster randomized trial, the investigators will determine whether a standardized modality education program directed at patients, in combination with a provider-directed intervention, can increase the use of home dialysis in incident dialysis patients in Canada.
Background: Patients with severe kidney failure require dialysis or transplantation to
survive. For those in whom a transplant is not an option, there are two main dialysis
options: hemodialysis (either incenter or at home) or home peritoneal dialysis. Home-based
therapies (peritoneal and home hemodialysis) are under-utilized in many Canadian
jurisdictions with the proportion of home-based therapies varying between 10 and 40% across
centres. The use of home dialysis remains lower than expected due to combination of patient,
caregiver, provider, and health system barriers. Previous studies have highlighted several
potential patient and caregiver barriers to use of home therapies including knowledge,
skills, personal circumstances, and social supports. Provider barriers have been reported to
include lack of training in peritoneal dialysis, lack (or perceived lack) in skills and
knowledge, bias, and possibly inadequate physician reimbursement for home dialysis.
The Canadian Kidney Knowledge Translation and Generation Network (CANN-NET), a national
network of clinicians, researchers and knowledge users that was established to ensure best
practices for patients with chronic kidney disease (CKD), recently created dialysis modality
educational tools aimed at patients and kidney health care providers. On behalf of CANN-NET,
the investigators propose a cluster randomized controlled trial (with clusters consisting of
severe CKD clinics) of a knowledge translation (KT) strategy to increase use of home dialysis
in patients with end-stage renal disease. Informed by careful survey work, clinics randomized
to the knowledge translation intervention will receive patient and provider directed
educational tools, including the MATCH D tool, compelling visual aids (infographic, white
board animated video, and an educational video on dialysis modality options), audit and
feedback, and in-person medical detailing. Control clinics will continue with their usual
practice with respect to dialysis modality education.
Primary Objective To determine whether a standardized modality education program directed at
patients, in combination with provider-directed interventions can increase the use of home
dialysis in incident dialysis patients in Canada
Study Design: A cluster randomized trial of CKD clinics across Canada comparing the efficacy
and safety of a KT intervention aiming to increase use of home dialysis in patients with
advanced CKD. The unit of observation will be the patient (i.e., outcomes will be measured at
the level of an individual patient), and the unit of randomization will be at the level of
the multidisciplinary CKD clinic.
Team: The investigative study team includes experts in the clinical epidemiology of CKD and
kidney failure, local opinion leaders from every province/region, as well experts in
knowledge translation and cluster randomized design. As such, the investigators are well
positioned to carry out the proposed study.
Research Significance: Home dialysis, in comparison to incenter hemodialysis, is associated
with increased patient independence, better clinical outcomes, and lower health care costs.
Due to a variety of factors, home dialysis use remains variable across Canada. This study
will test the effectiveness of a KT strategy to increase the use of home dialysis.
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