Chronic Kidney Disease Clinical Trial
— ImPartOfficial title:
An Optimization Trial of a Stakeholder-enhanced Intervention to Improve the Decisional Partnership of Chronic Kidney Disease Dyads (IMPART)
Using a highly innovative methodology, the Multiphase Optimization Strategy (MOST), the purpose of this study is to pilot test, an optimization trial approach to develop and refine the decision partnering skills of persons with stage 4 chronic kidney disease and their caregivers. Using a 2x2x2 full factorial design, 64 dyads (patients and one identified caregiver) will be randomized to receive one or more lay coach-delivered decision partnering training components, based on Pearlin's Stress-Health Model of Family Caregiving and Rini's Social Support Effectiveness theory. The components include: 1) caregiver coaching on effective decision support (1 vs. 3 sessions); 2) caregiver decision support communication training (1 session vs. none); and 3) patient social support effectiveness psychoeducation (yes vs. no).
Status | Recruiting |
Enrollment | 128 |
Est. completion date | January 2028 |
Est. primary completion date | July 30, 2027 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 18 Years and older |
Eligibility | Inclusion Criteria: - Patients 1. Age =18; 2. EMR documented diagnosis of stage 4 CKD (2 eGFR 29-15 within 90 days); 3. Ability to speak and read English and complete baseline questionnaires; 4. Patients must have an enrolled caregiver Exclusion Criteria: - Patients 1. Receiving hospice; 2. Receiving dialysis; 3. Medical record documentation of active unmedicated severe mental illness, moderate-severe dementia, suicidal ideation, uncorrected hearing loss, and active substance abuse. Inclusion Criteria: - Caregivers 1. Age =18; 2. Self-endorsing or identified by the patient as a relative, friend, or partner that has a close relationship with you and who assists you with your medical decisions and who may or may not live in the same residence as you and who is not paid for their help 3. Caring for a patient with CKD; 4. Ability to speak and read English and complete baseline questionnaires; 5. Caregivers must have an enrolled patient. Exclusion Criteria: - Caregivers 1) Self-reported unmedicated mental illness, Moderate-severe dementia, active suicidal ideation, uncorrected hearing loss, or active substance abuse ascertained by scripted study introduction questioning. |
Country | Name | City | State |
---|---|---|---|
United States | Shena Gazaway | Birmingham | Alabama |
Lead Sponsor | Collaborator |
---|---|
University of Alabama at Birmingham | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Acceptability of Intervention Measure | four-item measure of implementation outcomes that are often considered "leading indicators" of implementation success; higher score indicate greater acceptability (highest score - 20) | 12 weeks | |
Primary | Intervention Appropriateness Measure | Four-item measure of implementation outcomes that are often considered "leading indicators" of implementation success; higher score indicate greater appropriateness (highest score - 20) | 12 weeks | |
Primary | Feasibility of Intervention | Intervention completion rate (# participants completing assigned components) will be tabulated, =75% completion rates for assigned components will be considered evidence of feasibility | 12 weeks after baseline | |
Primary | Feasibility of Data Collection | Intervention assessment completion rate (# participants completing each study assessment) will be tabulated, =75% completion rates for study assessments will be considered evidence of feasibility | baseline, 12 weeks, 24 weeks after baseline | |
Primary | Feasibility of Intervention Process | Feasibility of Intervention Measure a four-item measure of implementation - higher scores = greater feasibility (highest score - 20) | 12 weeks | |
Primary | Acceptability of Intervention and Study Procedures | Determined by thematic analysis, of digitally recorded, semi-structured qualitative interviews adapted from prior study teams' work. Open-ended questions will query participants about their experiences with their assigned intervention components, the navigator, study procedures, how program impacted their engagement in shared decision-making and changes they would like to see made to the intervention and study procedures. | 24 weeks | |
Secondary | Health-related decision process for patient as measured by the Decision Conflict Scale | 16-item measure; perceptions of uncertainty in choosing options, factors contributing to uncertainty (e.g., feeling uninformed, unclear values) and feeling that decisions were informed and values-based - Scores range from 0 [no decisional conflict] to 100 [extremely high decisional conflict]. | baseline, 12 weeks, and 24 weeks after baseline | |
Secondary | Health-related decision process for patient as measured by the Social Support Effectiveness- Questionnaire | 25 item measure; perceptions of help received in last 3 months with higher scores indicating more effective support - The total possible score is 66 points | baseline, 12 weeks, and 24 weeks after baseline | |
Secondary | Patient and Caregiver well-being/distress as measured by the Hospital Anxiety and Depression Scale | 14 items total, items measure anxiety and depressive symptoms. Higher scores=worse anxiety/depression - Scoring for each item ranges from zero to three, with three denoting highest anxiety or depression level. A total subscale score of >8 points out of a possible 21 denotes considerable symptoms of anxiety or depression. | baseline, 12 weeks, and 24 weeks after baseline | |
Secondary | Patient wellbeing/quality of life as measured by the Kidney Disease Quality of Life Scale (KDQOL 36) | 36 items measure three components: physical health score, mental health score, and kidney disease health score. Physical health score, mental health score, and kidney disease health score are averaged scores of sub-scales. The range of each score and each sub-scale is 0 - 100, and higher values indicate better QOL status | baseline, 12 weeks, and 24 weeks after baseline | |
Secondary | Patient and caregiver interaction as measured by the Dyadic Coping Inventory | 37-item instrument designed to measure perceived communication and dyadic coping in close relationships when one or both partners are stressed - higher scores = better coping between members of the dyad | baseline, 12 weeks, and 24 weeks after baseline | |
Secondary | Caregiver wellbeing/quality of life as measured by the PROMIS Global Health 10 | 10 items, measures global health-related quality of life (HRQOL) in 2 domains: physical and mental health; scoring allows for cost-effectiveness estimates. Higher scores=higher HRQO | baseline, 12 weeks, and 24 weeks after baseline |
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