Heart disease is a common comorbidity in individuals with chronic kidney disease (CKD).
However, patients with CKD are 20-50% less likely to receive heart tests and treatments
for acute coronary syndromes and there is also substantial variability in management for
patient with CKD and stable coronary disease. The variability and disparities in care for
people with CKD are attributed to three common obstacles: concern over potential kidney
function deterioration from procedures, limited understanding of the benefits and risks
of invasive versus medical treatment approaches for individual patients with CKD, and
inadequate strategies to align treatment decisions with patient values and preferences.
Addressing these barriers necessitates a shift towards patient-centered care and informed
decision-making in cardiovascular and kidney care. Offering personalized risk information
and decision support to patients with CKD and their care providers could help surmount
these obstacles. These patient-oriented approaches to heart disease care require weighing
treatment decisions' risks and benefits through informed discussions between patients and
providers.
Shared decision-making (SDM), a collaborative approach between patients and healthcare
providers, integrates clinical knowledge with patient values, preferences, and risk
tolerance to personalize care decisions. SDM, when integrated into care practices,
enhances patient satisfaction and experiences. However, despite its benefits, only a
minority of Canadian patients report experiencing SDM, highlighting the need for its
broader implementation.
Patient decision aids (PDAs) are tools for facilitating collaborative medical decisions,
particularly when multiple treatment options exist. PDAs equip patients with information
on treatment choices, associated risks, and benefits, and help them clarify their values
in the decision-making process. A Cochrane Systematic Review highlighted that when
utilized, PDAs enhance patient knowledge, ensure informed decision-making, and foster
active patient involvement in the decision process. Guideline frameworks like the
International Patient Decision Aid Standards (IPDAS) and Ottawa Framework ensure the
rigor and standardization of PDA development.
Trial Objectives:
This study will implement and evaluate a decision aid for use by patients with CKD and
heart disease and their healthcare providers when making treatment decisions for coronary
artery disease, including with acute coronary syndrome and stable coronary artery
disease.
Specific objectives are:
To measure the effectiveness of delivery of personalized information for patients
with CKD and heart disease and their health care providers within clinical care. The
investigators will measure use and completion of the decision-aid during clinical
care encounters for management of heart disease within an implementation pilot
trial. Quantitative and qualitative methods will be used to measure how effectively
the decision aid conveys personalized information. The investigators will also
examine how closely management decisions correlate with risk estimates for patients
who received the decision aid. Measures from patients with and without use of the
decision aid will be compared using a cluster randomized, pre- versus
post-implementation, design, to evaluate effectiveness.
To work towards better recognition of patient preferences and their incorporation
into decision making, the investigators will measure the knowledge, experience, and
satisfaction of patients who receive the decision-aid within the implementation
pilot trial. The investigators will compare the expressed preferences of patients to
the management approach that patients received and determine whether greater
concordance is achieved using the decision aid than observed in the absence of a
decision aid.
To examine the decision aid's effects on awareness, understanding, and incorporation
of shared decision-making practices, the investigators will survey and interview
health care providers on knowledge and confidence with shared decision-making before
and after use of the decision aid. The investigators will also measure the
decisional conflict of patients who received the decision aid and those who did not,
which is an outcome measure that has been shown to improve with interventions that
support shared decision-making.
Primary objective: Conduct an implementation pilot study in Canada, deploying the
decision aid accompanied by implementation training and resources for culturally
sensitive shared decision-making within clinical care.
Secondary objective: To document and evaluate the feasibility, acceptability, and
satisfaction with use of the decision aid.