title: iChoose Kidney: A Clinical Decision Aid for Kidney Transplantation Versus Dialysis Treatment.
abstract: BACKGROUND
  Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly one third of end-stage renal disease (ESRD) patients are not educated about kidney transplantation as a treatment option at the time of ESRD diagnosis. Access to individualized, evidence-based prognostic information is needed to facilitate and encourage shared decision making about the clinical implications of whether to pursue transplantation or long-term dialysis.
  
  
  METHODS
  We used a national cohort of incident ESRD patients in the US Renal Data System surveillance registry from 2005 to 2011 to develop and validate prediction models for risk of 1- and 3-year mortality among dialysis versus kidney transplantation. Using these data, we developed a mobile clinical decision aid that provides estimates of risks of death and survival on dialysis compared with kidney transplantation patients.
  
  
  RESULTS
  Factors included in the mortality risk prediction models for dialysis and transplantation included age, race/ethnicity, dialysis vintage, and comorbidities, including diabetes, hypertension, cardiovascular disease, and low albumin. Among the validation cohorts, the discriminatory ability of the model for 3-year mortality was moderate (c statistic, 0.7047; 95% confidence interval, 0.7029-0.7065 for dialysis and 0.7015; 95% confidence interval, 0.6875-0.7155 for transplant). We used these risk prediction models to develop an electronic, user-friendly, mobile (iPad, iPhone, and website) clinical decision aid called iChoose Kidney.
  
  
  CONCLUSIONS
  The use of a mobile clinical decision aid comparing individualized mortality risk estimates for dialysis versus transplantation could enhance communication between ESRD patients and their clinicians when making decisions about treatment options.
authors.affiliation: 1 Department of Surgery, Division of Transplantation, Emory University, Atlanta, GA. 2 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA. 3 Emory University School of Medicine, Atlanta, GA. 4 Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, GA. 5 Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, NY. 6 Appex.io, Atlanta, GA. 7 Department of Health Policy and Management, Rollins School of Public Health, Atlanta, GA. 8 Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Patzer
authors.forename: Mohua
authors.initials: M
authors.lastname: Basu
authors.forename: Christian P
authors.initials: CP
authors.lastname: Larsen
authors.forename: Stephen O
authors.initials: SO
authors.lastname: Pastan
authors.forename: Sumit
authors.initials: S
authors.lastname: Mohan
authors.forename: Michael
authors.initials: M
authors.lastname: Patzer
authors.forename: Michael
authors.initials: M
authors.lastname: Konomos
authors.forename: William M
authors.initials: WM
authors.lastname: McClellan
authors.forename: Janice
authors.initials: J
authors.lastname: Lea
authors.forename: David
authors.initials: D
authors.lastname: Howard
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gander
authors.forename: Kimberly Jacob
authors.initials: KJ
authors.lastname: Arriola
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002755:Choice Behavior; D003142:Communication; D034201:Computers, Handheld; D020000:Decision Support Systems, Clinical / Q000295:instrumentation*; D003661:Decision Support Techniques; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D010353:Patient Education as Topic; D010358:Patient Participation; D018579:Patient Selection; D010817:Physician-Patient Relations; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D012985:Software Design; D014481:United States / Q000453:epidemiology; D055815:Young Adult