title: A randomized controlled trial protocol testing a decision support intervention for older patients with advanced kidney disease.
abstract: OBJECTIVE
  To assess the effectiveness of a decision support intervention using a pragmatic single blind Randomized Controlled Trial.
  
  
  BACKGROUND
  Worldwide the proportion of older people (aged 65 years and over) is rising. This population is known to have a higher prevalence of chronic diseases including chronic kidney disease. The resultant effect of the changing health landscape is seen in the increase in older patients (aged ≥65 years) commencing on dialysis. Emerging evidence suggests that for some older patients dialysis may provide minimal benefit. In a majority of renal units non-dialysis management is offered as an alternative to undertaking dialysis. Research regarding decision-making support that is required to assist this population in choosing between dialysis or non-dialysis management is limited.
  
  
  METHODS
  A multisite single blinded pragmatic randomized controlled trial is proposed.
  
  
  METHODS
  Patients will be recruited from four Queensland public hospitals and randomizd into either the control or intervention group. The decision support intervention is multimodal and includes counselling provided by a trained nurse. The comparator is standard decision-making support. The primary outcomes are decisional regret and decisional conflict. Secondary outcomes are improved knowledge and quality of life. Ethics approval obtained November 2014.
  
  
  CONCLUSIONS
  This is one of the first randomized controlled trials assessing a decision support intervention in older people with advance chronic kidney disease. The results may provide guidance for clinicians in future approaches to assist this population in decision-making to ensure reduced decisional regret and decisional conflict.
authors.affiliation: School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.|Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Leanne
authors.initials: L
authors.lastname: Brown
authors.affiliation: School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.
authors.forename: Glenn
authors.initials: G
authors.lastname: Gardner
authors.affiliation: School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia.|Chronic Kidney Disease Centre for Research Excellence, University of Queensland, Brisbane, Queensland, Australia.|Kidney Health Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Ann
authors.initials: A
authors.lastname: Bonner
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003657:Decision Making; D003661:Decision Support Techniques; D019468:Disease Management; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D010358:Patient Participation / Q000379:methods*; D011793:Queensland; D018570:Risk Assessment; D012307:Risk Factors; D016037:Single-Blind Method
keywords: chronic kidney disease; conservative kidney management; decision making; dialysis; non-dialysis management; nurse; randomized controlled trial