A Randomized Controlled Trial of a Mobile Clinical Decision Aid to Improve Access to Kidney Transplantation: iChoose Kidney.
Kidney transplantation is the preferred treatment for patients with end-stage renal disease, as it substantially increases a patient's survival and is cost saving compared to a lifetime of dialysis. However, transplantation is not universally chosen by patients with renal failure, and limited knowledge about the survival benefit of transplantation vs. dialysis may play a role. We created a mobile application clinical decision aid called iChoose Kidney to improve access to individualized prognosis information comparing dialysis and transplantation outcomes. We describe the iChoose Kidney study, a randomized controlled trial designed to test the clinical efficacy of a mobile health decision aid among end-stage renal disease patients referred for kidney transplantation at three large, diverse transplant centers across the U.S. Approximately 450 patients will be randomized to receive either: (1) standard of care or "usual" transplantation education, or (2) standard of care plus iChoose Kidney. The primary outcome is change in knowledge about the survival benefit of kidney transplantation vs. dialysis from baseline to immediate follow-up; secondary outcomes include change in treatment preferences, improved decisional conflict, and increased access to kidney transplantation. Analyses are also planned to examine effectiveness across subgroups of race, socioeconomic status, health literacy and health numeracy. Engaging patients in health care choices can increase patient empowerment and improve knowledge and understanding of treatment choices. If the effectiveness of iChoose Kidney has a greater impact on patients with low health literacy, lower socioeconomic status, and minority race, this decision aid could help reduce disparities in access to kidney transplantation.
Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322.
Rachel E
RE
Patzer
Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322.
Mohua
M
Basu
Renal and Pancreatic Transplant Program: Columbia University Medical Center, 622 West 169th Street, New York, NY 10032.
Sumit
S
Mohan
Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322.
Kayla D
KD
Smith
Northwestern University Comprehensive Transplant Center, 676 St. Clair Street #1900, Chicago, IL 60611.
Michael
M
Wolf
Northwestern University Comprehensive Transplant Center, 676 St. Clair Street #1900, Chicago, IL 60611.
Daniela
D
Ladner
Northwestern University Comprehensive Transplant Center, 676 St. Clair Street #1900, Chicago, IL 60611.
John J
JJ
Friedewald
Renal and Pancreatic Transplant Program: Columbia University Medical Center, 622 West 169th Street, New York, NY 10032.
Mariana
M
Chiles
Northwestern University Comprehensive Transplant Center, 676 St. Clair Street #1900, Chicago, IL 60611.
Allison
A
Russell
Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322.
Laura
L
McPherson
Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322.
Jennifer
J
Gander
Emory Transplant Center, 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322.
Stephen
S
Pastan
Education; Kidney Transplantation; Mobile health; Randomized trial; Staff