Transforming Hemodialysis-Related Vascular Access Education
- Conditions
- Hemodialysis Vascular AccessChronic Kidney Disease
- Interventions
- Behavioral: Usual CareBehavioral: Educational MaterialsBehavioral: Motivational Interviewing
- Registration Number
- NCT05997875
- Lead Sponsor
- University of Pennsylvania
- Brief Summary
The focus of this study is on vascular access for hemodialysis. This is a randomized clinical trial testing 3 educational approaches to help patients with advanced chronic kidney disease prepare for placement of hemodialysis vascular access. Study participants will each be assigned to one of the 3 approaches: 1) "Education", in which participants will be given a video and brochure that provide information about the types of vascular access and what can be expected before and after the vascular access is placed, 2) "Education-Plus", in which participants will be given the video and brochure and will also have sessions by telehealth with a motivational interviewing coach to provide additional support around vascular access placement, and 3) "Usual Care", in which participants will have the usual education provided by their kidney doctor and clinic staff just as if they were not in the study. Participants in all 3 groups will be asked to complete questionnaires by telephone and may be invited to be interviewed about their experience with the study intervention at the end of the study. Study participation will last for about 12 months, with most of the study activities taking place during the first 3 months.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 360
- Age 18 years or older
- Nephrology visit for chronic kidney disease during the last 18 months
- Most recent eGFR less than or equal to 20 ml/min/1.73 m2 or 2-year Kidney Failure Risk Equation score greater than 40%
- Documentation in the medical record or confirmation from the treating nephrologist of a patient-nephrologist discussion about hemodialysis
- Planning for peritoneal dialysis, preemptive transplant, or conservative management of kidney failure
- Previous placement of an AV access
- Prior appointment with surgeon for AV access evaluation or creation
- Cognitive dysfunction or severe visual impairment that prevents use of the education materials
- Does not speak either English or Spanish
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Usual Care Usual Care - Education Usual Care - Education Educational Materials - Education-Plus Educational Materials - Education-Plus Motivational Interviewing - Education-Plus Usual Care -
- Primary Outcome Measures
Name Time Method Surgery for Creation of Hemodialysis Arteriovenous Access (Effectiveness outcome) Within 12 months after randomization or before hemodialysis initiation, whichever comes first The proportion of participants who have arteriovenous access creation surgery.
- Secondary Outcome Measures
Name Time Method Preparedness for Decision-Making (Effectiveness outcome) 12 weeks after randomization A participant's level of preparedness for decision-making as measured by the Preparation for Decision-Making Scale. The total score ranges from 0-100, with higher scores indicating a higher perceived level of preparation for decision-making.
Vascular Access Knowledge (Effectiveness outcome) 12 weeks after randomization The change from baseline in vascular access knowledge as measured by the Patient Perceived Vascular Access Knowledge scale. The total score ranges from 0 to 10, with higher scores indicating a higher level of vascular access knowledge.
Characteristics of Enrolled Participants - quantitative reach assessment (Implementation outcome) Baseline An assessment of the demographic and socioeconomic characteristics of patients who enroll in the trial.
Reasons Nephrologists Opt-Out on Behalf of Patients - qualitative reach assessment (Implementation outcome) Up to 4 years after trial initiation (full duration of the trial) The reasons that nephrologists opt out of having an eligible patient approached by the research team for possible enrollment as identified through qualitative interviews.
Completed Appointment with Surgeon for Vascular Access Evaluation (Effectiveness outcome) Within 12 months after randomization or before hemodialysis initiation, whichever comes first The proportion of participants with a completed appointment with a surgeon for evaluation for vascular access creation.
Imaging for Planning Arteriovenous Vascular Access Creation (Effectiveness outcome) Within 12 months after randomization or before hemodialysis initiation, whichever comes first The proportion of participants with completed vascular imaging via ultrasound or angiography for planning arteriovenous vascular access creation surgery.
Usable Arteriovenous Vascular Access (Effectiveness outcome) Up to 4 years after randomization (full duration of the trial) For participants who start hemodialysis, the proportion with a usable arteriovenous access at dialysis initiation.
Acceptability of Intervention Content, Delivery, and Accessibility - qualitative acceptability assessment (Implementation outcome) 12 to 16 weeks after randomization The acceptability of the content, delivery, and accessibility of educational materials and motivational interviewing coaching as identified through qualitative interviews.
Chronic Kidney Disease Class Attendance - quantitative fidelity assessment (Implementation outcome) Within 12 months The proportion of participants who attend a Chronic Kidney Disease education class provided by their nephrology clinic
Scheduled Appointment with Surgeon for Vascular Access Evaluation (Effectiveness outcome) Within 12 months after randomization or before hemodialysis initiation, whichever comes first The proportion of participants with a scheduled appointment with a surgeon for evaluation for vascular access creation.
Decision Self-Efficacy (Effectiveness outcome) 12 weeks after randomization The change from baseline in decision self-efficacy as measured by the Decision Self-Efficacy Scale. The total score ranges from 0 to 11, with higher scores indicating a higher level of self-efficacy when making decisions about hemodialysis vascular access.
Characteristics of Eligible Patients - quantitative reach assessment (Implementation outcome) Pre-Enrollment An assessment of the demographic and socioeconomic characteristics of patients who are eligible for the trial.
Participant Contact Attempts for Motivational Interviewing - quantitative barriers/facilitators assessment (Implementation outcome) 12 month period after randomization The number and type (email, phone, text messaging) of attempted and confirmed participant contacts by the motivational interviewing coach.
System-Level Barriers to Arteriovenous Access Creation From Clinical Staff Perspective - qualitative implementation/barriers assessment (Implementation outcome) Up to 4 years after trial initiation (full duration of the trial) System-level barriers to arteriovenous vascular access creation and relevant system contextual factors as identified through qualitative interviews.
Characteristics of Participants who Withdraw from the Trial - quantitative reach assessment (Implementation outcome) From eligibility until 12 months An assessment of the demographic and socioeconomic characteristics of participants who withdraw from the trial.
Reasons for Participation - qualitative reach assessment (Implementation outcome) 12-16 weeks after randomization The reasons for participation and non-participation as identified through qualitative interviews
Receipt of Educational Materials - quantitative fidelity assessment (Implementation outcome) Within 12 weeks after randomization The proportion of participants with confirmed receipt of the "Getting Ready" brochure (only be assessed for the Education and Education-Plus groups)
Completed Motivational Interviewing Sessions - quantitative fidelity assessment (Implementation outcome) Within 12 months after randomization The proportion of participants who completed the scheduled motivational interviewing sessions (only be assessed for the Education-Plus group)
Characteristics of Participants who Complete the Trial - quantitative reach assessment (Implementation outcome) 12 months An assessment of the demographic and socioeconomic characteristics of participants who complete the trial.
Declined Enrollment - quantitative reach assessment (Implementation outcome) Pre-enrollment The reasons for declining enrollment as documented in screening logs and provided in aggregate for an enrolling center.
Acceptability Intervention Measure - quantitative acceptability assessment (Implementation outcome) 12 -16 weeks after randomization The acceptability of the intervention as measured by the Acceptability of Intervention Measure (AIM). The total score ranges from 1-5, with higher scores indicating a higher level of acceptability of the intervention.
System-Level Barriers to Arteriovenous Access Creation From Participant Perspective - qualitative implementation/barriers assessment (Implementation outcome) Within 12 months System-level barriers to arteriovenous vascular access creation and relevant system contextual factors as identified through qualitative interviews.
Viewing of Video - quantitative fidelity assessment (Implementation outcome) Within 12 weeks after randomization The proportion of participants with confirmed viewing of the "Getting Ready" video, which will only be assessed for the Education and Education-Plus groups.
Brochure Delivery Mode - quantitative barriers/facilitators assessment (Implementation outcome) Within 12 weeks after randomization The selected mode for delivery of the "Getting Ready" brochure by center, clinic, and participant sociodemographic characteristics.
Video Delivery Mode - quantitative barriers/facilitators assessment (Implementation outcome) Within 12 weeks after randomization The selected mode for viewing of the "Getting Ready" video by center, clinic, and participant sociodemographic characteristics.
Missed Motivational Interviewing Sessions - quantitative barriers/facilitators assessment (Implementation outcome) 12 month period after randomization The number of missed motivational interviewing sessions.
Trial Locations
- Locations (2)
University of Pennsylvania
🇺🇸Philadelphia, Pennsylvania, United States
University of North Carolina at Chapel Hill
🇺🇸Chapel Hill, North Carolina, United States