Interactive decision aid on therapy decision making for patients with chronic kidney disease: A prospective exploratory pilot study.

Abstract

Objective: Patients with advanced chronic kidney disease (CKD) face challenging decisions about kidney replacement therapy (KRT) options. This study aimed to evaluate the effectiveness of an Interactive Patient-Decision-Aid App for Kidney Replacement Therapy (iPtDA-KRT App) in improving decision self-efficacy, knowledge, and readiness while reducing decisional conflict and regret among patients with advanced CKD.

Methods: A prospective, two-arm clinical trial was conducted with 70 patients who used either the mobile app-based iPtDA-KRT or a paper-based PtDA for 4 weeks. Key measures included decision self-efficacy (DSES), decisional conflict (DCS), KRT knowledge (KRTKS), preparation for decision-making (PrepDM), and decision regret (DRS). These measures were assessed immediately post-intervention and at 4 weeks post-intervention. Additionally, outcomes such as DSES, DCS, and DRS were tracked at 8 weeks post-intervention. Data were analyzed using generalized estimating equations.

Results: The experimental group included 19 male and 16 female patients with a mean age of 66.4 ± 14.0 years, while the control group included 22 male and 13 female patients with a mean age of 59.7 ± 16.1 years. The experimental group demonstrated significantly greater and sustained improvements in self-efficacy, knowledge, and preparation for decision-making compared to the control group. Reductions in decisional conflict and regret were also maintained over time.

Conclusions: The iPtDA-KRT App demonstrated substantial and lasting benefits over paper-based PtDAs in supporting patients' complex decision-making. These findings suggest that digital, interactive PtDAs may enhance informed decision-making, reduce long-term decisional conflict, and improve patient confidence in clinical settings.

Trial registration: This study was registered at ClinicalTrials.gov (Identifier: NCT05666544).