A Randomized Pilot Trial of a Nephrologist Communication Tool for Discussing Conservative Management.

Abstract

Key points: Conservative kidney management is infrequently presented to patients as a treatment option for kidney failure. Conservative Kidney Management Jumpstart Tool is a communication tool that helps nephrologists discuss patients' values and care options. The tool improved discussions about values and conservative management with patients.

Background: It is difficult for patients to make informed decisions about kidney failure unless they know all their treatment options. Conservative management is an important option infrequently presented alongside other kidney failure treatments by nephrologists.

Methods: We conducted a randomized pilot trial testing the feasibility and acceptability of a communication tool, called the Conservative Kidney Management Jumpstart Tool, in assisting nephrologists with discussing conservative management with their patients. We recruited patients aged 75 years or older with stage 4 or 5 CKD in the greater Seattle area between April 2023 and May 2025. Patients were randomized in 1:1 fashion to either their nephrologists receiving the tool to use with them at their next clinic visit (intervention) or usual care (control). Our primary outcome and feasibility measure was patient-reported discussion of conservative management during the clinic visit. Our secondary outcome and acceptability measure was change in patients' satisfaction with their nephrologist's serious illness communication skills (using the Quality of Communication Scale, with higher scores indicating higher quality) before and after the visit. We performed an intent-to-treat analysis of the primary end point using a chi-squared test. We used paired-samples t tests to assess within-patient changes in the secondary end point.

Results: We randomized 74 patients (age 80±1, 19% women, 69% White) to either the control ( n =37) or intervention ( n =37) group. Patients whose nephrologists received the tool were more likely to discuss conservative management during their clinic visit (60% versus 19%, P = 0.001) than patients in the control group. Patients whose nephrologists received the tool rated their nephrologist's communication skills at 7.5±2.1 before the visit and 9.0±1.7 after the visit ( P < 0.001) as compared with 7.8±1.9 and 7.9±1.8 ( P = 0.54), respectively, among patients in the control group.

Conclusions: The tool was feasible and acceptable to patients, promoting patient-nephrologist discussion of conservative management and improving patients' satisfaction with their nephrologist's communication skills.

Clinical trial registry name and registration number: ClinicalTrials.gov ID: NCT05753020 .