iChoose Kidney: A Clinical Decision Aid for Kidney Transplantation Versus Dialysis Treatment

Autor: Kimberly R. Jacob Arriola, Rachel E. Patzer, Sumit Mohan, Stephen O. Pastan, Mohua Basu, Janice P. Lea, Michael Konomos, David Howard, Michael Patzer, William M. McClellan, Jennifer C. Gander, Christian P. Larsen
Rok vydání: 2017
Předmět:
Adult
Male
medicine.medical_specialty
Health Knowledge
Attitudes
Practice
medicine.medical_treatment
030232 urology & nephrology
030230 surgery
Choice Behavior
Risk Assessment
Article
Decision Support Techniques
03 medical and health sciences
Young Adult
0302 clinical medicine
Patient Education as Topic
Renal Dialysis
Risk Factors
Software Design
Diabetes mellitus
medicine
Humans
Registries
Patient participation
Young adult
Intensive care medicine
Dialysis
Kidney transplantation
Aged
Aged
80 and over
Transplantation
Physician-Patient Relations
business.industry
Communication
Incidence
Patient Selection
Middle Aged
medicine.disease
Decision Support Systems
Clinical
Kidney Transplantation
Mobile Applications
Confidence interval
United States
Computers
Handheld
Kidney Failure
Chronic
Female
Patient Participation
Risk assessment
business
Zdroj: Transplantation. 100(3)
ISSN: 1534-6080
Popis: Background Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly one third of end-stage renal disease (ESRD) patients are not educated about kidney transplantation as a treatment option at the time of ESRD diagnosis. Access to individualized, evidence-based prognostic information is needed to facilitate and encourage shared decision making about the clinical implications of whether to pursue transplantation or long-term dialysis. Methods We used a national cohort of incident ESRD patients in the US Renal Data System surveillance registry from 2005 to 2011 to develop and validate prediction models for risk of 1- and 3-year mortality among dialysis versus kidney transplantation. Using these data, we developed a mobile clinical decision aid that provides estimates of risks of death and survival on dialysis compared with kidney transplantation patients. Results Factors included in the mortality risk prediction models for dialysis and transplantation included age, race/ethnicity, dialysis vintage, and comorbidities, including diabetes, hypertension, cardiovascular disease, and low albumin. Among the validation cohorts, the discriminatory ability of the model for 3-year mortality was moderate (c statistic, 0.7047; 95% confidence interval, 0.7029-0.7065 for dialysis and 0.7015; 95% confidence interval, 0.6875-0.7155 for transplant). We used these risk prediction models to develop an electronic, user-friendly, mobile (iPad, iPhone, and website) clinical decision aid called iChoose Kidney. Conclusions The use of a mobile clinical decision aid comparing individualized mortality risk estimates for dialysis versus transplantation could enhance communication between ESRD patients and their clinicians when making decisions about treatment options.
Databáze: OpenAIRE
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