In the Journals

Patient support tool may improve treatment decisions for those with CKD, hepatitis C

For patients with both chronic kidney disease and the hepatitis C virus, an education and support tool increased knowledge of the conditions, thereby making patients more certain of — and engaged with — their treatment decisions, according to the results of this study.

“Given the complexity of the decisions about when and how to treat HCV infection and CKD, consistent communication between patients and their clinicians can facilitate evidence-informed preference-consistent treatment choices,” lead study author Nerissa George, MPH, of Washington University in St. Louis School of Medicine, and colleagues wrote. “Patient education and decision support tools could help patients learn about CKD and HCV and navigate through discussions about CKD and HCV treatment with their clinicians, including primary care physicians, nephrologists, hepatologists and transplant surgeons.”

In addition, the researchers suggested increased patient understanding of treatment risks, benefits and appropriate timing for initiation “could increase their confidence in their treatment choices.”

For this purpose, they developed a tool consisting of four main parts. These included “plain language” information about treatment options, personalized education based on patients’ medical history, an assessment of individual patient values that could influence treatment choice and a printable summary page designed to facilitate patient-clinician discussions.

The tool was administered electronically to 70 patients and completed by 56 patients (82.1% were black; 60.7% had a household income of less than $15,000). Before using the tool, patients were most concerned with their ability to pay for drugs to treat HCV infection (often not fully covered by health insurance, leading to high copayments or out-of-pocket costs, according to the researchers), as well as how HCV infection impacted their CKD.

Researchers found that, after using the tool, patients had significantly greater knowledge of both conditions (mean post-test percent of questions answered correctly, 65.74% vs. 53.44% in on the pre-test) and had more certainty about their choice. Certainty was based on a four-item test that evaluated patients’ perspective on whether they had enough information and support to make a choice, as well as if they were “clear about their values for risks and benefits of their choice” (mean post-test score 3.13 vs. 2.65 pre-test score).

Regarding usability, 77.8% of patients reported the tool easy to use, while 75.5% felt “very confident” using it.

Based on these results, the researchers wrote, “well-informed patients who participate in their health care decisions may show increased self-care behaviors and decreased stress associated with their diagnosis.”

“Overall, the patient education and decision support tool may improve decision quality and patient engagement in their CKD and HCV infection care decisions,” they concluded. “ ... Patients may choose therapies that positively improve their health outcomes and those that align with their values when they better understand the risks and benefits of options. Future studies should continue to evaluate ways to improve care decisions among this population.” – by Melissa J. Webb

Disclosures: George reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

For patients with both chronic kidney disease and the hepatitis C virus, an education and support tool increased knowledge of the conditions, thereby making patients more certain of — and engaged with — their treatment decisions, according to the results of this study.

“Given the complexity of the decisions about when and how to treat HCV infection and CKD, consistent communication between patients and their clinicians can facilitate evidence-informed preference-consistent treatment choices,” lead study author Nerissa George, MPH, of Washington University in St. Louis School of Medicine, and colleagues wrote. “Patient education and decision support tools could help patients learn about CKD and HCV and navigate through discussions about CKD and HCV treatment with their clinicians, including primary care physicians, nephrologists, hepatologists and transplant surgeons.”

In addition, the researchers suggested increased patient understanding of treatment risks, benefits and appropriate timing for initiation “could increase their confidence in their treatment choices.”

For this purpose, they developed a tool consisting of four main parts. These included “plain language” information about treatment options, personalized education based on patients’ medical history, an assessment of individual patient values that could influence treatment choice and a printable summary page designed to facilitate patient-clinician discussions.

The tool was administered electronically to 70 patients and completed by 56 patients (82.1% were black; 60.7% had a household income of less than $15,000). Before using the tool, patients were most concerned with their ability to pay for drugs to treat HCV infection (often not fully covered by health insurance, leading to high copayments or out-of-pocket costs, according to the researchers), as well as how HCV infection impacted their CKD.

Researchers found that, after using the tool, patients had significantly greater knowledge of both conditions (mean post-test percent of questions answered correctly, 65.74% vs. 53.44% in on the pre-test) and had more certainty about their choice. Certainty was based on a four-item test that evaluated patients’ perspective on whether they had enough information and support to make a choice, as well as if they were “clear about their values for risks and benefits of their choice” (mean post-test score 3.13 vs. 2.65 pre-test score).

Regarding usability, 77.8% of patients reported the tool easy to use, while 75.5% felt “very confident” using it.

Based on these results, the researchers wrote, “well-informed patients who participate in their health care decisions may show increased self-care behaviors and decreased stress associated with their diagnosis.”

“Overall, the patient education and decision support tool may improve decision quality and patient engagement in their CKD and HCV infection care decisions,” they concluded. “ ... Patients may choose therapies that positively improve their health outcomes and those that align with their values when they better understand the risks and benefits of options. Future studies should continue to evaluate ways to improve care decisions among this population.” – by Melissa J. Webb

Disclosures: George reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.