Many patients with chronic kidney disease (CKD) are provided little information regarding advanced care planning (ACP). Being informed earlier would empower patients and help them make the best decisions regarding dialysis and other issues that may arise.

Although guidelines recommend earlier and more personalized ACP, little evidence exists of its incorporation into practice. For this reason, researchers at the George Washington (GW) School of Nursing conducted an interventional study to learn how the coaching style they’ve developed may benefit patients.* 

What Type of Coaching Intervention was Created?

Researchers developed an ACP-focused interventional coaching style geared toward a CKD clinical setting. They describe their style as “motivational interviewing, providing a patient-centered approach responsive to various patient experiences and pre-existing levels of engagement.”

The team goes on to say that, “The intervention, called ‘Make Your Wishes about You – MY WAY,’ employs in-person coaching aligned with evidence indicating that in-person methods are consistently effective.” 

What Did the Researchers Do?

The research team recruited participants from three clinics in different states who met these requirements:

• Diagnosis of stage 3 to 5 CKD
• Age of 55 years or older
• Fluency in English

The 254 qualified participants received one of two interventions, which included either individualized in-person ACP coaching or self-guided educational material called enhanced usual care (EUC). 

The in-person ACP coaching was administered by nurses or social workers with experience in nephrology or palliative care. The enhanced usual care group was given the MY WAY education materials and verbally encouraged to bring their completed directives to the clinic. 

Researchers developed a primary outcome-measured system using a 45-point ACP engagement scale at 14 weeks and an advance directive or portable medical order at 16 weeks after enrollment. The two intervention groups were then compared and analyzed.

What Did they Find?

Of the 254 patients analyzed in the study, 46.5% were 65 to 74 years old, and 54% had stage 3 CKD. 

Patients who were coached scored 1.9 points higher at 14 weeks on the ACP engagement scale. “Overall, 32.8% of intervention patients had an advance directive compared to 17.8% (23 of 129) of patients in the comparison group. In a site-adjusted multivariable model, coached patients were 79% more likely to have a documented advance directive or portable medical order,” the researchers wrote.

What Does It Mean?

The study’s findings indicate that individualized coaching that incorporates motivational interviewing may be beneficial to patients. 

Researchers add, “Individualized coaching may be effective in enhancing ACP, but its impact may be influenced by the healthcare environment where it is delivered.”

*Neumann, M. E. (2021, October 18). Individualized coaching may help patients with CKD who need advanced care planning. Healio. Retrieved November 8, 2021, from https://www.healio.com/news/nephrology/20211018/individualized-coaching-may-help-patients-with-ckd-who-need-advanced-care-planning