Physicians Report Satisfaction with iChoose Kidney App Improving Transplant Decision Making
The iChoose Kidney app has been available both as a free download and in an online format for over two years and has been downloaded by more than 2,000 users. Developed by a team led by Rachel Patzer, PhD, director of the Emory Transplant Health Services and Outcomes Research Program, and Mohua Basu, MPH, a transplant epidemiologist for the Emory Transplant Center (ETC), the app provides an individualized comparison of mortality risk estimates for end-stage renal disease (ESRD) patients on dialysis vs. living or deceased donor kidney transplantation.
"Evidence suggests that nearly 1/3 of dialysis patients in the U.S. are not informed about transplantation as a treatment option for kidney disease, even though kidney transplantation provides significant survival advantages over long-term dialysis, and living donation has better graft and patient survival rates than deceased donor transplantation," says Patzer. "Though the data exists to help patients make treatment decisions, it's not being used. iChoose Kidney takes about a minute to complete, and is a simple tool that can be used at the bedside to communicate evidence-based prognosis information through graphics that are patient-friendly."
Shortly after it became available, Patzer, Basu, and participating nephrologists and kidney transplant surgeons at the ETC, Columbia Transplant Center in New York, and Northwestern Transplant Center in Chicago began evaluating the app with their patients in a randomized, controlled trial. The findings were recently announced by Basu at the 2016 American Transplant Congress, and concluded that the iChoose Kidney decision-making support tool shows promise in improving the communication between physicians and patients regarding the survival benefit of transplantation compared to dialysis.
The study enrolled 470 patients from the three large transplant centers and randomly assigned 230 control patients to receive standard education, and 240 intervention patients to receive standard education plus the iChoose Kidney decision tool. Thirty-four transplant nephrologists and surgeons participated in the study, which evaluated how the use of iChoose Kidney improved patient knowledge of treatment options, patient uncertainty and preferences about treatments options, patient access to receiving a kidney transplant, and whether physicians found the tool useful during transplant evaluations.
The results showed providers reviewed living vs. deceased donation with 93% of the intervention patients and only 80% of control patients. The providers believed the tool improved patient understanding of the survival benefits of transplantation vs. dialysis in 90% of the intervention patients and understanding of the survival benefit of living vs. deceased donor kidney transplantation in 86% of intervention patients. The physicians also believed 71% of control patients would have benefited from using the iChoose app, as the "visual depiction was easier to understand," "it was easier to interpret risks to patients," iChoose Kidney included "more precise estimates" and "more quantitative data," and that "patients may be more motivated to try to find a living donor" after using the app.
"We also plan to assess the impact of iChoose Kidney on access to waitlisting and kidney transplantation once we have longer follow-up times," Basu reported.