SPIRIT Advance Care Planning for Kidney Failure
Trial Summary
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of the SPIRIT treatment for kidney failure?
Advance care planning (ACP), which is part of the SPIRIT treatment, helps patients with kidney failure by ensuring their treatment preferences are known and respected at the end of life. Studies show that ACP can improve end-of-life care by aligning medical interventions with patients' wishes, potentially leading to a more dignified and preferred end-of-life experience.12345
Is the SPIRIT Advance Care Planning intervention safe for humans?
How is the SPIRIT treatment for kidney failure different from other treatments?
The SPIRIT treatment is unique because it focuses on advance care planning, which involves discussions to help patients with kidney failure understand their illness, set goals, and make informed decisions about their care. Unlike traditional treatments that focus on medical interventions, SPIRIT emphasizes patient-centered communication and planning to improve end-of-life care.1241011
What is the purpose of this trial?
Despite advances in dialysis, only 50% of dialysis patients are alive 3 years after the onset of end-stage renal disease (ESRD). Although withdrawal of dialysis precedes 1 in 4 deaths of patients with ESRD, withdrawal from dialysis and aggressive treatment is rarely discussed by patients and their surrogates with sufficient time to consider alternatives such as hospice or dying at home. Over the last decade, the researchers have developed and iteratively tested a patient and family-centered advance care planning intervention based on the Representational Approach to Patient Education called "Sharing Patient's Illness Representation to Increase Trust" (SPIRIT). SPIRIT is a 6-step, 2-session, face-to-face intervention to promote cognitive and emotional preparation for end-of-life decision making for patients with ESRD and their surrogates.This study is a multicenter, clinic-level cluster randomized trial to evaluate the effectiveness of SPIRIT delivered by dialysis care providers as part of routine care in free-standing outpatient dialysis clinics compared to usual care plus delayed SPIRIT implementation. The researchers will recruit 400 dyads of patients at high risk of death in the next year and their surrogates from dialysis clinics in four states. Patients and surrogates will complete questionnaires at baseline and two weeks after the intervention. Surrogates will complete a post-bereavement assessment three months after the death of the patient.
Research Team
Mi-Kyung Song, PhD, RN
Principal Investigator
Emory University
Eligibility Criteria
This trial is for patients with end-stage renal disease (ESRD) on dialysis who can speak and understand English, along with their chosen surrogates capable of decision-making. It excludes those too ill or cognitively impaired, without a surrogate, already in hospice care, or surrogates unable to complete questionnaires.Inclusion Criteria
Exclusion Criteria
Timeline
Screening
Participants are screened for eligibility to participate in the trial
Intervention
SPIRIT is a two-session, 60-minute, structured psychoeducational intervention targeting both patient and surrogate.
Follow-up
Participants are monitored for safety and effectiveness after the intervention, with assessments at baseline and two weeks after the intervention.
Post-bereavement Assessment
Surrogates complete a post-bereavement assessment three months after the death of the patient.
Optional Extension
Optional extension of the observational period for an additional 12 months, for up to 21 months of observation.
Treatment Details
Interventions
- Comparison Condition
- SPIRIT
Find a Clinic Near You
Who Is Running the Clinical Trial?
Emory University
Lead Sponsor
National Institute of Nursing Research (NINR)
Collaborator