Original ArticleEffects of an intervention to improve communication about end-of-life care among African Americans with chronic kidney disease
Section snippets
Sample and design
Dialysis clinic patients were eligible to join the study if they (a) had been receiving either center hemodialysis or home peritoneal dialysis for at least 3 months, (b) were over the age of 18, and (c) had a surrogate decision maker who was over the age of 18. Thirty-four patients were assessed for eligibility and approached with study information by a social worker at the clinic. Nineteen patient and surrogate dyads who joined the study as pairs were stratified by type of dialysis
Sociodemographic and clinical characteristics of the sample
Most of the patients were men (n = 10, 58.8%), single (n = 11, 64.7%), and had completed a high school education or higher (n = 15, 88.2%). Their average age is 52.82 (SD = 15.50) years. Just less than half of the patients (n = 8, 47.1%) reported their annual household incomes to be <$11,000 and stated that Medicare was their primary health insurance. Most of the surrogates were women (n = 15, 88.2%), single (n = 11, 64.7%), and had completed a high school education or higher (n = 15, 88.2%).
Discussion
Among the primary outcomes, only dyads' congruence improved significantly after PC-ACP. The hypotheses that PC-ACP would decrease patients' decisional conflict and increase surrogates' decision-making confidence were not supported. We observed a shift in preferences for life-sustaining treatment from baseline to 1 week follow-up among seven (70%) patients in the intervention group. However, the direction of the shift was counter to our expectation. The shift occurred either from “stop all
Acknowledgment
This study was supported by the University of Pittsburgh Central Research Development Fund and was conducted at the University of Pittsburgh School of Nursing. The authors thank Linda Briggs, MS, MA, RN, and Bernard Hammes, PhD, for their contributions to the project: interventionist training and the consultations in implementing the intervention. The authors also thank Iris Hayes, MSW, and the staff at the Dialysis Clinic Inc.-Oakland for their effort in participant recruitment.
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Senior author: Tel.: +1 608 263 5277; e-mail address: [email protected] (S.E. Ward).