Development and usability testing of an interactive Patient-Decision-Aid App for patients with advanced chronic kidney disease.

Abstract

Patient decision aids (PtDAs) help patients make informed healthcare choices. However, paper-based PtDAs are often limited by time constraints, low health literacy, and limited patient understanding. While digital PtDAs may offer better support, their use for advanced chronic kidney disease (CKD) patients deciding on kidney replacement therapy (KRT) remains limited. This study developed and tested an interactive digital PtDA app (iPtDA-KRT App) to help patients with advanced CKD make informed decisions about KRT. The study included prototype development with input from patients and experts (n = 22), followed by pilot testing with 45 participants (patients and healthcare providers). The iPtDA-KRT App integrates multimedia content, interactive videos, and decision-making tools. In the pilot test, 24 patients were assigned to either the iPtDA-KRT App group or a control group using a paper-based PtDA. Pre- and post-intervention surveys assessed knowledge, decisional conflict, and decision preparedness. Twenty-one healthcare providers also evaluated the iPtDA-KRT App's usefulness. Compared to the paper-based PtDA, the iPtDA-KRT App significantly improved patients' knowledge, increased decision preparedness, and reduced decisional conflict. Healthcare providers reported high satisfaction with the iPtDA-KRT App, especially clinicians. Patients also found it easy to use and helpful for decision-making. The iPtDA-KRT App is a promising tool to support informed decision-making in patients with advanced CKD. However, as this was a pilot study with a limited sample size, findings should be interpreted with caution. Further large-scale studies are needed to confirm its effectiveness.