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| ID | Type | Description | Link |
|---|---|---|---|
| P30DK092949 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) | NIH |
| University of Chicago | OTHER |
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The goal of this pilot clinical trial is to learn if an intervention delivering education, motivational support, and social support can prevent worsening kidney disease in adults with diabetes and early-stage kidney disease. The main questions it aims to answer are:
The investigators will compare information collected about participants' response to this intervention with a group of similar patients who receive general diabetes information.
Participants will meet virtually with a nurse approximately 1 week before a scheduled primary care provider visit and complete surveys over the phone three times in a period of three months.
Chronic kidney disease (CKD) progression to kidney failure causes devastating declines in quality of life and mortality, with high healthcare costs. CKD affects ~15% of all adults in the U.S. and ~40% of adults with diabetes, with substantial variability in rate of progression to kidney failure. Negative social determinants of health (SDOH), such as food insecurity can speed up disease progression. However, if CKD progression to kidney failure can be prevented or delayed, patients can experience minimal impact on health and well-being. The diagnosis, treatment, and monitoring of early-stage, asymptomatic CKD occurs predominantly in the primary care setting, including for those with diabetes. Unfortunately, the rates of guideline-based CKD care delivery are low, and as a result, clinical diagnosis of early-stage CKD is as low as 50%. Delay in receiving a CKD diagnosis is associated with faster progression to kidney failure. Furthermore, because CKD is not always prioritized in the busy primary care setting, most patients are unaware they have CKD and have low rates of CKD knowledge, which impedes their ability to adhere to treatment. To address the issues of underdiagnosis, patients' lack of disease knowledge and self-efficacy, and the impact of SDOH for patients with diabetes and CKD, proactive action is critical. The investigators will target patients with diabetes who are eligible for an early-stage CKD diagnosis with a nurse-led, pre-primary care-visit 1:1 virtual session including evidence-based CKD education, motivational interviewing, and SDOH screening with referrals to services.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | Participants will participate in a nurse-led virtual session delivering education about chronic kidney disease, motivational interviewing to set a self-management goal, and screening/referral for social determinants of health barriers to treatment adherence and engagement. |
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| Control group | Active Comparator | The attention control group will participate in a nurse-led virtual session delivering general information about diabetes and treatment. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| CKD Awareness, Referrals, Education, and Support (CARES) | Behavioral | We will target diabetic patients eligible for an early-stage CKD diagnosis with a nurse-delivered, pre-PCP-visit 1:1 virtual session including 1) tailored, evidence-based CKD education 2) motivational interviewing with self-management goal setting, and 3) social determinants of health screening with referrals to services as needed. |
| Measure | Description | Time Frame |
|---|---|---|
| Motivation for diabetes-related self-care behaviour scale | Participant self-report. A scale from 1-5, with a lower score meaning not motivated and a higher score meaning highly motivated. Items are different self-management behaviors (e.g., medication, diet, exercise). | From enrollment to study completion (2-3 months) |
| Kidney Disease Knowledge Survey | Participant self-report. A set of fact-based questions about kidney disease which has a right and a wrong answer. Participants will be scored based on % correct answers. | From enrollment to study completion (2-3 months) |
| CKD Self Efficacy Instrument | Participant self-report. The scale ranges from 1-10, with low scores indicating not at all confident and high scores indicating totally confident. | From enrollment to study completion (2-3 months) |
| Social referral uptake | Participant self-report of uptake of any support services for barriers to treatment adherence that are needed. | From enrollment to study completion (2-3 months) |
| Measure | Description | Time Frame |
|---|---|---|
| Brief Illness Perceptions Questionnaire | Participant self-report. Scale from 1-10, with the meaning of numbers changing per item. Assessing participants' perspective and understanding of their chronic condition. Items assessed individually or using clustering approaches. | From enrollment to study completion (2-3 months) |
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Inclusion Criteria:
Exclusion Criteria:
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Data collected from participants includes: demographic, clinical history characteristics, comorbidity data, and new diagnoses or treatment plan changes will be collected through electronic medical record (EMR) abstraction. Social determinants of health barriers and uptake, self-efficacy, patient activation, motivation, treatment adherence, CKD knowledge, and CKD perceptions, feasibility, and acceptability quantitative data will be acquired through self-report questionnaires. All data will be collected in REDCap and de-identified prior to receipt by the repository, and a unique study identifier will be created for each subject.
All deidentified quantitative study data that are not designated as restricted use by our repository, INtellectual property in DIGital form available online in an Open environment (INDIGO), will be shared openly.
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All data will be shared the end of the award period or the time of an associated publication, whichever comes first. Publication-specific data will be shared when the pre-print is available. A DOI will aid in findability and the DOI will be included in relevant publications whenever possible. Study data deposited in INDIGO will be available to the research community in perpetuity.
Users of the public use data must register with INDIGO and agree to the Terms of Use, which are designed to protect study participants by limiting data use to scientific research and aggregate statistical reporting, prohibiting attempts to identify study participants, and requiring immediate reporting of any disclosure of study participant identity. Data users also agree not to share or redistribute any data downloads.
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| ID | Term |
|---|---|
| D051436 | Renal Insufficiency, Chronic |
| D003920 | Diabetes Mellitus |
| ID | Term |
|---|---|
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
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| ID | Term |
|---|---|
| D012017 | Referral and Consultation |
| D004522 | Educational Status |
| D010166 | Palliative Care |
| ID | Term |
|---|---|
| D011364 | Professional Practice |
| D009934 | Organization and Administration |
| D006298 | Health Services Administration |
| D012959 | Socioeconomic Factors |
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| Attention control | Behavioral | The control group will receive an attention control session of general education about diabetes-related health behaviors (e.g., diet and physical activity) that does not refer to CKD, based on American Diabetes Association materials. |
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| Patient activation Measure |
Participant self-report. Scales are 1-4 with a not applicable option, lower scores meaning less activated and engaged in care and higher scores meaning more activated and engaged in care. |
| From enrollment to study completion (2-3 months) |
| PROMIS Medication Adherence Scale | Participant self-report. Scale from 1-5 indicating agree to disagree, with items about performance of medication adherence behaviors. | From enrollment to study completion (2-3 months) |
| Dialysis Diet and Fluid Non-adherence Questionnaire | Participant self-report. One item asking how many days in the last week guidelines were not followed, and another item asking to what degree they were not followed, from completely to not at all. | From enrollment to study completion (2-3 months) |
| International Physical Activity Questionnaire | Participant self-report. Scale is 1-7 indicating the number of days a type of physical activity was performed in the previous week. Items are different types of physical activity behaviors. | From enrollment to study completion (2-3 months) |
| Care plan changes | review of EHR data related to PCP visit, assess if any CKD-related information or changes were documented | From enrollment to study completion (2-3 months) |
| Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences | Participant self-report. Items and response options vary and ask questions about social determinants of health issues (e.g., food insecurity, housing insecurity). Screening tool with no scores. | From enrollment to study completion (2-3 months) |
| D005261 |
| Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D002908 | Chronic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D044882 | Glucose Metabolism Disorders |
| D008659 | Metabolic Diseases |
| D009750 | Nutritional and Metabolic Diseases |
| D004700 | Endocrine System Diseases |
| D011154 | Population Characteristics |
| D005791 | Patient Care |
| D013812 | Therapeutics |
| D006296 | Health Services |
| D005159 | Health Care Facilities Workforce and Services |