My Voice — web-based advance care planning for people on dialysis

Web-based Advance Care Planning Intervention for Patients With Kidney Failure on Dialysis: Pilot Testing of 'My Voice'

This project will test whether the My Voice website helps people on dialysis and their caregivers have clearer advance care planning conversations and feel more prepared for future end-of-life care.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 100 (estimated)
• Ages: 21 Years and up
• Sex: All
• Sponsor: Duke-NUS Graduate Medical School (other)
• Locations: 1 site (Singapore)
• Trial ID: NCT07309367 on ClinicalTrials.gov

What this trial studies

My Voice is a web-based intervention with separate patient and caregiver modules designed to educate people with kidney failure on dialysis about their illness, help them identify goals and preferences for end-of-life care, and coach them on talking with clinicians and loved ones. In this pilot interventional study, participants receiving the My Voice intervention will be compared with usual ACP practices in dialysis centres to see if the website improves the quality of conversations, patient knowledge, engagement in ACP, and preparedness for future care. Eligible participants are adults with stage 5 CKD on dialysis, with normal cognition and ability to read English, Mandarin, or Malay, and their family caregivers; sessions and conversations may be audio-recorded for evaluation. The trial is being conducted in Singapore with collaboration between Duke-NUS and the National Kidney Foundation and focuses on feasibility and preliminary signals of benefit rather than definitive outcomes.

Who should consider this trial

Good fit: Adults (≥21) in Singapore who are citizens or permanent residents with stage 5 CKD receiving dialysis, normal cognition (MMSE ≥24), able to read English, Mandarin, or Malay, and agreeable to audio-recording are the intended participants.

Not a fit: Patients with significant cognitive impairment, those who cannot read the supported languages, lack internet access or comfort with web tools, or who are not on dialysis are unlikely to benefit from this web-based program.

Why it matters

Potential benefit: If successful, the intervention could help align care with patients' wishes by improving ACP conversations, knowledge, and preparedness for end-of-life decisions.

How similar studies have performed: Some web-based advance care planning tools have shown improved preparedness in other chronic illnesses, but web-based ACP specifically targeted to dialysis patients remains relatively untested and this work is a pilot effort.

Eligibility criteria

Inclusion Criteria: For patients

* Singapore citizens or permanent residents; aged 21 years (age of majority) or older
* CKD stage 5; receiving dialysis
* Identified as eligible for SIC by NKF HCPs based on one or more of the following:

  1. clinical deterioration with a terminal condition or
  2. intolerability to dialysis or
  3. having two or more unplanned hospitalizations for renal complications in the past 6 months (from medical records); or
  4. known to palliative care or under conservative care as indicated in the discharge summary or
  5. poor functional status indicated by the Fragility Assessment for Elders (FIFE) score \>4
* Normal cognitive function as indicated by Mini Mental Scale Examination (MMSE) score of 24 or more (based on medical record)
* Able to speak and read English, Mandarin or Malay
* Agreeable to be audio-recorded

Inclusion Criteria: For caregivers

* Aged 21 years old and above
* Family caregivers of the patients recruited i.e. Caregiver primarily involved in providing care, ensuring provision of care, and/or in making decisions regarding patient's care, with no expectation of financial compensation
* Able to speak and read English, Mandarin or Malay
* Have a phone and/or an electronic device with internet access.
* Agreeable to be audio-recorded

Exclusion Criteria: For Patients

* Patients with cognitive impairment or serious mental illness will be excluded
* Patients who had prior serious illness conversations (SIC) will be excluded
* Are not easily contactable via mobile phone or landline

Exclusion Criteria: For Caregivers

* Those who are foreign domestic workers/maids
* Are not easily contactable via mobile phone or landline

Where this trial is running

Singapore

• Duke NUS Medical School — Singapore, Singapore (RECRUITING)

Study contacts

• Study coordinator: Chandrika Ramakrishnan, MBBS; MPH

Conditions: Kidney Failure, Chronic Therapy, Hemodialysis, Advance care planning, Web intervention, Dialysis withdrawal