The WISHED Trial: implementation of an interactive health communication application for patients with chronic kidney disease

BACKGROUND Despite many advantages over facility-based therapies, less than 25 % of prevalent dialysis patients in Ontario are on a home therapy. Interactive health communication applications, web-based packages for patients, have been shown to have a beneficial effect on knowledge, social support, self-efficacy, and behavioral and clinical outcomes but have not been evaluated in patients with chronic kidney disease (CKD). Web-based tools designed for patients with CKD exist but to our knowledge have not been assessed in their ability to influence dialysis modality decision-making. OBJECTIVE To determine if a web-based tool increases utilization of a home-based therapy in patients with CKD starting dialysis. DESIGN This is a multi-centered randomized controlled study. SETTING Participants will be recruited from sites in Canada. PARTICIPANTS Two hundred and sixty-four consenting patients with an estimated glomerular filtration rate (eGFR) less than 20 ml/min/1.73 m(2) who have received modality education will be enrolled in the study. MEASUREMENTS The primary outcome will be the proportion of participants who are on dialysis using a home-based therapy within 3 months of dialysis initiation. Secondary outcomes will include the proportion of patients intending to perform a home-based modality and measures of dialysis knowledge, decision conflict, and social support. METHODS The between-group differences in frequencies will be expressed as either absolute risk differences and/or by calculating the odds ratio and its associated 95 % confidence interval. CONCLUSIONS This study will assess whether access to a website dedicated to supporting and promoting home-based dialysis therapies will increase the proportion of patients with CKD who initiate a home-based dialysis therapy. TRIAL REGISTRATION ClinicalTrials.gov #NCT01403454, registration date: July 21, 2011.