Trial reportAmerican journal of kidney diseases : the official journal of the National Kidney Foundation2025
Implementation of An Advance Care Planning Intervention in Dialysis Clinics.
Trial report in American journal of kidney diseases : the official journal of the National Kidney Foundation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Examining Quality-of-Life Priorities of Older Adults Receiving Hemodialysis: A Q-Methodology Study.Kidney medicine · 2026Article
- Advance Care Planning in Dialysis Patients With a Conversation Game.Kidney international reports · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors.
Funding
Abstract
RATIONALE &
objectiveSharing Patient's Illness Representations to Increase Trust (SPIRIT) is an evidence-based advance care planning intervention targeting dialysis patients and their surrogate decision-makers. To address SPIRIT's implementation potential, we report on a process evaluation in our recently completed 5-state cluster-randomized trial. STUDY
designA descriptive study of implementation within a randomized clinical trial. SETTING &
participants231 patient-surrogate dyads and 60 dialysis care providers in the 22 active intervention clinics. EXPOSURE: Status as a patient/surrogate, care provider, or care provider "champion" who all were randomized to clinics implementing the SPIRIT implementation. OUTCOME: (1) Intervention reach (eg, number of dyads who received SPIRIT relative to each clinic's census); (2) fidelity (eg, champions' self-evaluation checklists, patient and surrogate surveys); (3) sustainability (patient, surrogate, and dialysis care provider acceptability surveys); and (4) context (eg, clinic characteristics).
resultsOf the 2 SPIRIT sessions, 191 participants (82.7%) completed session 1 and 146 (76.4% of 191) completed the optional session 2. Of the 40 champions, 34 completed at least 1 SPIRIT session 1. Champions reported that all 6 intervention steps were completed in 98% to 100% of their sessions. The median duration of session 1 and session 2 were 60 minutes and 15 minutes, respectively. The acceptability surveys suggested a high level of acceptance by patients, surrogates, and providers. Champions reported the main benefits of SPIRIT to be enhanced learning; communication; and improved relationships for patients, surrogates, and providers. The challenges champions reported were scheduling a time that worked for the patient, surrogate, and champion; feeling torn between SPIRIT and other clinical demands; and the emotional burden on the champions themselves. LIMITATIONS: The lack of data on actual continued use of SPIRIT and low provider participation in acceptability survey.
conclusionsThis study suggests that SPIRIT was delivered with high fidelity and was experienced positively by stakeholders. However, challenges such as staffing and emotional burden required clinic-level support and warrant future studies testing implementation strategies to address these barriers.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.