Advance care planning and end-of-life decision making in dialysis: a randomized controlled trial targeting patients and their surrogates.

Background: Few trials have examined long-term outcomes of advance care planning (ACP) interventions. We examined the efficacy of an ACP intervention on preparation for end-of-life decision making for dialysis patients and surrogates and for surrogates' bereavement outcomes.

Study Design: A randomized trial compared an ACP intervention (Sharing Patient's Illness Representations to Increase Trust [SPIRIT]) to usual care alone, with blinded outcome assessments.

A systematic evaluation of websites offering information on chronic kidney disease.

In this study, we described the content and characteristics of 40 non-proprietary websites offering information about chronic kidney disease (CKD) and evaluated their information quality using the DISCERN scale and readability using Flesch Reading Ease and Flesch-Kincaid grade level. The areas in which the websites scored the lowest on the DISCERN scale were whether the website discussed knowledge gaps, presented balanced information, and was clear about the information source. Websites that rated higher quality on the DISCERN scale were more difficult to read.

Patient-reported cognitive functioning and daily functioning in chronic dialysis patients.

Subjective cognitive impairment negatively affects daily functioning, health-related quality of life, and health care consumption, and is predictive of future cognitive decline in many patient populations. However, no subjective measures of multidimensional cognitive functioning have been evaluated for dialysis patients. Our purposes were to examine (1) the association between patient-reported (subjective) cognitive functioning and objective cognitive functioning and (2) the relationships between subjective and objective cognitive functioning and everyday functioning of dialysis patients.

Patient perspectives on informed decision-making surrounding dialysis initiation.

Background: Careful patient-clinician shared decision-making about dialysis initiation has been promoted, but few studies have addressed patient perspectives on the extent of information provided and how decisions to start dialysis are made.

Methods: Ninety-nine maintenance dialysis patients recruited from 15 outpatient dialysis centers in North Carolina completed semistructured interviews on information provision and communication about the initiation of dialysis. These data were examined with content analysis.

Psychological symptoms and end-of-life decision making confidencein surrogate decision-makers of dialysis patients.

This cross-sectional descriptive study explored surrogate decision-makers' psychological symptoms and their own assessment of decision-making abilities before actual involvement in end-of-life decision-making for their loved ones. One hundred-twenty dialysis patients' surrogates (79 African Americans and 41 Caucasians) completed scales measuring decision-making confidence, anxiety and depression, Post-Traumatic Symptoms (PTSS), and a sociodemographic questionnaire. Forty-two (35%) and 14 (11.

Impact of the HEALTHY Study on Vending Machine Offerings in Middle Schools.

Purposeobjectives: The purpose of this study is to report the impact of the three-year middle school-based HEALTHY study on intervention school vending machine offerings. There were two goals for the vending machines: serve only dessert/snack foods with 200 kilocalories or less per single serving package, and eliminate 100% fruit juice and beverages with added sugar.

Methods: Six schools in each of seven cities (Houston, TX, San Antonio, TX, Irvine, CA, Portland, OR, Pittsburg, PA, Philadelphia, PA, and Chapel Hill, NC) were randomized into intervention (n=21 schools) or control (n=21 schools) groups, with three intervention and three control schools per city.