Capacity Coaching: A Pilot Randomized Trial of a Self-Management Intervention for Patients on Dialysis

Background: End Stage Kidney Disease (ESKD) patients are trusted to handle numerous healthcare tasks associated with managing their disease, often overwhelming their capacity. This can lead to poor health outcomes and increased healthcare use. Capacity Coaching (CC) aims to bolster patients' ability to manage their treatment load. This pilot study evaluates the feasibility of CC in ESKD care and its potential effects on clinical and patient-reported outcomes (PROs). Methods: This randomized mixed-methods pilot trial involved English-speaking adult ESKD patients receiving in-center or home dialysis care at a large academic medical center. Intervention consisted of 6 CC sessions with a board-certified wellness coach embedded in their clinical care plan. Clinical outcomes included hospitalizations, Emergency Department (ED), primary care (PC) visits, shortened or missed dialysis sessions, interdialytic weight, and serum albumin levels. PROs analyzed included treatment burden, self-efficacy, fatigue, emotional distress, and illness intrusiveness. Mixed models were used, adjusting for fixed effects of arm, time (baseline, 3 and 6 months), their interaction, and the random effect of the patient. Secondary analysis results were adjusted based on adherence to the intervention (≥ 3 CC sessions) using the FREQ procedure. Results: Of the 93 patients approached, 33 consented and were randomized (16 to CC, 17 to usual care [UC]). Of the 16 patients randomized to CC, 11 were adherent to the intervention. CC was feasible within the team, with patients attending an average of 3.6 (SD 2.13) sessions overall, and 4.8 (SD 1.17) when adjusted for adherence. CC patients had fewer ED visits compared to the control group in the overall analysis (p=0.03), with increased significance when adjusted for adherence (p=0.008). While CC showed reduced shortened and skipped dialysis sessions, this was not statistically significant. Moreover, fatigue was significantly decreased (p=0.047) in the CC arm compared to the UC arm when adjusted for adherence. Conclusion: Capacity Coaching appears effective in reducing ED visits and fatigue for ESKD patients who adhere to the intervention, suggesting its potential for larger trials. The pilot highlights the need for improved patient-reported outcome data collection. Funding: NIDDK Support, Other U.S. Government Support