Introduction Patients with End-Stage Kidney Disease (ESKD) often face healthcare tasks beyond their capacity, leading to adverse outcomes. Capacity Coaching (CC), a novel shared decision-making (SDM) intervention, aims to collaboratively designs tailored treatment plans for ESKD between patients and clinicians. This pilot study assesses CC’s impact on clinical and patient-reported outcomes in ESKD care.

Methods A randomized mixed-methods pilot trial involved English-speaking adult ESKD patients undergoing in-center or home dialysis care at a large academic medical center. Clinical outcomes encompassed hospitalizations, Emergency Department (ED), and primary care (PC) visits and missed dialysis sessions. Patient-reported outcomes (PROs) comprised treatment and symptom burden, self- efficacy, and care satisfaction. Mixed models were employed, adjusting for fixed effects of arm, time (baseline, 3 and 6 months), their interaction, and the random effect of the patient.

Results Of 93 approached patients, 33 consented and were randomized (16 CC, 17 Standard Care [SC]). CC patients attended an average of 3.6 sessions. CC resulted in fewer ED visits compared to SC (p=0.04). Although CC showed a reduction in shortened and skipped dialysis sessions, statistical significance was not reached. PROs showed no significant differences between groups, with non- response being a common issue.

Discussion CC as an SDM intervention is a feasible intervention to tailor ESKD programs to align with both patient and clinician goals. Future directions involve larger randomized control trials in diverse populations to generalize the findings of this study.

Conclusion Capacity Coaching appears to be an effective SDM intervention, improving treatment adherence and reducing emergency visits for ESKD patients, indicating its potential for larger trials.