Department of Community Health
Research on Ethics, Aging, and Community Health Lab
Research on Ethics, Aging, and Community Health Lab

Implementing the Decision Aid for Renal Therapy (DART)

DART is an online, interactive, decisional-aid tool designed to help older adults that are in stages 4 and 5 of kidney failure consider which treatment options are right for them. DART is available in English and Spanish and provides a comprehensive review of the various treatment options available to patients, including types of dialysis, transplantation, and conservative kidney management.

Achieving Widespread Goal-Concordant, Timely Treatment Decisions in Older Adults with Kidney Failure

DART is designed to be supportive of patients who are navigating complex care decisions. For each treatment option, it explains what types of procedures are involved, what day-to-day treatment looks like, and expected impacts on one’s independence and daily routines. DART also facilitates patient reflection about their treatment goals, priorities and values, helping to strengthen communication between patients and their care teams and improve timely, goal-concordant treatment decisions.

Implementing DART has benefits for patients, clinicians, and caregivers. DART has been proven to increase patient knowledge about CKD, reduce decisional conflict, support more confident decision-making, and advance goal-concordant care among older adults with advanced CKD. Clinicians that prescribe DART can adapt the tool to fit into their existing workflows and use DART as a guide to improve conversations about treatment with patients. DART is also beneficial for caregivers, who can review DART with their loved ones and help them prioritize their preferences when making decisions about treatment.

The REACH Lab at Tufts University, led by Dr. Keren Ladin, is currently conducting an implementation study with support from the Patient-Centered Outcomes Research Institute that aims to fully implement DART into real-world healthcare settings in partnership with six diverse healthcare sites.

View the DART decision-aid tool

DART Implementation Toolkit

This DART Implementation Toolkit is designed for clinical sites that are interested in implementing DART into their routine kidney care. The toolkit is organized into three key stages of implementation:

  • Planning for Implementation
  • Preparing Teams
  • Using DART with Patients

Below are outlined steps paired with helpful resources for sites to support their own implementation of DART, depending on which stage of implementation they are at.

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1. Plan for Implementation

Plan and prepare for implementation of DART in your practice

Includes:

  • DART content, evidence base, and purpose overviews
  • Outline roles and responsibilities among care teams
  • Options for DART delivery workflows
  • Implementation roadmap
  • Menu of EHR integration systems
  • DART workflow planning sheet
  • Implementation tracking sheet

Who it's for: 
DART clinical champions, Nephrology leadership

How to use it:
Use the Planning Implementation tools to prepare your practice and start to adapt workflows.

    • The DART core concepts and evidence base document introduces core concepts of DART, including why it was created, the evidence base supporting the effectiveness of DART gathered from the DART clinical trial study, and the benefits of DART for patients and healthcare staff.
    • The DART project abstract is a document that outlines the goals of the DART implementation project and includes an overview of objective, aims, implementation approach, and evaluation framework. 
    • Overview of DART Content is a source that describes the core components of DART video that patients will interact with and how this video helps patients with decision-making guidance.

    • The roles and responsibilities document outlines the different potential roles in site teams, including the site champion, Nurse/CKD educator, Nephrologist, and Nephrology/Administrative leader. The purpose and responsibilities of each role are also outlined, with the goal of increasing the synergy of each role.
    • The options for DART delivery workflows document outlines some potential options which sites may consider to establish processes for identifying DART-eligible patients and referring them to the tool, depicted via diagrams and written descriptions. 
    • We know that some patients may be less likely to engage with patient portals or electronic notifications. The delivering DART outside the EHR guidance document describes considerations for sites on how to ensure DART is still accessible to these patients. 
    • Part of the DART implementation process is understanding the exact parameters for how DART is integrated into clinical workflows. The DART workflow planning worksheet has been created to define site-specific workflows for introducing and using DART.
    • The Implementation Roadmap document outlines key phases of DART implementation, including the planning, launching, and sustainment phases, and provides guidance on key activities to complete in each step.
    • Menu of EHR integration systems goes over the methods and strategies to integrate DART into existing EHR systems, as well as steps to consider to initiate integration, ordering and prescribing DART electronically, and documenting delivery and completion of DART. 
    • Sites will vary in their decided practices for how to monitor DART delivery and outcomes. To begin to think about aspects of DART implementation to track, sites may reference the implementation tracking sheet template as a starting point.

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2. Prepare Your Team

Equip clinical staff with the knowledge and tools to deliver DART confidently

Includes:

  • Clinical delivery of DART FAQ sheet
  • DART benefits and incentives summary
  • Slide decks for introducing and discussing DART
  • Reference guides for introducing DART and engaging in shared decision-making conversations

Who it's for: 
DART delivery staff (Nephrologists, APPs, nurses, care navigators/educators)

How to use it:
Use these training and support materials to train care teams on how to prescribe DART and effectively use DART with patients.

    • The DART overview for clinicians one-pager gives a comprehensive overview of what DART is, the evidence base for DART and the patient benefits, as well as considerations for how DART can fit into your workflow.
    • The DART introductory email template offers an editable guide for site leads to use when notifying clinicians about DART implementation at their site.
    • The DART overview for clinicians flyer gives a quick, digestible overview of what DART is, for which patients DART is beneficial, and a diagram depicting the integration of DART in clinical workflows.
    • The DART delivery Quick Guide for clinicians offers a detailed but brief overview of DART for clinical staff, covering its purpose, benefits for patients, key considerations for delivery, and how DART fits into clinical workflows.
    • The Clinical Delivery of DART FAQ addresses questions sites might have about DART delivery, including for whom DART is intended, implications of using DART for billing and physician time, and how to use the preference sheets in treatment discussions.
    • The DART benefits and incentives outlines ways in which DART can benefit clinicians and patients, including saving clinicians’ time, increasing patient satisfaction, and promoting more productive visits.
    • Slide decks for leadership and staff to use when introducing DART to their teams brief version | extended version
    • Quick Guide for introducing DART to patients provides language examples and strategies for care teams on how to introduce DART to their patients.
    • One pager guides for SDM conversations can be reviewed by care teams to help them introduce DART in shared decision-making conversations with patients. 

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3. Use DART With Patients

Support patients in accessing, understanding, and engaging with DART

Includes:

  • Pamphlets for patients
  • Prescription pad with QR code
  • DART access instruction manual
  • DART hand-outs with preference sheet
  • DART clinic room flyers
  • Presentation templates for introduction in options classes
  • Tip sheets for staff to respond to DART questions

Who it's for: 
DART delivery staff, patients, caregivers, family

How to use it:
Patient-facing materials support providers during DART delivery and provide patients with accessible, engaging resources to improve their comfort-level navigating DART.