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22/95 Chronic Kidney Disease education for patients, families, and carers commissioning brief

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Published: 28 July 2022

Version: 1.0 July 2022

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Introduction

The aim of the Health Technology Assessment (HTA) Programme is to ensure that high quality research information on the clinical effectiveness, cost-effectiveness and broader impact of healthcare treatments and tests are produced in the most efficient way for those who plan, provide or receive care from NHS and social care services. The commissioned workstream invites applications in response to calls for research on specific questions which have been identified and prioritised for their importance to the NHS, patients and social care.

Research question

What types of interventions aimed at delivering chronic kidney disease (CKD) information and education are clinically and cost effective, for whom, and under what circumstances? 

  • Interventions: Interventions designed to deliver CKD information and education for patients in the earlier stages of the disease (not primarily focused on renal replacement), as well as their families and carers, in line with the current NICE guidelines (see, in particular, NG203).
    If appropriate, applicants may include interventions that were not developed specifically for CKD information and education and would need to be adapted for that purpose.
  • Patient group: CKD patients with moderate or high risk of progression to end stage kidney disease within five years.
    Applicants to define and justify relevant sub-groups, based on health (comorbidities, stage of CKD, etc.), demographic (age, ethnicity, locality, etc.), and/or any other relevant characteristics (e.g., health literacy).
  • Setting: Any relevant setting in the UK and similarly developed health systems.
  • Study design: An appropriate mixed-methods evidence synthesis to examine: (1) how CKD education and information is currently delivered in the UK; (2) what interventions for improving clinically relevant patient-centred outcomes through CKD information and education are most likely to be clinically and cost effective  (whether or not they are part of current practice in the UK); and (3) what barriers need to be considered and what facilitators put in place for relevant patient sub-groups to increase chances of success.
  • Important outputs:  Findings of the evidence synthesis; findings of the systematic review(s) underpinning the evidence synthesis; a typology of relevant interventions, including adaptations for specific patient sub-groups; clear, actionable recommendations for further research based around the interventions.

Rationale

Chronic Kidney Disease (CKD) – the progressive damage and loss of function of a kidney - is a common condition. However, it tends to be asymptomatic until its later stages, by which time patients may require dialysis or a transplant and have a significantly increased risk of a heart attack, stroke, and premature death.

CKD is frequently picked up at the earlier asymptomatic stages through routine blood and urine tests and can be managed to stop or delay progression towards kidney failure. In addition to follow- up by health professionals, self-management can make a critical difference to outcomes but is often hindered by general lack of health literacy, poor understanding of the specific condition, and insufficient prioritisation of the kidneys (most CKD patients have several comorbidities).

NICE guidelines recommend offering people with CKD, their families and carers, “high-quality information or education programmes”. But while the guidelines suggest a list of topics that should be covered, there is no indication of the best mode of delivery. In practice, provision varies. Offering an information leaflet or signposting the patient to a website may be the least resource-intensive options for the health service. There appears to be, however, little to no adequate evidence regarding the clinical effectiveness of these simple solutions or regarding the potential added clinical benefit and cost effectiveness of providing more intensive education programmes – either one-to-one or in a group setting, of facilitating peer support, or any other measures aimed at addressing specific barriers faced by particular patients.

Given the wide range of options for delivering CKD information and education, the heterogeneity of the patient group and a very mixed evidence base, the HTA Programme is interested in funding a high-quality mixed-methods evidence synthesis that will examine the current practice in the UK and determine future research priorities focused on the interventions with the strongest signals of efficacy and potential for implementation in the NHS. Of particular interest are the needs of patients who face significant barriers to effective self-management of CKD, such as low health literacy or socio-economic deprivation. Important outputs from this work may also include actionable recommendations for research that addresses the perspectives of health and social service organisation and delivery.

Additional commissioning brief background information

A background document is available that provides further information to support applicants for this call. It is intended to summarise what prompted the call and the existing evidence base, including relevant work from the HTA and wider NIHR research portfolio. It was researched and written on the basis of information from a search of relevant sources and databases, and in consultation with a number of experts in the field. If you would like a copy please email htaresearchers@nihr.ac.uk.

Making an application

If you wish to submit a Stage 1 application for this call, the online application form can be found on the Funding opportunities page.  To select this call, use the filters on the right of the screen or search using the call name and/or number.

Your application must be submitted on-line no later than 1pm on the 25 January 2023. Applications will be considered by the HTA Funding Committee at its meeting in March 2023.

Guidance notes and supporting information for HTA Programme applications are available.

Important: Shortlisted Stage 1 applicants will be given eight weeks to submit a Stage 2 application. The Stage 2 application will be considered at the Funding Committee in July 2023.

Applications received electronically after 1300 hours on the due date will not be considered.

For commissioned topics, the Programme strongly discourages the practice of the same co-applicant joining more than one competing team. There may be unusual circumstances where the same person could be included on more than on application eg a lead from a named charity or a unique national expert in a condition.

For such exceptions (i) each application needs to state the case as to why the same person is included (ii) the shared co-applicant should not divulge application details between teams and (iii) both teams should acknowledge in their application that they are aware that one of their co-applicants is part of a competing application and that study details have not been shared.

Should you have any queries please contact us by email at htagb@nihr.ac.uk.