# Best Case/Worst Case: A Multisite Randomized Clinical Trial of Scenario Planning for Patients with End-Stage Kidney Disease

> **NIH NIH R01** · UNIVERSITY OF WISCONSIN-MADISON · 2022 · $637,011

## Abstract

ABSTRACT
Nearly half of all patients starting dialysis are now over age 65. Median survival after initiating dialysis is short
and patients experience frequent hospital stays, pain, fatigue, cognitive dysfunction and depression. Yet few
receive palliative care in time to alleviate symptoms, document care goals and prepare for end of life. Given
the burdens of treatment and poor prognosis, older adults with end-stage kidney disease would benefit from
upstream interventions that both improve decision making about dialysis and promote timely receipt of
palliative care in order to clarify goals, address symptoms and reduce unwanted invasive procedures. This
proposal serves the long-term goal of increasing the use of palliative care for older patients with life-limiting
illnesses and reducing unwanted invasive treatments at the end of life.
“Best Case/Worst Case: A Multisite Randomized Clinical Trial of Scenario Planning for Patients with
End-Stage Kidney Disease” is a five-year R01 that responds specifically to PA-18-502 for development and
evaluation of innovative decision aids for seriously ill older patients and/or their proxy decision makers. Our
research team has developed a novel communication tool called “Best Case/Worst Case” that employs
scenario planning and a graphic aid to illustrate options, acknowledge uncertainty and describe outcomes
within the context of the patient's underlying health and prognosis. We have pilot-tested this intervention for
patients with kidney disease and demonstrated that nephrologists can use this tool to improve decision making
about dialysis and this may increase utilization of palliative care. We are now ready to test the intervention in a
large-scale efficacy study. We propose a multisite cluster randomized trial in which 320 patients making a
dialysis initiation decision receive nephrologist communication using the Best Case/Worst Case tool, or
communication as usual. We aim to test the effect of the Best Case/Worst Case intervention on receipt of
palliative care and intensity of treatment at the end of life (Aim 1), quality of life (Aim 2), and the quality of
communication (Aim 3) for older patients with end-stage kidney disease.
This award will allow us to test an intervention that is easily scalable and can be disseminated rapidly for use
with older patients with life-limiting kidney disease. The research is innovative because it tests scenario
planning —a decision-making strategy that has been successfully applied in business and government—but is
not widely used in healthcare. The research is significant because if the intervention is effective, it has the
potential to transform how specialists talk about options and dramatically improve receipt of palliative care.
Our multidisciplinary team has a long history of collaboration. We are well positioned to achieve our objectives
within the scope of this award given our strong pilot data and commitment from the Palliative Care Research
Cooperative Group an...

## Key facts

- **NIH application ID:** 10357958
- **Project number:** 5R01AG065365-03
- **Recipient organization:** UNIVERSITY OF WISCONSIN-MADISON
- **Principal Investigator:** Margaret Schwarze
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $637,011
- **Award type:** 5
- **Project period:** 2020-06-01 → 2025-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10357958

## Citation

> US National Institutes of Health, RePORTER application 10357958, Best Case/Worst Case: A Multisite Randomized Clinical Trial of Scenario Planning for Patients with End-Stage Kidney Disease (5R01AG065365-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10357958. Licensed CC0.

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