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Table 1 The nephrogeriatric assessment used in DIALOGICA

From: DIALysis or not: Outcomes in older kidney patients with GerIatriC Assessment (DIALOGICA): rationale and design

Domain Measure Type Explanation Scale / cut-off
Functional status Activities of Daily Living (Katz) [14] SAQ Grading of dependency on 6 functions, e.g. bathing, dressing. 0–12, higher scores indicating more dependency, no cut-off values.
  Instrumental Activities of Daily Living (Lawton) [15] SAQ Grading of dependency on 8 more complex functions, e.g. handling finances, driving. 0–8 for women, 0–5 for men. Higher scores indicating more independency, no cut-off values.
  Fall risk assessment IAQ One-year history of falling and graded fear of falling. Yes/no; 1 (‘no fear’) to 10 (‘very afraid’).
  Hand grip strength T Measured using a Jamar handheld dynamometer, 3 repetitive measurements for both hands. Highest measurement is used for analysis. Individual cut-off values based on age and gender [16].
Psychological status Montreal Cognitive Assessment (MoCA) [17] T Screening tool for cognitive impairment in 8 domains (visuospatial, naming, memory, attention, language, abstraction, delayed recall, orientation). 0–30, higher scores indicating better cognitive performance, < 26 indication of cognitive impairment.
  Six-item Cognitive Impairment Test (6-CIT) [18] T Fast, 6-item screening tool for dementia, assessing orientation, attention and memory. 0–28, higher scores indicating worse cognitive performance, > 10 indication of cognitive impairment.
  Letter-Digit Substitution Test (LDST) [19] T Speed-dependent task to measure speed of processing by matching letters to corresponding numbers provided in the key. 0–135 correct matches after 60 s, reference values based on age, gender and level of education [20].
  Geriatric Depression Scale (GDS-15) [21] IAQ Initial two-item screening tool (‘Whooley-questions’) on mood and anhedonia, if any of the 2 positive followed by 15 additional binary questions [22]. Yes/no, 0–15, higher scores indicating more or stronger degree of depressive symptoms, > 5 indicative of depression.
  Life Orientation Test - Revised (LOT-R) [23] SAQ 10 Items including 4 filler items, 3 items for optimism and 3 items for pessimism. Scored using 5-point Likert scales. 0–12 per construct (optimism or pessimism) or 0–24 for total score (higher scores then indicating more optimism). Reference values based on age and gender [24].
Somatic status Clinical Frailty Scale [25] CA Clinicians judgement of frailty based on 9 pictures with accompanying text. 1 (‘very fit’) to 9 (‘terminally ill’).
  Charlson Comorbidity Index [26] CA Comorbid conditions with weighted scores for the condition. 1–6 per condition, total range of 0–33. Higher scores indicating more or more severe comorbidity. No cut-off values.
  Surprise question CA Clinicians response to the question: “Would I be surprised if the patient died in the next 12 months?”, assessed by either nephrologist or (predialysis) nurse Yes/no.
  Mini Nutritional Assessment - Short Form (MNA-SF) [27] IAQ 6 Questions for assessing the risk of malnourishment. 0–7 ‘malnourished’, 8–11 ‘risk of malnourishment’, 12–14 ‘well-nourished’.
HRQoL and symptoms Twelve-item Short Form Health Survey (SF-12) [28] SAQ 12 Questions regarding HRQoL, resulting in a mental and physical component score. Scored using 3- and 5-point Likert scales. Used in Dutch nephrological care as PRO. 0–100, higher scores indicating better HRQoL, no cut-off values.
  Dialysis Symptom Index (DSI) [29] SAQ 30 Questions regarding presence of specific symptoms, when present scored on a 5-point Likert scale. Used in Dutch nephrological care as PRO. Yes/no, if yes 1 (‘not at all’) to 5 (‘very much’). Total score 0–30 for each ‘yes’, higher scores indicating higher number of symptoms. No cut-off values.
Costs Five-level EQ-5D (EQ-5D-5L) [30] SAQ 5 Questions regarding health aspects (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) using a 5-point Likert scale and 1 overall health score on a visual-analogue scale. Used to calculate QALYs in cost-effectiveness analysis 1 (‘no problems’) to 5 (‘unable to/extreme problems’); 0 ‘worst health you can imagine’ to 100 (‘the best health you can imagine’ for the visual-analogue scale. Reference values using Dutch value set [31].
  (subset of questions from) iMTA Productivity & Medical Costs Questionnaire [32, 33] SAQ 8 General questions and 22 questions on healthcare use in the previous 3 months. Used to calculate healthcare-related costs in cost-effectiveness analysis. NA
Decisional regret Treatment Choice Questionnaire & Decisional Conflict Scale (DCS) [34, 35] SAQ Questionnaire filled in when treatment choice has been made. Contains 23 questions regarding the choice made. NA for Treatment Choice Questionnaire; 0–100 for DCS, higher scores indicating higher decisional conflict, no cut-off values.
  Decision Regret Scale (DRS) [36] SAQ 5 Questions on regret regarding the choice for either conservative care or dialysis on a 5-point Likert scale. 0–25, higher scores indicating stronger feelings of regret. No cut-off or reference values [37].
  1. Abbreviations: CA Clinician Assessment, HRQoL Health-Related Quality of Life, IAQ Interviewer-Administered Questionnaire, iMTA Institute for Medical Technology Assessment, PRO Patient Reported Outcome, SAQ Self-Administered Questionnaire, T Test, NA Not Applicable, QALY Quality Adjusted Life Year