Research

My Voice (Kidney)

Web-based advance care planning intervention for patients with kidney failure on dialysis: Pilot testing of ‘My Voice’

Advance care planning (ACP) is critical for patients with end stage kidney disease (ESKD). However, ACP rates are low among ESKD patients, and conversations tend to occur late in acute care settings. My Voice-Renal, a web-based intervention, is tailored for patients with ESKD on dialysis and their family caregivers. It supports education on ESKD and dialysis, enables users to reflect on values and understand care options when dialysis becomes difficult to tolerate, and prepares patients and caregivers for ACP conversations broadly and on future dialysis decisions.

The study aims to implement My Voice in the care pathway, test its preliminary efficacy, and assess feasibility and acceptability. A mixed-methods design includes a 2-arm cluster randomised controlled trial and qualitative feedback across six National Kidney Foundation (NKF) dialysis centres. Outcomes will evaluate quality of serious illness conversations, ACP engagement, preparedness for end of life, knowledge and peace. Acceptability will be assessed qualitatively through in-depth interviews with patients, caregivers, and renal healthcare providers.

Principal Investigator

Dr. Chandrika Ramakrishnan

Research Fellow, Lien Centre for Palliative Care, Duke-NUS Medical School

Study Team

Site Principal Investigator:

  • Associate Professor Choo Chon Jun Jason, Medical Director, National Kidney Foundation Singapore

Co-Investigators:

  • Associate Professor Alethea Yee, Senior Consultant, Department of Supportive and Palliative Care, National Cancer Centre Singapore
  • Professor Eric Finkelstein, Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore
  • Assistant Professor Gillian Phua Li Gek, Senior Consultant, Department of Supportive and Palliative Care, National Cancer Centre Singapore
  • Dr. Lee Chun Fan, Biostatistician, Centre for Quantitative Medicine (CQM), Duke-NUS Medical School, Singapore

Publications

  • Malhotra C, Ramakrishnan C, Lakin J, Choo JCJ, Yee A. Digital Advance Care Planning for Dialysis Patients - Usability and Acceptability. Kidney Int Rep. 2025 Sep 3;10(11):4073-4076. doi: 10.1016/j.ekir.2025.08.038. PMID: 41278361; PMCID: PMC12640010.

Presentations

  • Singapore Palliative Care Conference 2026, Digital ACP for renal failure. 18–19 April 2026

Contact Person

Dr. Chandrika Ramakrishnan, Research Fellow: chandrika.ramky@duke-nus.edu.sg

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