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Kidney Week

Abstract: PO2399

Treatment Adherence Support and Relationships with CKD Providers: A Qualitative Analysis

Session Information

Category: CKD (Non-Dialysis)

  • 2102 CKD (Non-Dialysis): Clinical, Outcomes, and Trials

Authors

  • Rivera, Eleanor, University of Illinois at Chicago, Chicago, Illinois, United States
  • Clark-Cutaia, Maya N., New York University, New York, New York, United States
  • Schrauben, Sarah J., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Townsend, Raymond R., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Lash, James P., University of Illinois at Chicago, Chicago, Illinois, United States
  • Colaizzo, Derek J., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Jaar, Bernard G., Johns Hopkins University, Baltimore, Maryland, United States
  • Charleston, Jeanne, Johns Hopkins University, Baltimore, Maryland, United States
  • Rincon-Choles, Hernan, Cleveland Clinic, Cleveland, Ohio, United States
  • He, Jiang, Tulane University, New Orleans, Louisiana, United States
  • Chen, Jing, Tulane University, New Orleans, Louisiana, United States
  • Hannan, Mary, University of Illinois at Chicago, Chicago, Illinois, United States
  • Hirschman, Karen B., University of Pennsylvania, Philadelphia, Pennsylvania, United States
Background

Adherence is critical in chronic kidney disease (CKD) to delay progression to kidney failure. Treatment plans for CKD can include medications, diet, and exercise. Overall adherence to treatment is low in CKD, and also as few as 40% of new kidney failure patients have any documented CKD-related care. The purpose of this study was to explore CKD patients’ experiences of adherence to treatment plans and what role their healthcare providers had in supporting adherence.

Methods

As part of a larger mixed-methods study of Chronic Renal Insufficiency Cohort (CRIC) study participants, a subset was randomly selected for 1:1 interviews. All CRIC participants are >45 years with CKD stages 1-4, and this sample consisted of University of Pennsylvania participants interviewed in 2019-2020. Participants described their experiences with adherence and what they have done when experiencing difficulty. Interviews were recorded, transcribed, and coded using conventional content analysis.

Results

The sample (n=32) had a mean age of 67 years, 53% women, 59% non-white. After analysis of factors relevant to treatment planning and adherence, four themes emerged: patient factors (multiple chronic conditions, motivation, outlook), provider factors (attentiveness, availability, communication), treatment planning factors (lack of plan, proactive patient research, provider-focused goals, and shared decision making), and patient responses to the treatment plan (disagreeing with treatment, frustration with their lack of adherence [“I know what to do”], lack of information, and positive feedback). Patients also described the impact of COVID on access to care and the positive impact of family, ancillary providers, and routines/habits.

Conclusion

These themes align with behavioral learning theory, which includes: internal antecedents (patient factors), external antecedents (provider factors), behavior (treatment planning and attempts at adherence), and consequences (adherence and responses to the treatment plan). Our results provide many potential points of intervention to support treatment adherence in CKD, and a tailored approach is needed to address patients' specific adherence factors.

Funding

  • Other NIH Support