Abstract: TH-PO0017
How Social Influences Affect KRT Decision-Making: A Four-Part Synergistic Support Structure
Session Information
- Educational Research Within and Across Disciplines
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Educational Research
- 1000 Educational Research
Authors
- Campbell-Montalvo, Rebecca, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Ruiz Brito, Shaira Mariel, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Davis, Cornesia Dejuan, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Shell, Popy, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Subhash, Shobha, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Ftouni, Darin, US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
- Shukla, Ashutosh M., US Department of Veterans Affairs Veterans Health Administration, Washington, District of Columbia, United States
Background
Selection of kidney replacement therapy (KRT), including dialysis modalities or conservative care, is complex and influenced by clinical and non-clinical factors. While epidemiological studies suggest that social influences affect KRT decisions and kidney failure outcomes, we lack mechanistic insight into how they mediate these events.
Methods
Within the qualitative arm of the TEACH-VET trial, we developed an interview guide grounded in the Theoretical Domains Framework (TDF) focused on Veterans’ capacity for informed KRT decision-making and identifying drivers to home dialysis selection and use. The present thematic analysis focuses on the “Social Influences” code, which captured interview narratives about social influences, like caregivers, family, friends, or others, and their impact on patient KRT decisions.
Results
We invited 45 of the 544 TEACH-VET enrollees for qualitative interviews; 42 participated (83% men; 67% white, 31% black). Found in all interviews, “Social Influences” was the second most detected concept, after “Knowledge” (i.e., participant medical information). Findings reveal a four-part synergistic support structure between patients and one or more social influences, generally involving a combination of 1) a relationship where KRT is a jointly-owned issue requiring cooperative decision-making, 2) provision of physical support—ongoing or anticipated (e.g., someone at home to lift dialysate bags), 3) provision of emotional support—direct or indirect (e.g., feelings of security knowing their spouse can help if they encounter a problem), and 4) shared discussion to make sense of the diagnosis and treatment options.
Conclusion
The domain of social influences within the TDF exerts a great impact on patients’ KRT decision-making, through its impact on other TDF domains, primarily emotion, environmental context, and intentions, and secondarily, patient beliefs about capabilities, skills, and knowledge. Thus, the systematic integration of social influences into KRT-directed patient education and treatment planning is essential to support informed, patient-centered KRT decisions and associated positive outcomes.
Funding
- Other U.S. Government Support