Kidney Week

Abstract: FR-PO1083

Implementing Comprehensive KRT Education in the Veterans Health Administration System: A Multilevel Stakeholder Qualitative Study

Session Information

• Home Dialysis: Modalities, Barriers, Utilization, and Clinical Outcomes
  October 23, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Schneider, Tali, University of South Florida, Tampa, Florida, United States

Tali Schneider, PhD

• Vyas, Anushka, University of Florida, Gainesville, Florida, United States

Anushka Vyas

• Ruiz Brito, Shaira Mariel, University of Florida, Gainesville, Florida, United States

Shaira Mariel Ruiz Brito

• Davis, Cornesia Dejuan, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Cornesia Dejuan Davis, MPH

• Shell, Popy, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Popy Shell, MPH

• Subhash, Shobha, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Shobha Subhash, MPH

• Shukla, Ashutosh M., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States

Ashutosh M. Shukla, MD, MBBS, FASN

• Campbell-Montalvo, Rebecca, University of South Florida, Tampa, Florida, United States

Rebecca Campbell-Montalvo, PhD

Group or Team Name

• ALIGN NFSG

Background

Veterans and the Veterans Health Administration (VHA) have emphasized the need to expand patient-centered home dialysis (HoD) use. Comprehensive Patient Education (CoPE) improves informed kidney replacement therapy (KRT) decision-making, particularly HoD uptake, yet remains inconsistently available. We conducted a qualitative stakeholder evaluation to identify multilevel determinants influencing system-based CoPE delivery for rural Veterans with advanced chronic kidney disease (CKD).

Methods

As part of a larger mixed-methods prospective study, we held 9 virtual focus groups with primary care providers (PCP; n=10), renal providers (RP; n=14), and VA center leaders (CL; n=12). The Theoretical Domains Framework (TDF), focusing on behavioral-related implementation determinants, guided data collection and analysis. Transcripts were coded to identify barriers and facilitators via iterative review with ≥80% intercoder reliability.

Results

Of the most frequently reported barriers and facilitators for each group, shared barriers across groups included fragmented patient communication/follow-up and limited site resources. Additional barriers differed by role: CL identified program cost and their own limited CoPE knowledge; PCP identified inadequate patient knowledge, limited social support, and lack of standardized protocols to integrating CoPE; RP emphasized challenges initiating CoPE early enough in CKD progression. All groups identified effective communication/follow-up as key facilitators. CL additionally highlighted facilitators of available resources, patient willingness, and social support; PCP emphasized patient knowledge and resources; RP identified site-related logistics for implementation feasibility.

Conclusion

Multilevel determinants shape VHA's ability to provide CoPE to eligible Veterans. Communication/follow-up difficulty and site resources emerged as shared barriers across groups, accordingly good communication/follow-up was a shared facilitator. Findings suggest that system-level efforts should prioritize standardized referral pathways, improved communication processes, leadership awareness of CoPE, and leveraging existing site resources and patient support systems to strengthen CoPE delivery.

Funding

• Veterans Affairs Support