Abstract
BackgroundKnowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management. The aim of this study was to analyze patient discourse on ongoing CKD monitoring encounters for health communication strategies that motivate patient engagement.MethodsPassages regarding CKD monitoring from 6 focus group transcripts on self-management with a total of 30 participants age ≥ 70 years from the Atlanta Veterans Affairs Renal Clinic across three different CKD trajectories (stable, linear decline, and non-linear) were extracted. These passages were examined using three-stage critical discourse analysis (description, interpretation, explanation) for recurring patterns across groups.ResultsFocus group participants were an average age of 75.1, 96.7% male, and 60% Black. Passages relating to CKD monitoring (n = 55) yielded predominantly negative communication themes. Perceived negative communication was characterized through a patient discourse of unequal exchange, whereby engaged patients would provide bodily fluids and time for appointments and continued to wait for meaningful, contextualized monitoring information from providers and/or disengaged providers who withheld that information. However, some encounters were depicted as helpful. Perceived positive communication was characterized by a patient discourse of kidney protection, whereby patients and providers collaborate in the mutual goal of preserving kidney function.ConclusionsPatient perceived an unequal exchange in CKD monitoring encounters. This perception appears rooted in a lack of easily understandable information. By accessing the positive discourse of protecting the kidneys (e.g., through eGFR level) vs. the discourse of damage (e.g., serum creatinine level), healthcare professionals can clarify the purpose of monitoring and in ways that motivate patient engagement in self-management. Patients being monitored for CKD progression may best be supported through messaging that conceptualizes monitoring as kidney protection and provides concrete contextualized information at each monitoring encounter.
Highlights
Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers can inform the important clinical goal of engaging patients in their chronic disease self-management
CKD is numerically communicated to patients in one of two ways, either in terms of damage to the kidney or in terms of remaining kidney function (the estimated glomerular filtration rate scale) [2]
Clinical practice guidelines recommend patients follow a set of recommendations regarding medications and lifestyle, including regular monitoring visits to prevent further declines in Estimated glomerular filtration rate (eGFR), to identify CKD complications, and to prepare patients for transplant or dialysis if kidney failure occurs [2]
Summary
Knowing how chronic kidney disease (CKD) patients talk about their encounters with providers (i.e., their discourse) can inform the important clinical goal of engaging patients in their chronic disease self-management. Clinical practice guidelines recommend patients follow a set of recommendations regarding medications and lifestyle, including regular monitoring visits to prevent further declines in eGFR, to identify CKD complications, and to prepare patients for transplant or dialysis if kidney failure occurs [2]. Among older adults, this situation is often complicated by an unpredictable (i.e., non-linear) trajectory of kidney function and the competing risk of death due to co-occurring chronic conditions before kidney failure occurs [3, 4]. Evidence suggests that CKD patients do not understand the goal of these regular monitoring visits, in part due to limitations in patients’ disease knowledge and in provider communications about CKD [5,6,7]
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