Rivera Eleanor, Clark-Cutaia Maya N, Schrauben Sarah J, Townsend Raymond R, Lash James P, Hannan Mary, Jaar Bernard G, Rincon-Choles Hernan, Kansal Sheru, He Jiang, Chen Jing, Hirschman Karen B
Department of Population Health Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL.
Rory Meyers College of Nursing, New York University, New York, NY.
Kidney Med. 2022 Sep 20;4(11):100545. doi: 10.1016/j.xkme.2022.100545. eCollection 2022 Nov.
RATIONALE & OBJECTIVE: Adherence to recommended medical treatment is critical in chronic kidney disease (CKD) to prevent complications and progression to kidney failure. Overall adherence to treatment is low in CKD, and as few as 40% of patients with kidney failure receive any documented CKD-related care. The purpose of this study was to explore the experiences of patients with CKD and their adherence to CKD treatment plans, and the role their health care providers played in supporting their adherence.
One-on-one interviews were conducted in 2019-2020 using a semi-structured interview guide. Participants described experiences with adherence to treatment plans and what they did when experiencing difficulty.
SETTING & PARTICIPANTS: Participants were recruited from the Chronic Renal Insufficiency Cohort (CRIC) study. All CRIC participants were older than 21 years with CKD stages 2-4; this sample consisted of participants from the University of Pennsylvania CRIC site.
Interviews were recorded, transcribed, and coded using conventional content analysis. Data were organized into themes using NVivo 12.
The sample (n = 32) had a mean age of 67 years, 53% were women, 59% were non-White, with a mean estimated glomerular filtration rate of 56.6 mL/min/1.73 m. From analysis of factors relevant to treatment planning and adherence, following 4 major themes emerged: patient factors (multiple chronic conditions, motivation, outlook), provider factors (attentiveness, availability/accessibility, communication), treatment planning factors (lack of plan, proactive research, provider-focused treatment goals, and shared decision making), and treatment plan responses (disagreeing with treatment, perceived capability deficit, lack of information, and positive feedback).
The sample was drawn from the CRIC study, which may not be representative of the general population with CKD.
These themes align with Behavioral Learning Theory, which includes concepts of internal antecedents (patient factors), external antecedents (provider factors), behavior (treatment planning factors), and consequences (treatment plan responses). In particular, the treatment plan responses point to innovative potential intervention approaches to support treatment adherence in CKD.
坚持推荐的医学治疗对于慢性肾脏病（CKD）预防并发症及进展至肾衰竭至关重要。CKD患者总体治疗依从性较低，仅有40%的肾衰竭患者接受过任何有记录的CKD相关护理。本研究旨在探索CKD患者的经历及其对CKD治疗计划的依从性，以及其医疗服务提供者在支持其依从性方面所起的作用。
2019年至2020年采用半结构化访谈指南进行一对一访谈。参与者描述了坚持治疗计划的经历以及遇到困难时的做法。
参与者从慢性肾功能不全队列（CRIC）研究中招募。所有CRIC参与者年龄均超过21岁，处于CKD 2至4期；该样本由宾夕法尼亚大学CRIC站点的参与者组成。
访谈进行录音、转录，并使用常规内容分析法进行编码。使用NVivo 12将数据整理成主题。
样本（n = 32）的平均年龄为67岁，53%为女性，59%为非白人，平均估计肾小球滤过率为56.6 mL/min/1.73 m²。通过对与治疗计划和依从性相关因素的分析，出现了以下4个主要主题：患者因素（多种慢性病、动机、前景）、提供者因素（专注度、可及性/可获得性、沟通）、治疗计划因素（缺乏计划、主动研究、以提供者为中心的治疗目标、共同决策）以及治疗计划反应（不同意治疗、感知能力不足、信息缺乏、积极反馈）。
样本取自CRIC研究，可能不代表CKD一般人群。
这些主题与行为学习理论相符，该理论包括内部前提（患者因素）、外部前提（提供者因素）、行为（治疗计划因素）和后果（治疗计划反应）等概念。特别是，治疗计划反应指出了支持CKD治疗依从性的创新潜在干预方法。
