Treatment adherence support and relationships with CKD providers: A qualitative analysis

ABSTRACT

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 11 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% nonwhite. 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. Conclusions: 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.