Research Project

INtegrating IllneSs Perceptions to Improve the PatienT-Provider Encounter for CKD (INSITE-CKD): A Pilot Study

Principal Investigator: Dunn, Susan L
Start Date: 2022-09-01
End Date: 2024-06-30
Funding Source: University of Chicago

Abstract

Chronic kidney disease (CKD) effects 1 in 7 adults in the U.S., with higher rates among racial and ethnic minority patients. Early-stage CKD patients often have no symptoms, however, progression to kidney failure has an enormous impact on quality of life, risk of death, and healthcare costs. Adhering to recommendations for medication, diet, and exercise are critical to slowing CKD progression, but many patients struggle with adherence. Recognizing patients as an important member of the care team allows the person to provide crucial insights about their unique perceptions and preferences to inform treatment. However, primary care providers (PCPs) face barriers to tailor care to patients, including a lack of time and resources. Tailored care is even less likely to occur for patients who need more complex care (e.g., older adults) and/or when there is racial/cultural discordance (e.g., racial/ethnic minorities). A strategy developed by the NIH is the routine measurement of data from patients using standardized measures (PROMIS) to enhance communication between patients and providers. Using a PROMIS-style standardized method of assessing patients’ lived experience with illness could be a time and resource-efficient method for providers to gather information about a patient and tailor treatment to best meet patients’ needs. Illness perceptions, or the unique way an individual understands their chronic condition, incorporate multiple, complex factors, including cultural norms about health and disease as well as personal and interpersonal experiences and can impact engagement in health behaviors. We propose the integration of illness perceptions within the clinic encounter, as they provide critical clinical information. An illness perceptions-based intervention is needed to promote positive patient-provider communication and appropriately tailored treatment plans to improve treatment adherence and patient health and wellness. This is especially critical for early-stage CKD patients who have been the target of few interventions to date to improve adherence and delay or prevent disease progression. Our intervention, INtegrating IllneSs Perceptions to Improve the PatienT-Provider Encounter for CKD (INSITE-CKD), trains PCPs to use systematically collected illness perceptions data as they engage with the patient during the clinic visit. The purpose of this study is to pilot test INSITE-CKD in 20 CKD patients, to explore potential outcomes related to the clinic visit and patient health, and to determine if the intervention is feasible and acceptable to patients and PCPs as a possible transformation of a primary care visit. The sample will come from the Mile Square Health Center in Chicago, a Federally Qualified Health Center with a high percentage of historically excluded populations. This health equity approach to clinical practice has the potential to begin to reduce persistent racial/ethnic minority disparities in chronic disease treatment and health outcomes though the respectful centering of the patient as a whole person who lives outside of the clinical encounter. Furthermore, this patient-centered approach is pragmatic and resource-conscious and designed for implementation in low-resource settings, with excellent potential for translation into practice.