Patient and Clinician Perspectives on Chronic Pain Communication in Advanced Kidney Disease

IF 4.6 2区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of the American Geriatrics Society Pub Date : 2026-09-19 Epub Date: 2026-04-15 DOI:10.1111/jgs.70439

Jessica E. Ma, Elena Uejo, Stella Quenstedt, Doreet Preiss, Jessica Sperling, Tyffany D. Locklear, Julia Gambino, C. Barrett Bowling, Andrea L. Chadwick, Christopher E. Cox, Karl A. Lorenz, Lynne Matallana, Joseph G. Winger, Hayden B. Bosworth, Karen Steinhauser

{"title":"Patient and Clinician Perspectives on Chronic Pain Communication in Advanced Kidney Disease","authors":"Jessica E. Ma, Elena Uejo, Stella Quenstedt, Doreet Preiss, Jessica Sperling, Tyffany D. Locklear, Julia Gambino, C. Barrett Bowling, Andrea L. Chadwick, Christopher E. Cox, Karl A. Lorenz, Lynne Matallana, Joseph G. Winger, Hayden B. Bosworth, Karen Steinhauser","doi":"10.1111/jgs.70439","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Chronic pain is highly prevalent among older adults with advanced chronic kidney disease (CKD stage 4, stage 5, and end-stage kidney disease [ESKD]). Yet, pain management involves a delicate balance between alleviating symptoms and avoiding harm related to impaired renal drug clearance and the high risk of medication side effects. Because little is known about how patients and clinicians navigate these complex pain management conversations, we examined patient and provider perspectives on communication and decision making in chronic pain and advanced kidney disease.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We conducted a qualitative study using semi-structured interviews based on the Ottawa Decision Support Framework. Participants included older adults (age ≥ 65) with both advanced CKD and chronic pain lasting ≥ 3 months and physicians and advanced practice providers from primary care, geriatrics, nephrology, and palliative care. We used thematic analysis to summarize major themes on communication and decision making.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>We interviewed 48 participants, including 24 older adults with advanced kidney disease and chronic pain and 24 clinicians, with 6 clinicians from each specialty. Three major themes about barriers to effective communication emerged: (1) treatment complexity and uncertainty; (2) fragmentation of care across specialties and the care team; and (3) divergent treatment preferences between patients and clinicians. Communication strategies to overcome these barriers included: open communication, multidisciplinary care team collaboration, patient advocacy, and relationship- and values-centered decision making.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>This study highlighted key barriers and potential communication strategies among older adults with chronic pain and advanced kidney disease. These findings can inform the development of targeted interventions that support patients and clinicians in navigating these complex conversations and decisions.</p>\n </section>\n </div>","PeriodicalId":17240,"journal":{"name":"Journal of the American Geriatrics Society","volume":"74 9","pages":"2511-2519"},"PeriodicalIF":4.6000,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American Geriatrics Society","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/jgs.70439","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/4/15 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Chronic pain is highly prevalent among older adults with advanced chronic kidney disease (CKD stage 4, stage 5, and end-stage kidney disease [ESKD]). Yet, pain management involves a delicate balance between alleviating symptoms and avoiding harm related to impaired renal drug clearance and the high risk of medication side effects. Because little is known about how patients and clinicians navigate these complex pain management conversations, we examined patient and provider perspectives on communication and decision making in chronic pain and advanced kidney disease.

Methods

We conducted a qualitative study using semi-structured interviews based on the Ottawa Decision Support Framework. Participants included older adults (age ≥ 65) with both advanced CKD and chronic pain lasting ≥ 3 months and physicians and advanced practice providers from primary care, geriatrics, nephrology, and palliative care. We used thematic analysis to summarize major themes on communication and decision making.

Results

We interviewed 48 participants, including 24 older adults with advanced kidney disease and chronic pain and 24 clinicians, with 6 clinicians from each specialty. Three major themes about barriers to effective communication emerged: (1) treatment complexity and uncertainty; (2) fragmentation of care across specialties and the care team; and (3) divergent treatment preferences between patients and clinicians. Communication strategies to overcome these barriers included: open communication, multidisciplinary care team collaboration, patient advocacy, and relationship- and values-centered decision making.

Conclusions

This study highlighted key barriers and potential communication strategies among older adults with chronic pain and advanced kidney disease. These findings can inform the development of targeted interventions that support patients and clinicians in navigating these complex conversations and decisions.

查看原文本刊更多论文

晚期肾病患者与临床对慢性疼痛交流的看法。

背景：慢性疼痛在患有晚期慢性肾病（CKD 4期、5期和终末期肾病[ESKD]）的老年人中非常普遍。然而，疼痛管理需要在缓解症状和避免损害肾脏药物清除和药物副作用的高风险之间取得微妙的平衡。由于对患者和临床医生如何进行这些复杂的疼痛管理对话知之甚少，我们研究了慢性疼痛和晚期肾病患者和提供者在沟通和决策方面的观点。方法：采用基于渥太华决策支持框架的半结构化访谈进行定性研究。参与者包括患有晚期CKD和慢性疼痛持续≥3个月的老年人（年龄≥65岁），以及来自初级保健、老年病学、肾脏病学和姑息治疗的医生和高级实践提供者。我们使用主题分析来总结沟通和决策的主要主题。结果：我们采访了48名参与者，包括24名患有晚期肾脏疾病和慢性疼痛的老年人和24名临床医生，每个专业6名临床医生。关于有效沟通障碍的三个主要主题：(1)治疗的复杂性和不确定性；(2)专科和护理团队之间的护理碎片化；(3)患者与临床医生治疗偏好的差异。克服这些障碍的沟通策略包括：开放沟通、多学科护理团队合作、患者倡导以及以关系和价值观为中心的决策。结论：这项研究强调了慢性疼痛和晚期肾脏疾病的老年人之间的主要障碍和潜在的沟通策略。这些发现可以为制定有针对性的干预措施提供信息，支持患者和临床医生在这些复杂的对话和决策中进行导航。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of the American Geriatrics Society 医学-老年医学

CiteScore

10.00

自引率

6.30%

发文量

504

审稿时长

3-6 weeks

期刊介绍： Journal of the American Geriatrics Society (JAGS) is the go-to journal for clinical aging research. We provide a diverse, interprofessional community of healthcare professionals with the latest insights on geriatrics education, clinical practice, and public policy—all supporting the high-quality, person-centered care essential to our well-being as we age. Since the publication of our first edition in 1953, JAGS has remained one of the oldest and most impactful journals dedicated exclusively to gerontology and geriatrics.