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Author Notes:

Correspondence: barrett.bowling@duke.edu, 3 Durham Geriatric Research, Education, and Clinical Center, Department of Veterans Affairs, Durham VA Medical Center, Durham, North Carolina, USA

Authors’ contributions: AEV analyzed the study data.

CBB, KVE, and TMJ conceived and designed the original study.

KVE facilitated the focus groups.

AEV, CBB, and KVE, interpreted the data and prepared the manuscript.

All authors read and approved the final manuscript.

Acknowledgements: We thank all the Veterans who participated in this study.

Disclosures: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

The authors declare that they have no competing interests


Research Funding:

This work was supported by a Career Development Award Level 2 from the US Department of Veterans Affairs (1IK2CX000856- 01A1) to C.B.B.

The funding source had no involvement in study design, data collection, data interpretation, or writing of the report.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Urology & Nephrology
  • Health communication
  • Chronic kidney disease
  • Chronic disease self-management
  • Patient engagement
  • Patient-centered care
  • CARE
  • CKD

Patient discourse on chronic kidney disease monitoring: a qualitative study at a Veterans Affairs Renal Clinic


Journal Title:

BMC Nephrology


Volume 19, Number 1


, Pages 183-183

Type of Work:

Article | Final Publisher PDF


Background: 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. The aim of this study was to analyze patient discourse on ongoing CKD monitoring encounters for health communication strategies that motivate patient engagement. Methods: Passages 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. Results: Focus 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. Conclusions: Patient 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.

Copyright information:

© 2018 The Author(s).

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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