Patient and Clinician Perspectives on Chronic Pain Communication in Advanced Kidney Disease.
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2026-04
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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.Type
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Ma, Jessica E, Elena Uejo, Stella Quenstedt, Doreet Preiss, Jessica Sperling, Tyffany D Locklear, Julia Gambino, C Barrett Bowling, et al. (2026). Patient and Clinician Perspectives on Chronic Pain Communication in Advanced Kidney Disease. Journal of the American Geriatrics Society. 10.1111/jgs.70439 Retrieved from https://hdl.handle.net/10161/34914.
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Scholars@Duke
Jessica Ma
Christopher Barrett Bowling
I am a geriatrician with research training in population health and chronic disease epidemiology. Through my work, I aim to inform patient-centered care that focuses on optimizing function and quality of life over traditional disease-based approaches. Much of my work has focused on chronic kidney disease, however I have recently broadened the scope of investigation to include other chronic conditions including hypertension and systemic lupus erythematosus. The unifying theme of this work has been applying a geriatric research approach to large studies of chronic disease. As Associate Director of Clinical Programs at the Durham VA Geriatric Research Education and Clinical Center, I have also had the opportunity to partner with nephrologists to develop clinical programs in the VA designed to provide patient-centered, geriatric care for older adults with kidney disease.
Christopher Ethan Cox
My work is conducted as a clinician, researcher, teacher, and administrator at Duke University. Currently, I am a Professor of Medicine with Tenure and the Director of the Duke Program to Support People and Enhance Recovery (ProSPER). My clinical work is based in ICUs at Duke University, though I am also a board-certified palliative medicine specialist.
My research focuses on understanding and improving the experience of critical illness and quality of care for patients, their families and loved ones, clinicians, and society in general. To do this, my work addresses topics and methodologies including digital technologies, health services research, behavioral and psychological concerns, communication improvement, and decision making support—all in the context of critical care and palliative medicine. I am very active in clinical trials as well. Our group is exceedingly, sincerely grateful for having been continuously funded by NIH since 2009. We cannot thank enough the patients, family members, and clinicians who have been included in our research over the years.
I am very active mentoring others. Not only is this a true joy, but also how I keep learning from others.
Key interests: Critical care, healthcare information technology, critical care echocardiography, mobile apps, AI
Joseph G Winger
Joseph G. Winger, PhD, is a licensed clinical psychologist and an Associate Professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. Dr. Winger's research focuses on developing and testing novel psychosocial interventions for patients facing life-limiting illnesses. His work emphasizes addressing spiritual and existential aspects of coping with debilitating symptoms, particularly maintaining a sense of meaning and purpose in life. His research has been supported by grants from the National Cancer Institute (R01CA291768), American Cancer Society (RSG-22-072-01-CTPS; PF-17-054-01-PCSM), and National Palliative Care Research Center (Kornfeld Scholar Award). Dr. Winger also serves as co-director of the Cognitive Behaviorally Informed Skills Training (CBIST) Program for Physical and Occupational Therapists. The CBIST program trains non-behavioral health specialists to integrate evidence-based cognitive and behavioral skills into their clinical practice to improve quality of care and patient outcomes.
Hayden Barry Bosworth
Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities.
Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.
Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy
Karen E. Steinhauser
Dr. Steinhauser's primary interests are end-of-life care, medical sociology and patient-provider relationships. Specifically, she investigates the composition and measurement of the quality of life for patients and their families at the end of life. Dr. Steinhauser is a Health Scientist with the Center for Health Services Research in Primary Care, VA Medical Center, Durham; Professor, Department of Population Health Science and Medicine; Senior Fellow with the Duke University Center for Aging; Associate Chief for Research, Duke Palliative Care, and Director, Duke Residency Professional Development Coaching Program.
Karen E. Steinhauser, PhD is a social scientist dedicated to improving quality of life of patients, families, and providers during serious illness. She is a Health Scientist with the Center for Health Services Research in Primary Care, VA Medical Center, Durham and Professor, Department of Medicine, Duke University Medical Center, Senior Fellow with the Duke University Center for Aging, and a former VA Career Development Awardee.
Karen Steinhauser, PhD, is Professor, Departments of Population Health Sciences and Medicine, Duke University Medical Center and Senior Fellow with the Duke University Center for Aging and Health Scientist with the Center for Health Services Research in Primary Care, VA Medical Center, Durham. Her research is dedicated to improving patient and family psychosocial and spiritual care, in serious illness. She has developed measurement tools to assess patient and family quality of life as well as psychosocial interventions to improve the experience of serious illness for patients and those who care for them. Dr. Steinhauser's research has used qualitative and qualitative methods, observational, trial and implementation research. Her latest work includes: developing a measure to assess the spiritual needs in palliative care, and addressing clinician resilience in palliative care. She serves as Associate Chief of Research for Duke Palliative Care, and Director of the Duke Residency Professional Development Coaching program. She has been a long-term member of AAHPM, having served on the research committee and being the 2015 Awardee for Excellence in Scientific Research in Palliative Care. She is the Director of Duke’s Residency Professional Development Coaching Program.
Area of expertise: Palliative Care, Qualitative Research
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