Educating, Contextualizing, and Deferring: Qualitative Investigation of Physician Communication About Chronic Kidney...

Chronic Kidney Disease (CKD) is a prevalent condition requiring ongoing patient counseling and engagement, yet little is known about how physicians communicate with patients about CKD in routine clinical practice. We conducted a qualitative study to examine physician communication approaches related to CKD and to assess how these approaches align with Picker's principles of patient-centered care framework.

Semi-structured interviews were conducted with primary care physicians and nephrologists practicing in community and safety-net settings. Using directed content analysis, we identified patterns in how clinicians describe educating patients, contextualizing clinical information, and deferring aspects of counseling to other providers.

Physicians predominantly emphasized information-giving and the use of laboratory data to explain disease status. In contrast, practices such as explicit patient preference elicitation, addressing fear, anxiety, or physical comfort, and involving family or support persons were infrequently described. Mapping these communication behaviors to patient-centered care principles highlighted specific elements that are routinely enacted and others that remain underutilized in everyday CKD counseling.

These findings identify concrete, feasible opportunities to strengthen patient-centered communication through brief, practice-ready strategies such as plain-language explanations, teach-back, values checks, and shared decision-making prompts. Enhancing these communication practices represents a pragmatic opportunity to improve the quality and patient-centeredness of CKD care.