Using structured problem solving to promote fluid consumption in the prevention of urinary stones with hydration (PUSH) trial.

Janet Audrain-McGovern, Sandra Amaral, Hunter Wessells, Ziya Kirkali, Hussein R Al-Khalidi, H Henry Lai, Peter P Reese, Gregory E Tasian, Naim M Maalouf, Jonathan D Harper, Alana C Desai, Charles D Scales, Salima Shah, Emily Funsten, Kristen Koepsell, Rebecca McCune

Journal: BMC nephrology 2024;25(1):183

PMID: 38807063

Free Full Text on BioMed Central View on PubMed

Abstract

BACKGROUND

Structured Problem Solving (SPS) is a patient-centered approach to promoting behavior change that relies on productive collaboration between coaches and participants and reinforces participant autonomy. We aimed to describe the design, implementation, and assessment of SPS in the multicenter Prevention of Urinary Stones with Hydration (PUSH) randomized trial.

METHODS

In the PUSH trial, individuals with a history of urinary stone disease and low urine output were randomized to control versus a multicomponent intervention including SPS that was designed to promote fluid consumption and thereby prevent recurrent stones. We provide details specifically about training and fidelity assessment of the SPS coaches. We report on implementation experiences related to SPS during the initial conduct of the trial.

RESULTS

With training and fidelity assessment, coaches in the PUSH trial applied SPS to help participants overcome barriers to fluid consumption. In some cases, coaches faced implementation barriers such as variable participant engagement that required tailoring their work with specific participants. The coaches also faced challenges including balancing rapport with problem solving, and role clarity for the coaches.

CONCLUSIONS

We adapted SPS to the setting of kidney stone prevention and overcame challenges in implementation, such as variable patient engagement. Tools from the PUSH trial may be useful to apply to other health behavior change settings in nephrology and other areas of clinical care.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier NCT03244189.

Address: Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. [email protected].; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 917 Blockley Hall | 423 Guardian Drive, Philadelphia, PA, 19104, USA. [email protected].; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.; University of New Mexico School of Medicine, Albuquerque, NM, USA.; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.; Department of Psychiatry, Perelman School of Medicine, Philadelphia, PA, USA.; Bristol Myers Squibb, Princeton, NJ, USA.; Department of Urology, University of Washington, Seattle, WA, USA.; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.; Department of Surgery (Urology), Duke Surgical Center for Outcomes Research & Equity in Surgery, Duke University School of Medicine, Durham, NC, USA.; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.; National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA.; Department of Internal Medicine and Charles and Jane Pak Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, TX, USA.; Department of Surgery (Urology), Washington University in St. Louis, St. Louis, MO, USA.; Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA.; Department of Surgery (Urology), Washington University in St. Louis, St. Louis, MO, USA.; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.; Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA.; Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.; University of New Mexico School of Medicine, Albuquerque, NM, USA.

DOI: 10.1186/s12882-024-03605-y

Link outs

Free resources

Full Text Sources:

Medical:

https://clinicaltrials.gov/search?term=AREA%5BRefe...

MeSH Terms: Humans, Problem Solving, Urinary Calculi, Drinking, Male, Female, Drinking Behavior