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Randomized Controlled Trial
. 2025 Oct:139:109254.
doi: 10.1016/j.pec.2025.109254. Epub 2025 Jul 5.

Understanding how patient education affects the process of treatment decision-making: Cultural model change in kidney disease therapy

Rebecca Campbell-Montalvo  1 , Darin Ftouni  2 , Popy Shell  3 , Shobha Subhash  3 , Kailyn Pearce  3 , Ashutosh M Shukla  4
Affiliations
Randomized Controlled Trial

Understanding how patient education affects the process of treatment decision-making: Cultural model change in kidney disease therapy

Rebecca Campbell-Montalvo et al. Patient Educ Couns. 2025 Oct.

Abstract

Objective: Chronic kidney disease affects 1 in 7 people in the US, and 1 in 6 US Veterans. Treatment for kidney failure includes home dialysis, which, despite its benefits, is infrequently used. A major barrier to using home dialysis is receiving adequate education about it. This research investigates how patient education affects treatment choices of Veterans with kidney disease.

Methods: As part of a randomized control trial, we interviewed 42 US Veterans with advanced chronic kidney disease. An interview based on the Theoretical Domains Framework elicited on the impact of study education on decision-making. Reflexive thematic analysis attuned to cultural model theory-the beliefs which motivate behavior held by groups-was used for analysis.

Results: There were four themes in the data: 1) Pre-education, patients had a lack of knowledge of kidney disease and treatment. 2) After education, patients reacted with surprise and then coping actions. 3) Patients experienced positive emotions and beliefs from education and coping. 4) Patients dealt with diagnosis and engaged in treatment decision-making. Ten cognitive, emotional, and behavioral subthemes were seen. Themes were found in the interviews of 76 % of participants receiving comprehensive patient education, but only 27 % of those receiving enhanced usual care.

Conclusion: We provide a mechanistic understanding of the process through which education affects cultural models to support patients' decision-making by preparing and equipping them to confront the future. We note that cultural model changes occur across longitudinal stages, which are recursive with one another and dynamic based on the individual case.

Practice implications: Because optimal dialysis outcomes require time to plan, create, and heal from dialysis access surgery, practitioners should provide patient education 6 months prior to estimated start to account for time needed for cultural model change. Helping patients know what to expect in terms of their own changing understanding may further support.

Keywords: Home dialysis choice; Medical anthropology; Qualitative; Theoretical Domains Framework; Veterans.

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Conflict of interest statement

Declaration of Competing Interest AMS reports additional ongoing research support from the US Department of Veterans Affairs, Clinical Science Research and Development award I01CX001661, consultancy agreements with Chemocentryx Inc, and an advisory or leadership role for the VHA National Peritoneal Dialysis Workgroup. The other authors declare that they have no relevant financial interests.

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