Conservative Kidney Management Jumpstart: Designing a Behavioral Nudge to Jumpstart Conversations about Conservative Kidney Management between Patients and Nephrologists.

key pointsBehavioral nudging can activate nephrologists to adopt new behaviors around discussing conservative kidney management with patients. Conservative kidney management Jumpstart is a nudge that offers nephrologists a framework and words-to-try to discuss health care values and conservative kidney management with patients. Conservative Kidney Management Jumpstart nudged nephrologists to discuss values and conservative kidney management with patients and revealed persistent challenges with these discussions.

backgroundNephrologists do not routinely discuss conservative kidney management (CKM) with their patients, hindering informed decision-making about kidney failure treatments. Nudges are interventions that facilitate behavior change and may assist nephrologists with discussing CKM.

methodsWe designed a behavioral nudge, called CKM Jumpstart, to assist nephrologists with discussing CKM with their patients. CKM Jumpstart was developed using human-centered design principles in 3 phases: ( 1 ) Discovery (March-June 2022): literature review and deliberation about the challenges to discussing CKM with an advisory panel; ( 2 ) Design (June-December 2022): multiple cycles of prototyping of CKM Jumpstart with input from the advisory panel and ten nephrologists across the United States; and ( 3 ) Implementation (April 2023-July 2025): testing a final version of CKM Jumpstart in 36 clinic visits with 19 nephrologists recruited from the greater Seattle area and conducting qualitative interviews with nephrologists about their experiences using CKM Jumpstart.

resultsIn the Discovery phase, we identified four major challenges to discussing CKM: ( 1 ) attitudes favoring dialysis as the norm; ( 2 ) lack of clarity about patients' health care values; ( 3 ) difficulty describing CKM; and, ( 4 ) fear of upsetting patients. The Design phase produced a prototype of CKM Jumpstart that addressed these challenges by providing a communication framework and example language that nephrologists could try to discuss patients' health care values and CKM. During the Implementation phase, all the nephrologists tried CKM Jumpstart at least once and were nudged to have conversations about values, CKM, and/or kidney failure treatment options more broadly. Nephrologists selectively used parts of CKM Jumpstart that suited their communication style. Some felt conversations occurred too early in patients' disease course and were uncertain about how to address conflicting values and treatment preferences.

conclusionsBehavioral nudging assists nephrologists with discussing health care values and CKM with patients. It can also reveal persistent challenges with having these discussions among nephrologists. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: A Pilot Study of The CKM JumpStart Tool, NCT05753020 .