ArticleJournal of the American Geriatrics Society2026
Patient and Clinician Perspectives on Chronic Pain Communication in Advanced Kidney Disease.
Article in Journal of the American Geriatrics Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundChronic 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.
methodsWe 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.
resultsWe 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.
conclusionsThis 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.
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