Supporting Patient-Centered Pregnancy Counseling in Nephrology Care: A Semistructured Interview Study of Patients and Nephrologists

BackgroundIndividuals with chronic kidney disease (CKD) are at increased risk of adverse pregnancy outcomes and are susceptible to disempowerment and decisional burden when receiving reproductive counseling and considering pregnancy. Nephrologists do not commonly counsel about reproductive health, and no tools exist to support patient-centered reproductive counseling for those with CKD.MethodsThirty patients aged 18-45 with CKD stages 1-5 who were assigned female sex at birth and 12 nephrologists from a single academic medical center participated in semi-structured qualitative interviews. They were asked about information needs, decision-support needs, as well as facilitators and barriers to reproductive health care and counseling. Thematic analysis was performed.ResultsFour main themes were identified: 1) assessing reproductive intentions; 2) information about reproductive health and kidney disease; 3) reproductive risk; and 4) communication and decision-making needs. Patients’ reproductive intentions varied over time and shaped the content of information needed from nephrologists. Patients and nephrologists both felt risk communication could be improved but focused on different aspects to improve the quality of this counseling; nephrologists focused on providing individualized risk estimates and patients focused on balancing risks with benefits and management. Patients desired nephrologists to bring up the topic of reproductive health and counseling in kidney clinic, and this is not commonly or systematically done currently.ConclusionsThis work highlights a critical need for more dialog about reproductive health in kidney care, identified differences in what patients and nephrologists think is important in communication and decision-making, and provides an important step in developing patient-centered reproductive counseling tools in nephrology. Individuals with chronic kidney disease (CKD) are at increased risk of adverse pregnancy outcomes and are susceptible to disempowerment and decisional burden when receiving reproductive counseling and considering pregnancy. Nephrologists do not commonly counsel about reproductive health, and no tools exist to support patient-centered reproductive counseling for those with CKD. Thirty patients aged 18-45 with CKD stages 1-5 who were assigned female sex at birth and 12 nephrologists from a single academic medical center participated in semi-structured qualitative interviews. They were asked about information needs, decision-support needs, as well as facilitators and barriers to reproductive health care and counseling. Thematic analysis was performed. Four main themes were identified: 1) assessing reproductive intentions; 2) information about reproductive health and kidney disease; 3) reproductive risk; and 4) communication and decision-making needs. Patients’ reproductive intentions varied over time and shaped the content of information needed from nephrologists. Patients and nephrologists both felt risk communication could be improved but focused on different aspects to improve the quality of this counseling; nephrologists focused on providing individualized risk estimates and patients focused on balancing risks with benefits and management. Patients desired nephrologists to bring up the topic of reproductive health and counseling in kidney clinic, and this is not commonly or systematically done currently. This work highlights a critical need for more dialog about reproductive health in kidney care, identified differences in what patients and nephrologists think is important in communication and decision-making, and provides an important step in developing patient-centered reproductive counseling tools in nephrology.