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.
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.
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.
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.
ClinicalTrials.gov Identifier NCT03244189.
BMC nephrology. 2024 May 28*** epublish ***
Peter P Reese, Salima Shah, Emily Funsten, Sandra Amaral, Janet Audrain-McGovern, Kristen Koepsell, Hunter Wessells, Jonathan D Harper, Rebecca McCune, Charles D Scales, Ziya Kirkali, Naim M Maalouf, H Henry Lai, Alana C Desai, Hussein R Al-Khalidi, Gregory E Tasian
Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. ., 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., 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., Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.