Capacity Coaching: A Novel Patient-Centered Method to Support Self-Management in CKD

Background: Patients with end-stage kidney disease (ESKD) must intensify self-management activities as they initiate dialysis. When self-management demands exceed their capacity to cope, patients experience treatment burden which is associated with non-adherence. Capacity Coaching is a novel, evidence-based intervention consisting of six or more sessions every two to four weeks based on patient need designed to increase patient capacity and reduce treatment burden. We aimed to determine the most common self-management challenges addressed in coaching sessions in patients completing Capacity Coaching visits as part of a pilot randomized trial. Methods: We conducted a qualitative content analysis of Capacity Coaching notes from encounters with trial participants. To participate in the trial, patients had to be receiving any modality of dialysis treatment and without any major barriers (e.g. cognitive impairment) to consent in English. Results: Coaching notes were available for 12 participants.Coaching topics were widely varied between patients, highlighting the individualized nature of the Capacity Coaching relationship. Topics included energy management to handle fatigue, increasing physical activity safely, transplant preparation after approval, transplant evaluation requirements including weight loss, mindset, life goals, grief from progression of disease, and transitioning from in-center to home dialysis. Participants who completed all six coaching appointments either reached their goals or planned to continue working on achieving them. Conclusion: Capacity Coaching meets a wide range of patient-directed needs for self-management support. This finding, combined with positive quantitative findings from the pilot trial suggests this novel coaching approach is useful for patients receiving dialysis. Next steps include conducting a larger trial enrolling participants also at earlier stages of chronic kidney disease and studying capacity coaching in patients with other nephropathies. Funding: Other U.S. Government Support