Increasing Autonomous Motivation in ESRD to Enhance Phosphate Binder Adherence

描述（由申请方提供）：终末期肾病（ESRD）患者的高磷血症是全因和心血管死亡的非传统风险因素。在ESRD患者中，不依从磷结合剂的比例高达74%，并且已被证明与包括态度在内的社会心理因素最相关。关于影响的数据有限， 态度和知觉自主支持磷结合剂的坚持和这两个心理社会结构可以积极影响，通过使用动机访谈技巧，以增加自主的动机。此外，已知ESRD中存在种族差异，但在了解弱势ESRD患者依从性差异的决定因素方面仍存在差距。PI在100名透析患者中进行了一项初步研究，结果显示积极的态度与较高的粘合剂药物依从性相关（p=0.04），药物依从性与血清磷水平相关（p<0.001）。更大的自主性支持与更好的药物依从性（p=0.017）和更好的磷控制相关，并注意到种族之间的细微差异。本提案的总体目标是PI通过确定动机访谈对不同ESRD患者磷结合剂依从性的影响，获得关键研究经验和技能。通过该项目，PI将在研究设计，实施，分析和传播研究结果方面获得宝贵的研究经验，这些将有效地为成功的职业生涯奠定基础，成为以患者为导向的临床研究者。PI概述了通过MPH计划整合结构化研究培训的培训计划;指导研究经验;参加地方和国家研究会议/会议并积极参与创新和非常支持的研究环境。该提议的奖项将促进PI获得以患者为导向的临床研究的经验和全面培训，以（a）成功获得职业发展研究奖，以解决肾脏疾病的差异，并最终（B）为独立资助的研究职业生涯奠定基础，通过领导行为临床试验测试新型多层次策略并将其转化为临床护理，识别和克服护理差距。

DESCRIPTION (provided by applicant): Hyperphosphatemia in end-stage renal disease (ESRD) patients is a non-traditional risk factor for all-cause and cardiovascular mortality. Non-adherence to phosphate binders is as high as 74% in ESRD patients and has been shown to be most related to psychosocial factors including attitudes. There is limited data on the influence of attitudes and perceived autonomy support on phosphate binder adherence and these two psychosocial constructs can be positively influenced through the use of motivational interviewing skills to increase autonomous motivation. Furthermore, racial disparities are known to exist in ESRD however and there are still gaps, which exist in understanding the determinants of disparities in adherence in vulnerable patients with ESRD. The PI conducted a pilot study in100 prevalent dialysis patients, which revealed that positive attitudes correlated with higher binder medication adherence (p=0.04) and medication adherence correlated with serum phosphorus levels (p<0.001). Greater perceived autonomy support was associated with both better medication adherence (p=0.017) and better phosphorus control and subtle underlying differences by race were noted. The overarching objective of this proposal is for the PI to gain critical research experience and skills by determining the impact of motivational interviewing on phosphate binder adherence in diverse ESRD patients. Through this project, the PI will gain valuable research experience in study design, implementation, analysis and dissemination of research findings, and these will effectively set the foundation for a successful career as a patient-oriented clinical investigator. The PI has outlined a training plan that integrates structured research training through the MPH Program; a mentored research experience; participation in local and national research meetings / conferences and active involvement in an innovative and extremely supportive research environment. This proposed award will facilitate the PI to gain experience and comprehensive training in patient-oriented clinical research to (a) successfully obtain a career development research award to address disparities in kidney disease and ultimately to (b) set the stage for an independently funded research career identifying and overcoming gaps in care by leading behavioral clinical trials testing novel multi-level strategies and translating them to clinical care.