# Harnessing Behavior to Decrease Urinary Stone Disease Morbidity Research Project

> **NIH NIH U01** · CHILDREN'S HOSP OF PHILADELPHIA · 2020 · $738,143

## Abstract

PROJECT SUMMARY
 This proposal is motivated by the following observations: 1) Fluid intake is a safe and effective method
to reduce urinary stone recurrence, but adherence is low; 2) Ureteral stents cause pain for many patients
despite pharmacologic treatments; 3) Behavior- the way that we respond to a situation or stimulus- is a critical
determinant of treatment adherence and the perception of pain; and 4) Behavioral economics and
complementary theories of behavioral coping provide conceptual frameworks to decrease stone recurrence
and stent pain among children and adults with urinary stone disease (USD).
 Barriers to increasing fluid intake among patients with USD include limited knowledge about sufficient
fluid volume, difficulty maintaining long-term engagement in meeting fluid goals, and inability to solve logistical
problems such as ready access to fluids at work or school. Therefore, a customized program of structured
problem solving (SPS), a systematic approach to identify the root cause of a problem and develop a feasible
solution, is needed. However, SPS alone may be insufficient. People are often motivated more by tangible,
short-term rewards - such as financial incentives - than by the possibility of health benefits realized only later in
time. This observation is relevant for USD, because the short-term benefits of fluid intake may not be apparent
since USD episodes commonly take place after months or years without symptoms. Financial incentives can
overcome present bias and are a novel approach to increasing fluid intake to prevent stone recurrence.
 Most patients with ureteral stents experience pain of varying intensity. This pain is often refractory to
medications, suggesting that factors other than biologic responses account for a large portion of symptoms.
Preoperative anxiety is associated with increased postoperative pain. Patients who catastrophize have
reduced ability to modulate pain due to excessive attention to pain (rumination), exaggerating the threat value
of pain (magnification), and feeling unable to cope (helplessness). Behavioral coping theory can be applied to
predict which patients will have intensified pain responses during procedures or following surgery. Accurately
predicting which patients are will have increased pain from ureteral stents could help identify those who would
benefit most from preemptive targeted cognitive and behavioral interventions to decrease pain.
 As part of the Urinary Stone Disease Research Network, we propose to conduct a randomized
controlled trial among adults and adolescents with USD to determine the efficacy of SPS, versus SPS
combined with financial incentives for meeting fluid intake goals, versus control to decrease symptomatic stone
recurrence. Second, we will conduct a prospective cohort study among adolescents and adults with USD who
undergo ureteral stent placement and identify psychological characteristics that predict increased pain due to
ureteral stents. Finally, we will...

## Key facts

- **NIH application ID:** 9997689
- **Project number:** 5U01DK110961-05
- **Recipient organization:** CHILDREN'S HOSP OF PHILADELPHIA
- **Principal Investigator:** PETER PHILIP REESE
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $738,143
- **Award type:** 5
- **Project period:** 2016-09-01 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9997689

## Citation

> US National Institutes of Health, RePORTER application 9997689, Harnessing Behavior to Decrease Urinary Stone Disease Morbidity Research Project (5U01DK110961-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9997689. Licensed CC0.

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