S.2 Ep. 14 | Hard Habits: What Kidney Stones Teach Us About Behavior Change
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Why is it so hard to change our behavior, even when we know what we should be doing? In this episode of Beyond the Endpoint, host Emily O'Brien sits down with Dr. Chuck Scales, a urologist and DCRI faculty member whose career took an unexpected turn into behavioral science. Using kidney stone prevention as a lens, Scales shares insights from the PUSH trial, the largest kidney stone prevention trial to date, which tested whether behavioral interventions could help patients drink more water and reduce stone recurrence. The results were surprising: patients in the intervention arm increased their fluid intake, but that improvement didn't translate into fewer stones. The conversation explores why behavior change is so hard to sustain, the structural barriers embedded in healthcare and daily life, and what the field is learning about individualized, environment-aware approaches.
Related Links
- Largest Study of Its Kind Tests Hydration Strategy for Kidney Stones (DCRI/Duke Health)
- Prevention of urinary stones with hydration: a randomised clinical trial of an adherence intervention (The Lancet)
- Leveraging behavioral modification technology for the prevention of kidney stones (Current Opinion in Urology)
- Using structured problem solving to promote fluid consumption in the prevention of urinary stones with hydration (PUSH) trial (BMC Nephrology)
About Our Guest
Charles D. Scales, Jr., MD, MSHS, FACS, is Associate Dean for Clinical Research Initiatives and Associate Professor of Urology and Population Health Sciences at Duke University, and a faculty member of the Duke Clinical Research Institute. He completed his medical training and urology residency at Duke before pursuing advanced study through the Robert Wood Johnson Foundation Clinical Scholars Program at UCLA, where he gained expertise in health services research, health policy, and quality of care. At the DCRI, Scales leads a health services and clinical research program focused on urinary stone disease, serving as principal investigator for the NIDDK Urinary Stone Disease Research Network. He leads two landmark multicenter studies: the Prevention of Urinary Stones with Hydration (PUSH) randomized clinical trial and the Study to Enhance Understanding of Stent-Associated Symptoms (STENTS) cohort study. Scales' research has been featured in U.S. News & World Report, Reuters, NPR, and the Wall Street Journal. In 2025, he was elected President-Elect of the Research on Calculus Kinetics (ROCK) Society and will begin his presidential term on January 31, 2027.