1
|
Aryal S, Bennett PN, Bloomer MJ. Culturally responsive care in haemodialysis: A scoping review. J Clin Nurs 2024. [PMID: 39007168 DOI: 10.1111/jocn.17373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/30/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
AIM To describe how clinicians provide culturally responsive care to culturally diverse people with kidney failure in haemodialysis centres. BACKGROUND Culturally diverse individuals receiving in-centre maintenance haemodialysis have unique cultural needs. Unmet cultural needs can impair and profoundly affect their experiences. Given culturally responsive care has the potential to enhance the experiences of culturally diverse people, it is vital to understand how clinicians provide culturally responsive care. METHOD A scoping review was undertaken using Arksey and OMalleys framework. Five databases: Medline and CINAHL Complete (EBSCO), PsycINFO, Embase (OVID) and ProQuest Theses and Dissertation databases were searched for research literature published in English between 1990 and 2023. Narrative synthesis was used to synthesise the data. RESULTS From the 17,271 records screened, 17 papers reporting 14 studies met the inclusion criteria. Narrative synthesis revealed two themes: (i) communication enablers and barriers including linguistic differences, professional and lay interpreter use; and (ii) the importance of culture, which encompassed acknowledging cultural priorities, accommodating cultural food preferences and access to cultural training. CONCLUSION While competing priorities associated with haemodialysis may be a challenge for clinicians, recognising the significance of cultural care needs and accommodating them in care is important. Demonstrating respect towards cultural diversity and providing person-centred care by facilitating the unique cultural needs of people with kidney failure in haemodialysis is imperative. RELEVANCE TO CLINICAL PRACTICE Culturally responsive care is complex and multidimensional. Individuals' cultural care needs should be acknowledged, respected, and accommodated in care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. The study protocol was registered in the Open Science Framework. https://osf.io/uv8g3.
Collapse
Affiliation(s)
- Sara Aryal
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Paul N Bennett
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia
| |
Collapse
|
2
|
Martinez A, Warner A, Powe NR, Fernandez A, Tuot DS. Association between English Proficiency and Kidney Disease Knowledge and Communication Quality among Patients with ESKD. KIDNEY360 2024; 5:560-568. [PMID: 38356152 PMCID: PMC11093550 DOI: 10.34067/kid.0000000000000398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
Key Points In one hospital-based safety-net dialysis unit, only one half of patients with ESKD knew their cause of kidney failure, which did not differ by English proficiency status. Patients with limited English proficiency (versus English-proficient patients) reported poorer communication with the dialysis care team (less listening, fewer clear explanations, less time spent). We highlight the need for tailored, patient-centered communication between limited English-proficient patients and dialysis care team members. Background ESKD is a chronic health condition for which communication between health care teams and patients is important to guide patient self-management activities. Yet, little is known about the quality of communication among patients with ESKD and their care team members. We examined the influence of patient's limited English proficiency (LEP) status on communication experiences at one dialysis center. Methods A survey was administered to adults receiving ESKD care at a dialysis unit within a public health care delivery system between July 2022 and February 2023, to ascertain kidney disease knowledge and perceptions of communication quality with the dialysis care team. Multivariable logistic and ordinal logistic regression models adjusted for age and sex were used to determine associations between LEP status and CKD knowledge. Results Among 93 eligible patients, 88.2% (n =82) completed the survey. Approximately 37.8% (n =31) had LEP, mean age was 58.8 years, 68.3% were men, mean dialysis vintage was 3.9 years, and 25% had a positive depression screen (LEP 30%; English-proficient 22%). A higher proportion of English-proficient patients screened positive for limited health literacy compared to those with LEP (74.5% versus 38.7%, P = 0.002). Overall, knowledge of assigned cause of ESKD (53.4%) and CKD/transplant knowledge (57.3%) was suboptimal. After adjustment, LEP status was not significantly associated with knowing the correct cause of kidney failure (odds ratio, 0.49; 95% confidence interval, 0.19 to 1.27) but was significantly associated with having a higher score on a CKD/transplant knowledge scale (odds ratio, 3.99; 95% confidence interval, 1.66 to 9.58). Patients with LEP reported poorer communication quality with dialysis providers and staff (less listening, fewer clear explanations, less time spent with patients) compared with English-proficient patients, although differences were not statistically significant. Conclusions Overall communication between patients with ESKD and members of the dialysis care team was suboptimal, regardless of English proficiency. Interventions to enhance communication for ESKD patients are needed.
Collapse
Affiliation(s)
- Ashley Martinez
- Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Austin Warner
- Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
| | - Neil R. Powe
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
| | - Alicia Fernandez
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
| | - Delphine S. Tuot
- Department of Medicine, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- Center for Vulnerable Populations, San Francisco School of Medicine, University of California, San Francisco, San Francisco, California
- Division of Nephrology, University of California, San Francisco, San Francisco, California
| |
Collapse
|
3
|
Biruete A, Leal-Escobar G, Espinosa-Cuevas Á, Mojica L, Kistler BM. Dieta de la Milpa: A Culturally-Concordant Plant-Based Dietary Pattern for Hispanic/Latine People with Chronic Kidney Disease. Nutrients 2024; 16:574. [PMID: 38474703 DOI: 10.3390/nu16050574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/16/2024] [Accepted: 02/18/2024] [Indexed: 03/14/2024] Open
Abstract
Chronic kidney disease (CKD) disproportionately affects minorities in the United States, including the Hispanic/Latine population, and is a public health concern in Latin American countries. An emphasis on healthy dietary patterns, including the Mediterranean and the Dietary Approaches to Stop Hypertension (DASH) diets, has been suggested as they are associated with a lower incidence of CKD, slower CKD progression, and lower mortality in kidney failure. However, their applicability may be limited in people from Latin America. The Dieta de la Milpa (Diet of the Cornfield) was recently described as the dietary pattern of choice for people from Mesoamerica (Central Mexico and Central America). This dietary pattern highlights the intake of four plant-based staple foods from this geographical region, corn/maize, common beans, pumpkins/squashes, and chilies, complemented with seasonal and local intake of plant-based foods and a lower intake of animal-based foods, collectively classified into ten food groups. Limited preclinical and clinical studies suggest several health benefits, including cardiometabolic health, but there is currently no data concerning CKD. In this narrative review, we describe and highlight the potential benefits of the Dieta de la Milpa in CKD, including acid-base balance, protein source, potassium and phosphorus management, impact on the gut microbiota, inflammation, and cultural appropriateness. Despite these potential benefits, this dietary pattern has not been tested in people with CKD. Therefore, we suggest key research questions targeting measurement of adherence, feasibility, and effectiveness of the Dieta de la Milpa in people with CKD.
Collapse
Affiliation(s)
- Annabel Biruete
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Gabriela Leal-Escobar
- Departamento de Nefrología, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City 14080, Mexico
| | - Ángeles Espinosa-Cuevas
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico
| | - Luis Mojica
- Tecnología Alimentaria, Centro de Investigación y Asistencia en Tecnología y Diseño del Estado de Jalisco (CIATEJ), Zapopan 45019, Mexico
| | - Brandon M Kistler
- Department of Nutrition Science, Purdue University, West Lafayette, IN 47907, USA
| |
Collapse
|
4
|
Rizzolo K, Shen JI. Barriers to home dialysis and kidney transplantation for socially disadvantaged individuals. Curr Opin Nephrol Hypertens 2024; 33:26-33. [PMID: 38014998 DOI: 10.1097/mnh.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE OF REVIEW People with kidney disease facing social disadvantage have multiple barriers to quality kidney care. The aim of this review is to summarize the patient, clinician, and system wide factors that impact access to quality kidney care and discuss potential solutions to improve outcomes for socially disadvantaged people with kidney disease. RECENT FINDINGS Patient level factors such as poverty, insurance, and employment affect access to care, and low health literacy and kidney disease awareness can affect engagement with care. Clinician level factors include lack of early nephrology referral, limited education of clinicians in home dialysis and transplantation, and poor patient-physician communication. System-level factors such as lack of predialysis care and adequate health insurance can affect timely access to care. Neighborhood level socioeconomic factors, and lack of inclusion of these factors into public policy payment models, can affect ability to access care. Moreover, the effects of structural racism and discrimination nay negatively affect the kidney care experience for racially and ethnically minoritized individuals. SUMMARY Patient, clinician, and system level factors affect access to and engagement in quality kidney care. Multilevel solutions are critical to achieving equitable care for all affected by kidney disease.
Collapse
Affiliation(s)
- Katherine Rizzolo
- Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Section of Nephrology
| | - Jenny I Shen
- The Lundquist Institute at Harbor-UCLA Medical Center, Torrance, California, USA
| |
Collapse
|
5
|
Cervantes L, Sinclair M, Camacho C, Santana C, Novick T, Cukor D. Social and Behavioral Barriers to Effective Care During the Transition to End-Stage Kidney Care. ADVANCES IN KIDNEY DISEASE AND HEALTH 2024; 31:21-27. [PMID: 38403390 DOI: 10.1053/j.akdh.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 02/27/2024]
Abstract
Individuals living with CKD are disproportionately burdened by a multitude of adverse clinical and person-centered outcomes. When patients transition from advanced kidney disease to kidney failure, the psychosocial effects as well as social determinants of health challenges are magnified, making this a particularly difficult time for patients beginning kidney replacement therapy. The key social determinants of health challenges often include food and housing insecurity, poverty, unreliable transportation, low level education and/or health literacy, lack of language interpreters and culturally concordant educational materials, lack of health care insurance coverage, and mistrust of the health care system. Psychosocial and physical stressors, such as depression, anxiety, sexual dysfunction, sleep difficulty, fatigue, and pain, are often part of the illness burden among individuals living with CKD and can interact synergistically with the social challenges making the transition to kidney replacement therapy particularly challenging. To better support patients during this time, it is critical that social and structural determinants of health as well as mental health be assessed and if needs are identified, that services be provided.
Collapse
Affiliation(s)
- Lilia Cervantes
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | - Matthew Sinclair
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Durham, NC
| | - Claudia Camacho
- Department of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO
| | | | - Tessa Novick
- Division of Nephrology, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin, TX
| | - Daniel Cukor
- Behavioral Health, The Rogosin Institute New York, NY.
| |
Collapse
|
6
|
Diaz-Martinez J, Kallus L, Levine HM, Lavernia F, Pierre AJ, Mancilla J, Barthe A, Duran C, Kotzker W, Wagner E, Hospital MM. Community-Engaged Research (CEnR) to Address Gaps in Chronic Kidney Disease Education among Underserved Latines-The CARE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7026. [PMID: 37947582 PMCID: PMC10649949 DOI: 10.3390/ijerph20217026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 10/25/2023] [Accepted: 11/03/2023] [Indexed: 11/12/2023]
Abstract
Ensuring equitable chronic kidney disease (CKD) education for Latine patients with low health literacy and low English proficiency stands as a critical challenge, and the "Caridad Awareness and Education" (CARE) initiative represents our ongoing effort to address this imperative issue. In collaboration with twenty-three patients living with CKD, diabetes and/or hypertension and twelve trained Community Health Workers (CHWs) from diverse Latine subgroups, we conducted a research initiative funded by the National Kidney Foundation. Our primary objective was to co-design and test culturally tailored patient education materials (PEMs) for underserved Latine adults at risk for or diagnosed with CKD. We effectively integrated Community-Engaged Research (CEnR) principles with a Human-Centered Design (HCD) approach to create a range of CKD-PEM prototypes in Spanish. Patient preferences for printed educational materials were clear. They favored printed materials that incorporated visual content with concise text over digital, email, texts, or online resources and personalized phone outreach and the involvement of CHWs. Additionally, patients identified their unwavering commitment to their families as a forceful motivator for caring for their kidney health. Currently, a culturally and linguistically tailored CKD flipchart for one-on-one education, led by CHWs, is undergoing a pilot testing phase involving a sample of one hundred Latine patients at risk for or diagnosed with CKD. This innovative approach signifies a commitment to amplifying the insights and expertise of the Latine community afflicted by kidney health disparities, effectively embracing a CEnR to forge meaningful and impactful CKD-PEMs.
Collapse
Affiliation(s)
- Janet Diaz-Martinez
- Research Center in a Minority Institution, Florida International University (FIU-RCMI), Miami, FL 33199, USA; (E.W.); (M.M.H.)
- Robert Stempel College of Public Health and School of Social Work, Florida International University, Miami, FL 33199, USA
| | - Laura Kallus
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | | | - Frank Lavernia
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Aydevis Jean Pierre
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Jessica Mancilla
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Ale Barthe
- Caridad Center, Boynton Beach, FL 33472, USA; (L.K.); (F.L.); (A.J.P.); (J.M.); (A.B.)
| | - Carlos Duran
- Florida Kidney Physicians, Boca Raton, FL 33431, USA; (C.D.); (W.K.)
| | - Wayne Kotzker
- Florida Kidney Physicians, Boca Raton, FL 33431, USA; (C.D.); (W.K.)
| | - Eric Wagner
- Research Center in a Minority Institution, Florida International University (FIU-RCMI), Miami, FL 33199, USA; (E.W.); (M.M.H.)
- Robert Stempel College of Public Health and School of Social Work, Florida International University, Miami, FL 33199, USA
| | - Michelle M. Hospital
- Research Center in a Minority Institution, Florida International University (FIU-RCMI), Miami, FL 33199, USA; (E.W.); (M.M.H.)
- Robert Stempel College of Public Health and School of Social Work, Florida International University, Miami, FL 33199, USA
| |
Collapse
|
7
|
Rizzolo K, Gonzalez Jauregui R, Barrientos I, Teakell J, Camacho C, Chonchol M, Waikar SS, Cervantes L. Barriers and Facilitators to Home Dialysis Among Latinx Patients with Kidney Disease. JAMA Netw Open 2023; 6:e2328944. [PMID: 37581885 PMCID: PMC10427944 DOI: 10.1001/jamanetworkopen.2023.28944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/02/2023] [Indexed: 08/16/2023] Open
Abstract
Importance Latinx people have a high burden of kidney disease but are less likely to receive home dialysis compared to non-Latinx White people. The disparity in home dialysis therapy has not been completely explained by demographic, medical, or social factors. Objective To understand the barriers and facilitators to home dialysis therapy experienced by Latinx individuals with kidney failure receiving home dialysis. Design, Setting, and Participants This qualitative study used semistructured interviews with Latinx adults with kidney failure receiving home dialysis therapy in Denver, Colorado, and Houston, Texas, between November 2021 and March 2023. Patients were recruited from home dialysis clinics affiliated with academic medical centers. Of 39 individuals approached, 27 were included in the study. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Main Outcomes and Measures Themes and subthemes regarding barriers and facilitators to home dialysis therapy. Results A total of 27 Latinx adults (17 [63%] female and 10 [37%] male) with kidney failure who were receiving home dialysis participated. Themes and subthemes were identified, 3 related to challenges with home dialysis and 2 related to facilitators. Challenges to home dialysis included misinformation and immigration-related barriers to care (including cultural stigma of dialysis, misinformation regarding chronic disease care, and lack of health insurance due to immigration status), limited dialysis education (including lack of predialysis care, no-nephrologist education, and shared decision-making), and maintenance of home dialysis (including equipment issues, lifestyle restrictions, and anxiety about complications). Facilitators to home dialysis included improved lifestyle (including convenience, autonomy, physical symptoms, and dietary flexibility) and support (including family involvement, relationships with staff, self-efficacy, and language concordance). Conclusions and Relevance Latinx participants in this study who were receiving home dialysis received misinformation and limited education regarding home dialysis, yet were engaged in self-advocacy and reported strong family and clinic support. These findings may inform new strategies aimed at improving access to home dialysis education and uptake for Latinx individuals with kidney disease.
Collapse
Affiliation(s)
- Katherine Rizzolo
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | | | - Ileana Barrientos
- Division of Renal Diseases and Hypertension, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Jade Teakell
- Division of Renal Diseases and Hypertension, McGovern Medical School at UTHealth Houston, Houston, Texas
| | - Claudia Camacho
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
| | - Michel Chonchol
- Division of Nephrology, University of Colorado-Anschutz Medical Campus, Aurora
| | - Sushrut S. Waikar
- Section of Nephrology, Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Lilia Cervantes
- Department of Medicine, University of Colorado-Anschutz Medical Campus, Aurora
| |
Collapse
|
8
|
Gely YI, Esqueda-Medina M, Johnson TJ, Arias-Pelayo ML, Cortes NA, Isgor Z, Lynch EB, Lange-Maia BS. Experiences With Kidney Transplant Among Undocumented Immigrants in Illinois: A Qualitative Study. Kidney Med 2023; 5:100644. [PMID: 37235043 PMCID: PMC10206204 DOI: 10.1016/j.xkme.2023.100644] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Rationale & Objective Noncitizen, undocumented patients with kidney failure have few treatment options in many states, although Illinois allows for patients to receive a transplant regardless of citizenship status. Little information exists about the experiences of noncitizen patients pursuing kidney transplantation. We sought to understand how access to kidney transplantation affects patients, their family, health care providers, and the health care system. Study Design A qualitative study with virtually conducted semistructured interviews. Setting & Participants Participants were transplant and immigration stakeholders (physicians, transplant center and community outreach professionals), and patients who have received assistance through the Illinois Transplant Fund (listed for or received transplant; patients could complete the interview with a family member). Analytical Approach Interview transcripts were coded using open coding and were analyzed using thematic analysis methods with an inductive approach. Results We interviewed 36 participants: 13 stakeholders (5 physicians, 4 community outreach stakeholders, and 4 transplant center professionals), 16 patients, and 7 partners. The following seven themes were identified: (1) devastation from kidney failure diagnosis, (2) resource needs for care, (3) communication barriers to care, (4) importance of culturally competent health care providers, (5) negative impacts of policy gaps, (6) new chance at life after transplant, and (7) recommendations for improving care. Limitations The patients we interviewed were not representative of noncitizen patients with kidney failure overall or in other states. The stakeholders were also not representative of health care providers because they were generally well informed on kidney failure and immigration issues. Conclusions Although patients in Illinois can access kidney transplants regardless of citizenship status, access barriers, and health care policy gaps continue to negatively affect patients, families, health care professionals, and the health care system. Necessary changes for promoting equitable care include comprehensive policies to increase access, diversifying the health care workforce, and improving communication with patients. These solutions would benefit patients with kidney failure regardless of citizenship.
Collapse
Affiliation(s)
- Yumiko I. Gely
- Rush Medical College, Rush University Medical Center, Chicago, IL
| | - Maritza Esqueda-Medina
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Tricia J. Johnson
- Department of Health Systems Management, Rush University Medical Center, Chicago, IL
| | | | - Nancy A. Cortes
- Rush Medical College, Rush University Medical Center, Chicago, IL
| | - Zeynep Isgor
- Department of Health Systems Management, Rush University Medical Center, Chicago, IL
| | - Elizabeth B. Lynch
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL
| | - Brittney S. Lange-Maia
- Department of Family and Preventive Medicine, Rush University Medical Center, Chicago, IL
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL
| |
Collapse
|
9
|
Alvarado F, Delgado C, Nicholas SB, Jaure A, Cervantes L. Qualitative analysis of stakeholder perspectives on engaging Latinx patients in kidney-related research. BMC Nephrol 2023; 24:79. [PMID: 36991364 PMCID: PMC10061843 DOI: 10.1186/s12882-023-03128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Abstract
Background
Latinx individuals are disproportionally burdened by kidney diseases compared to non-Latinx White individuals and are underrepresented in kidney-related research. We aimed to describe stakeholder perspectives on Latinx patient engagement in kidney-related research.
Methods
We conducted a thematic analysis of two online moderated discussions and an interactive online survey with open-text responses involving participants (i.e. stakeholders), with personal and/or professional experiences with Latinx patients with kidney diseases and their families/caregivers.
Results
Among the eight stakeholders (Female:75%; Latinx ethnicity:88%), there were three physicians, one nurse, one patient with kidney disease who received a kidney transplant, one policy maker, one Doctor of Philosophy, and one executive director of a non-profit health organization. We identified five themes. The majority of themes and their respective subthemes (in parentheses) reflected barriers to engagement: Lack of personal relevance (unable to relate to research staff and marketing resources, and unclear benefit of research to self, family, and community); fear and vulnerability (immigration concerns, stigma with seeking care, skepticism of Western medicine); logistical and financial barriers (limited opportunities to enroll in clinical trials, out-of-pocket costs, transportation issues); and distrust and asymmetry of power (related to limited English proficiency or health literacy, and provider bias). The last theme centered on stimulating interest and establishing trust in the research process.
Conclusions
To overcome barriers to engagement in kidney-related research and establish trust among potential Latinx research participants, stakeholders recommended employing cultural responsiveness and community-based strategies. These strategies can help identify local health priorities, enhance research recruitment and retention strategies, and establish partnerships that continue to elevate research endeavors aiming to enhance the health of Latinx individuals with kidney diseases.
Collapse
|
10
|
Jain S, Hauschildt K, Scheunemann LP. Social determinants of recovery. Curr Opin Crit Care 2022; 28:557-565. [PMID: 35993295 DOI: 10.1097/mcc.0000000000000982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to examine evidence describing the influence of social determinants on recovery following hospitalization with critical illness. In addition, it is meant to provide insight into the several mechanisms through which social factors influence recovery as well as illuminate approaches to addressing these factors at various levels in research, clinical care, and policy. RECENT FINDINGS Social determinants of health, ranging from individual factors like social support and socioeconomic status to contextual ones like neighborhood deprivation, are associated with disability, cognitive impairment, and mental health after critical illness. Furthermore, many social factors are reciprocally related to recovery wherein the consequences of critical illness such as financial toxicity and caregiver burden can put essential social needs under strain turning them into barriers to recovery. SUMMARY Recovery after hospitalization for critical illness may be influenced by many social factors. These factors warrant attention by clinicians, health systems, and policymakers to enhance long-term outcomes of critical illness survivors.
Collapse
|
11
|
Vélez-Bermúdez M, Adamowicz JL, Askelson NM, Lutgendorf SK, Fraer M, Christensen AJ. Disparities in dialysis modality decision-making using a social-ecological lens: a qualitative approach. BMC Nephrol 2022; 23:276. [PMID: 35931965 PMCID: PMC9356453 DOI: 10.1186/s12882-022-02905-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with end-stage kidney disease (ESKD) may choose to undergo dialysis in-center or at home, but uptake of home dialysis in the US has been minimal despite its benefits over in-center dialysis. Factors that may have led patients to select home dialysis over in-center dialysis are poorly understood in the literature, and interventions to improve selection of home dialysis have focused on patient knowledge and shared decision-making processes between patients and providers. The purpose of this study was to explore micro- and macro-level factors surrounding dialysis modality decision-making among patients undergoing in-center and home dialysis, and explore what leads patients to select home dialysis over in-center dialysis. METHODS Semi-structured qualitative interviews were conducted in a dialysis clinic at a large Midwestern research hospital, from September 2019 to December 2020. Participants were 18 years or older, undergoing dialysis for ESKD, and had the cognitive ability to provide consent. Surveys assessing demographic and clinical information were administered to participants following their interviews. RESULTS Forty patients completed interviews and surveys (20 [50%] in-center dialysis, 17 [43%] female, mean [SD] age, 59 [15.99] years). Qualitative findings suggested that healthcare access and engagement before entering nephrology care, after entering nephrology care, and following dialysis initiation influenced patients' awareness regarding their kidney disease status, progression toward ESKD, and dialysis options. Potential modifiers of these outcomes include race, ethnicity, and language barriers. Most participants adopted a passive-approach during decision-making. Finally, fatigue, concerns regarding one's dialyzing schedule, and problems with fistula/catheter access sites contributed to overall satisfaction with one's dialysis modality. CONCLUSIONS Findings point to broader factors affecting dialysis selection, including healthcare access and racial/ethnic inequities. Providing dialysis information before entering nephrology and after dialysis initiation may improve patient agency in decision-making. Additional resources should be prioritized for patients of underrepresented backgrounds. Dialysis decision-making may be appropriately modeled under the social-ecological framework to inform future interventions.
Collapse
Affiliation(s)
- Miriam Vélez-Bermúdez
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA.
| | - Jenna L Adamowicz
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA
| | - Natoshia M Askelson
- Department of Community and Behavioral Health, University of Iowa, Iowa City, IA, USA
| | - Susan K Lutgendorf
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA.,Department of Obstetrics & Gynecology, University of Iowa, Iowa City, IA, USA.,Department of Urology, University of Iowa, Iowa City, IA, USA.,Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - Mony Fraer
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Alan J Christensen
- Department of Psychological & Brain Sciences, University of Iowa, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Department of Psychology, East Carolina University, Greenville, NC, USA
| |
Collapse
|
12
|
Perez L, Biruete A. Lack of Cultural and Language Concordant Nutrition Education for Hispanic/Latinx Individuals with Chronic Kidney Disease: A Call to Action. J Am Soc Nephrol 2022; 33:1262-1264. [PMID: 35545302 PMCID: PMC9257809 DOI: 10.1681/asn.2022040430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Luis Perez
- L Perez, Department of Renal Medicine and Hypertension, University of Colorado, Denver, United States
| | - Annabel Biruete
- A Biruete, Department of Nutrition and Dietetics, Indiana University Purdue University at Indianapolis, Indianapolis, United States
| |
Collapse
|
13
|
Cervantes L, Robinson B, Steiner J, Myaskovsky L. Culturally Concordant Community-Health Workers: Building Sustainable Community-Based Interventions that Eliminate Kidney Health Disparities. J Am Soc Nephrol 2022; 33:1252-1254. [PMID: 35474023 PMCID: PMC9257810 DOI: 10.1681/asn.2022030319] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Lilia Cervantes
- L Cervantes, Department of Medicine, University of Colorado, Aurora, United States
| | - Bruce Robinson
- B Robinson, Arbor Research Collaborative for Health, Ann Arbor, United States
| | - John Steiner
- J Steiner, Kaiser Permanente Colorado Institute for Health Research, Aurora, United States
| | - Larissa Myaskovsky
- L Myaskovsky, Center for Healthcare Equity in Kidney Disease (CHEK-D) and Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, United States
| |
Collapse
|
14
|
Rizzolo K, Cervantes L, Shen J. Racial and Ethnic Disparities in Home Dialysis Use in the United States: Barriers and Solutions. J Am Soc Nephrol 2022; 33:1258-1261. [PMID: 35440500 PMCID: PMC9257804 DOI: 10.1681/asn.2022030288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Katherine Rizzolo
- K Rizzolo, Department of Renal Medicine and Hypertension, University of Colorado, Denver, United States
| | - Lilia Cervantes
- L Cervantes, Department of Medicine, University of Colorado - Anschutz Medical Campus, Aurora, United States
| | - Jenny Shen
- J Shen, The Lundquist Institute, Torrance, United States
| |
Collapse
|
15
|
Shen JI, Perl J. Is There an Ideal Recipe to Increase Home Dialysis Use? Is It Enough? Clin J Am Soc Nephrol 2022; 17:484-486. [PMID: 35314482 PMCID: PMC8993473 DOI: 10.2215/cjn.02150222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Jenny I Shen
- Division of Nephrology and Hypertension, The Lundquist Institute at Harbor-University of California, Los Angeles Medical Center, Torrance, California
| | - Jeffrey Perl
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
- Division of Nephrology, Department of Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| |
Collapse
|
16
|
Iorember FM, Bamgbola OF. Structural Inequities and Barriers to Accessing Kidney Healthcare Services in the United States: A Focus on Uninsured and Undocumented Children and Young Adults. Front Pediatr 2022; 10:833611. [PMID: 35450110 PMCID: PMC9016185 DOI: 10.3389/fped.2022.833611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
The population of children living in poverty and lacking healthcare insurance has increased in the United States of America in the last decade. Several factors have been responsible for this trend including illegal immigration, socioeconomic deprivation, young age, racial segregation, environmental degradation, and discriminatory housing policies. These systemic barriers have contributed to the exclusion of families from essential healthcare services. They are also contributory to the development of chronic illnesses (such as dialysis-dependent kidney disease) that are debilitating and frequently require considerable therapeutic resources. This unfortunate scenario creates a never-ending vicious cycle of poverty and diseases in a segment of society. For pediatric nephrologists, the challenges of caring for uninsured children with chronic kidney disease are all too familiar. Federally funded healthcare programs do not cover this patient population, leaving them the option of seeking care in emergency healthcare settings. Presentation with a critical illness often necessitates urgent placement of vascular catheters and the choice of acute hemodialysis. Adverse social environment influences the need for protracted chronic hemodialysis and a delay in kidney transplantation. Consequently, there is greater comorbidity, recurrent hospitalization, and a higher mortality rate. New policies should address the deficit in health insurance coverage while promoting social programs that will remove structural barriers to health care resources for undocumented children and young adults.
Collapse
Affiliation(s)
- Franca M Iorember
- Division of Pediatric Nephrology, Baylor College of Medicine, Children's Hospital of San Antonio, San Antonio, TX, United States
| | - Oluwatoyin F Bamgbola
- Division of Pediatric Nephrology, SUNY Downstate Medical Center, Brooklyn, NY, United States
| |
Collapse
|