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Loor JM, Judd NS, Rice CM, Perea DD, Croswell E, Singh PP, Unruh M, Zhu Y, Sehgal AR, Goff SL, Bryce CL, Myaskovsky L. Protocol for the AKT-MP trial: Access to Kidney Transplantation in Minority Populations. Contemp Clin Trials Commun 2022; 30:101015. [PMID: 36246997 PMCID: PMC9562954 DOI: 10.1016/j.conctc.2022.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/02/2022] [Accepted: 10/01/2022] [Indexed: 11/01/2022] Open
Abstract
Background Kidney transplant (KT) is the optimal treatment for kidney failure (KF), and although completion of KT evaluation is an essential step in gaining access to transplantation, the process is lengthy, time consuming, and burdensome. Furthermore, despite similar referral rates to non-Hispanic Whites, both Hispanic/Latinos and American Indians are less likely to be wait-listed or to undergo KT. Methods The Access to Kidney Transplantation in Minority Populations (AKT-MP) Trial compares two patient-centered methods to facilitate KT evaluation: kidney transplant fast track (KTFT), a streamlined KT evaluation process; and peer navigators (PN), a peer-assisted evaluation program that incorporates motivational interviewing. This pragmatic randomized trial will use a comparative effectiveness approach to assess whether KTFT or PN can help patients overcome barriers to transplant listing. We will randomly assign patients to the two conditions. We will track participants' medical records and conduct surveys prior to their initial evaluation clinic visit and again after they complete or discontinue evaluation. Conclusion Our aims are to (1) compare KTFT and PN to assess improvements in kidney transplant (KT) related outcomes and cost effectiveness; (2) examine how each approach effects changes in cultural/contextual factors, KT concerns, KT knowledge, and KT ambivalence; and (3) develop a framework for widespread implementation of either approach. The results of this trial will provide key information for facilitating the evaluation process, improving patient care, and decreasing disparities in KT.
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Affiliation(s)
- Jamie M. Loor
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Nila S. Judd
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Claudia M. Rice
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Diana D. Perea
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, United States
| | - Pooja P. Singh
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Mark Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Yiliang Zhu
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Ashwini R. Sehgal
- Department of Medicine, Case Western Reserve University, United States
| | - Sarah L. Goff
- Department of Health Policy and Management, University of Massachusetts, Amherst, United States
| | - Cindy L. Bryce
- Department of Health Policy and Management, University of Pittsburgh, School of Public Health, United States
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
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2
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Identifying Modifiable System-Level Barriers to Living Donor Kidney Transplantation. Kidney Int Rep 2022; 7:2410-2420. [DOI: 10.1016/j.ekir.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/11/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
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Hamid M, Rogers E, Chawla G, Gill J, Macanovic S, Mucsi I. Pretransplant Patient Education in Solid-organ Transplant: A Narrative Review. Transplantation 2022; 106:722-733. [PMID: 34260472 DOI: 10.1097/tp.0000000000003893] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Education for pretransplant, solid-organ recipient candidates aims to improve knowledge and understanding about the transplant process, outcomes, and potential complications to support informed, shared decision-making to reduce fears and anxieties about transplant, inform expectations, and facilitate adjustment to posttransplant life. In this review, we summarize novel pretransplant initiatives and approaches to educate solid-organ transplant recipient candidates. First, we review approaches that may be common to all solid-organ transplants, then we summarize interventions specific to kidney, liver, lung, and heart transplant. We describe evidence that emphasizes the need for multidisciplinary approaches to transplant education. We also summarize initiatives that consider online (eHealth) and mobile (mHealth) solutions. Finally, we highlight education initiatives that support racialized or otherwise marginalized communities to improve equitable access to solid-organ transplant. A considerable amount of work has been done in solid-organ transplant since the early 2000s with promising results. However, many studies on education for pretransplant recipient candidates involve relatively small samples and nonrandomized designs and focus on short-term surrogate outcomes. Overall, many of these studies have a high risk of bias. Frequently, interventions assessed are not well characterized or they are combined with administrative and data-driven initiatives into multifaceted interventions, which makes it difficult to assess the impact of the education component on outcomes. In the future, well-designed studies rigorously assessing well-defined surrogate and clinical outcomes will be needed to evaluate the impact of many promising initiatives.
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Affiliation(s)
- Marzan Hamid
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
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4
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Kayler LK, Ranahan M, Keller M, Dolph B, H Feeley T. Using Focus Groups to Understand Dialysis Staff Perspectives on Delivering Transplant Education. Prog Transplant 2022; 32:12-18. [PMID: 34873981 PMCID: PMC10997426 DOI: 10.1177/15269248211064869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Kidney transplant education in dialysis facilities could be optimized with internet resources, like videos, but most qualitative research predates widespread availability of online video education about kidney transplantation. To improve understanding of dialysis staff transplant education practices, as well as the potential value of video, we conducted focus groups of dialysis center staff members in Buffalo, NY. METHODS/APPROACH Seventeen focus groups (97 participants: 53 nurses, 10 dialysis technicians, 6 social workers, 6 dieticians, 7 administrative personnel, 2 trainees, and 1 insurance coordinator) from 8 dialysis facilities in Buffalo, NY, were conducted, audio-recorded, transcribed, and analyzed. After thematic data analysis, a diverse patient and caregiver community advisory board was invited to comment, and their voices were integrated. Findings: Five key themes were identified that captured barriers to transplant education delivery and how online video could be a facilitator: (1) delivery of transplant education was reliant on one person, (2) other dialysis staff had time to answer transplant questions but felt uninformed, (3) patient lack of interest in existing supplementary transplant education, (4) patient disinterest in transplantation education was due to education timing, feeling overwhelmed, and transplant fear/ambivalence, and (5) video education could be flexible, low effort, and spark transplant interest. Study limitations are potential selection bias and inclusion of English-speaking participants only. DISCUSSION Dialysis staff barriers of time, insufficient knowledge, and limited resources to provide education to patients and their care partners may be mitigated with online educational videos without increasing staff workload.
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Affiliation(s)
- Liise K Kayler
- Transplant and Kidney Care Regional Center of Excellence, 2070Erie County Medical Center, Buffalo, New York, United States
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Molly Ranahan
- Transplant and Kidney Care Regional Center of Excellence, 2070Erie County Medical Center, Buffalo, New York, United States
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Maria Keller
- Transplant and Kidney Care Regional Center of Excellence, 2070Erie County Medical Center, Buffalo, New York, United States
| | - Beth Dolph
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Thomas H Feeley
- Department of Communication, University at Buffalo, State University of New York, Buffalo, NY, USA
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5
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Poinen K, Van Der Hoek M, Copland MA, Tennankore K, Canney M. Perceptions of Multidisciplinary Renal Team Members toward Home Dialysis Therapies. KIDNEY360 2021; 2:1592-1599. [PMID: 35372972 PMCID: PMC8785775 DOI: 10.34067/kid.0006222020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 08/09/2021] [Indexed: 02/04/2023]
Abstract
Background Patients with ESKD are encouraged to pursue home dialysis therapy with the aims of improving quality of life, increasing patient autonomy, and reducing cost to health care systems. In a multidisciplinary team setting, patients interact with nephrologists, nurses, and allied health staff, all of whom may influence a patient's modality choice. Our objective was to evaluate the perceptions of all renal team members toward home dialysis therapies. Methods We performed a cross-sectional survey of multidisciplinary renal team members across five renal programs in British Columbia, Canada. The survey contained questions regarding primary work area, modality preference, patient and system factors that may influence modality candidacy, perceived knowledge of home therapies, and need for further education. Results A total of 334 respondents (22 nephrologists, 172 hemodialysis nurses, 49 home nurses, 20 predialysis nurses, and 71 allied health staff) were included (48% response rate). All respondents felt that home dialysis was beneficial for patients who work or study, improved patients' quality of life, and provided cost savings to the system. Compared with in-center hemodialysis nurses, home therapies nurses were between five and nine times more likely to favor a home therapy for patients of older age, lower socioeconomic status, lower educational level, higher burden of comorbidities, and those lacking social supports. Nephrologists and patients were felt to have the most influence on modality choice, whereas dialysis nurses were seen as having the least effect on modality choice. Most respondents felt the need for further education in home therapies. Conclusions The majority of multidisciplinary team members, including allied health staff, acknowledged the benefits of home therapies. There were significant discrepancies among team members regarding patient-/system-level factors that may affect the candidacy of home therapies. Structured, focused, and repeated education sessions for all renal team members may help to address misperceptions around factors that influence modality candidacy.
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Affiliation(s)
- Krishna Poinen
- University of British Columbia, Vancouver, British Columbia, Canada,BC Renal, Vancouver, British Columbia, Canada
| | | | - Michael A. Copland
- University of British Columbia, Vancouver, British Columbia, Canada,BC Renal, Vancouver, British Columbia, Canada
| | - Karthik Tennankore
- Division of Nephrology, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Mark Canney
- BC Renal, Vancouver, British Columbia, Canada,Department of Medicine, University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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6
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Designing a Liver Transplant Patient and Family Decision Support Tool for Organ Offer Decisions. Transplant Direct 2021; 7:e695. [PMID: 33937520 PMCID: PMC8081471 DOI: 10.1097/txd.0000000000001140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/21/2021] [Accepted: 01/31/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND For liver transplant candidates on the waiting list, deciding to accept a donor organ with known or potential risk factors can be stressful and can lead to declined offers. Current education for patients and family often takes place during transplant evaluations and can be overwhelming and result in low retention and poor understanding of donor quality. METHODS In the first phase, we sought to understand provider experiences when counseling patients about donor risks and donor offers. We conducted interviews and focus groups with liver transplant providers at 1 local center and at a national clinician conference. Twenty providers participated: 15 hepatologists and 5 surgeons. The provider feedback was used to create an initial outline of content that is consistent with decision support frameworks. In a second phase, graphic design collaborators created mockups of a patient-friendly tool. We reviewed mockups with 4 transplant coordinators and 9 liver transplant candidates for feedback on clarity and utility to prepare for an organ offer. Patient responses allowed a comparison of perceived readiness to receive an offer call before and after viewing mockups. RESULTS We identified themes relating to the offer process, repetition and timing of education, and standardization and tailoring of content. The results indicated a gap in available education after the evaluation session, and information specific to offer decisions is needed. Patient feedback emphasized the need to review the offer process before a real offer. CONCLUSIONS Patients and providers responded favorably to a patient tool addressing existing gaps in education while waiting for a donor offer. Additional patient, family, and provider feedback will guide the development of an interactive tool to prepare patients and families for an offer decision.
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7
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Yohanna S, Naylor KL, Mucsi I, McKenzie S, Belenko D, Blake PG, Coghlan C, Dixon SN, Elliott L, Getchell L, Ki V, Nesrallah G, Patzer RE, Presseau J, Reich M, Sontrop JM, Treleaven D, Waterman AD, Zaltzman J, Garg AX. A Quality Improvement Intervention to Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) in Patients With Chronic Kidney Disease: Clinical Research Protocol of a Cluster-Randomized Clinical Trial. Can J Kidney Health Dis 2021; 8:2054358121997266. [PMID: 33948191 PMCID: PMC8054216 DOI: 10.1177/2054358121997266] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background: Many patients with kidney failure will live longer and healthier lives if
they receive a kidney transplant rather than dialysis. However, multiple
barriers prevent patients from accessing this treatment option. Objective: To determine if a quality improvement intervention provided in chronic kidney
disease (CKD) programs (vs. usual care) enables more patients with no
recorded contraindications to kidney transplant to complete more steps
toward receiving a kidney transplant. Design: This protocol describes a pragmatic 2-arm, parallel-group, open-label,
registry-based, cluster-randomized clinical trial—the Enhance Access to
Kidney Transplantation and Living Kidney Donation (EnAKT LKD) trial. Setting: All 26 CKD programs in Ontario, Canada, with a trial start date of November
1, 2017. The original end date of March 31, 2021 (3.4 years) has been
extended to December 31, 2021 (4.1 years) due to the COVID-19 pandemic. Participants: During the trial, the 26 CKD programs are expected to care for more than 10
000 adult patients with CKD (including patients approaching the need for
dialysis and patients receiving dialysis) with no recorded contraindications
to a kidney transplant. Intervention: Programs were randomly allocated to provide a quality improvement
intervention or usual care. The intervention has 4 main components: (1)
local quality improvement teams and administrative support; (2) tailored
education and resources for staff, patients, and living kidney donor
candidates; (3) support from kidney transplant recipients and living kidney
donors; and (4) program-level performance reports and oversight by program
leaders. Primary Outcome: The primary outcome is the number of key steps completed toward receiving a
kidney transplant analyzed at the cluster level (CKD program). The following
4 unique steps per patient will be counted: (1) patient referred to a
transplant center for evaluation, (2) at least one living kidney donor
candidate contacts a transplant center for an intended recipient and
completes a health history questionnaire to begin their evaluation, (3)
patient added to the deceased donor transplant wait list, and (4) patient
receives a kidney transplant from a living or deceased donor. Planned Primary Analysis: Study data will be obtained from Ontario’s linked administrative healthcare
databases. An intent-to-treat analysis will be conducted comparing the
primary outcome between randomized groups using a 2-stage approach. First
stage: residuals are obtained from fitting a regression model to
individual-level variables ignoring intervention and clustering effects.
Second stage: residuals from the first stage are aggregated at the cluster
level as the outcome. Limitations: It may not be possible to isolate independent effects of each intervention
component, the usual care group could adopt intervention components leading
to contamination bias, and the relatively small number of clusters could
mean the 2 arms are not balanced on all baseline prognostic factors. Conclusions: The EnAKT LKD trial will provide high-quality evidence on whether a
multi-component quality improvement intervention helps patients complete
more steps toward receiving a kidney transplant. Trial registration: Clinicaltrials.gov; identifier: NCT03329521.
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Affiliation(s)
| | - Kyla L Naylor
- ICES, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Istvan Mucsi
- Division of Nephrology, University of Toronto, ON, Canada
| | | | - Dmitri Belenko
- Division of Nephrology, University of Toronto, ON, Canada
| | - Peter G Blake
- Division of Nephrology, Western University, London, ON, Canada.,Ontario Renal Network, Ontario Health, Toronto, Canada
| | | | - Stephanie N Dixon
- ICES, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Lori Elliott
- Ontario Renal Network, Ontario Health, Toronto, Canada
| | - Leah Getchell
- Division of Nephrology, London Health Sciences Centre, ON, Canada
| | - Vincent Ki
- Ontario Renal Network, Ontario Health, Toronto, Canada.,Trillium Health Partners, Mississauga, ON, Canada
| | - Gihad Nesrallah
- Ontario Renal Network, Ontario Health, Toronto, Canada.,Humber River Regional Hospital, Toronto, ON, Canada
| | - Rachel E Patzer
- Health Services Research Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Health Research Institute, ON, Canada
| | - Marian Reich
- Canadians Seeking Solutions and Innovations to Overcome Chronic Kidney Disease, Patient Council, Vancouver, BC, Canada
| | - Jessica M Sontrop
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Division of Nephrology, London Health Sciences Centre, ON, Canada
| | - Darin Treleaven
- Division of Nephrology, McMaster University, Hamilton, ON, Canada.,Trillium Gift of Life Network, Toronto, ON, Canada
| | - Amy D Waterman
- Division of Nephrology, University of California, Los Angeles, USA
| | - Jeffrey Zaltzman
- Trillium Gift of Life Network, Toronto, ON, Canada.,Division of Nephrology, St. Michael's Hospital, Toronto, ON, Canada
| | - Amit X Garg
- ICES, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Division of Nephrology, Western University, London, ON, Canada.,Ontario Renal Network, Ontario Health, Toronto, Canada
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8
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Wesselman H, Ford CG, Leyva Y, Li X, Chang CCH, Dew MA, Kendall K, Croswell E, Pleis JR, Ng YH, Unruh ML, Shapiro R, Myaskovsky L. Social Determinants of Health and Race Disparities in Kidney Transplant. Clin J Am Soc Nephrol 2021; 16:262-274. [PMID: 33509963 PMCID: PMC7863655 DOI: 10.2215/cjn.04860420] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 11/16/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Black patients have a higher incidence of kidney failure but lower rate of deceased- and living-donor kidney transplantation compared with White patients, even after taking differences in comorbidities into account. We assessed whether social determinants of health (e.g., demographics, cultural, psychosocial, knowledge factors) could account for race differences in receiving deceased- and living-donor kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Via medical record review, we prospectively followed 1056 patients referred for kidney transplant (2010-2012), who completed an interview soon after kidney transplant evaluation, until their kidney transplant. We used multivariable competing risk models to estimate the cumulative incidence of receipt of any kidney transplant, deceased-donor transplant, or living-donor transplant, and the factors associated with each outcome. RESULTS Even after accounting for social determinants of health, Black patients had a lower likelihood of kidney transplant (subdistribution hazard ratio, 0.74; 95% confidence interval, 0.55 to 0.99) and living-donor transplant (subdistribution hazard ratio, 0.49; 95% confidence interval, 0.26 to 0.95), but not deceased-donor transplant (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.67 to 1.26). Black race, older age, lower income, public insurance, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, less transplant knowledge, and fewer learning activities were each associated with a lower probability of any kidney transplant. Older age, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, and fewer learning activities were each associated with a lower probability of deceased-donor transplant. Black race, older age, lower income, public insurance, higher body mass index, dialysis before kidney transplant, not presenting with a potential living donor, religious objection to living-donor transplant, and less transplant knowledge were each associated with a lower probability of living-donor transplant. CONCLUSIONS Race and social determinants of health are associated with the likelihood of undergoing kidney transplant.
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Affiliation(s)
- Hannah Wesselman
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana
| | - Christopher Graham Ford
- Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Yuridia Leyva
- Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Xingyuan Li
- Eli Lilly and Company, Indianapolis, Indiana
| | - Chung-Chou H. Chang
- Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania,Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Kellee Kendall
- Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Emilee Croswell
- Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - John R. Pleis
- Division of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Yue Harn Ng
- Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico
| | - Mark L. Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, New York
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico,Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico
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9
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Abstract
BACKGROUND Kidney transplant is the best treatment for most end-stage renal disease (ESRD) patients, but proportionally few ESRD patients receive kidney transplant. To make an informed choice about whether to pursue kidney transplant, patients must be knowledgeable of its risks and benefits. To reliably and validly measure ESRD patients' kidney transplant knowledge, rigorously tested measures are required. This article describes the development and psychometric testing of the Knowledge Assessment of Renal Transplantation (KART). METHODS We administered 17 transplant knowledge items to a sample of 1294 ESRD patients. Item characteristics and scale scores were estimated using an Item Response Theory graded response model. Construct validity was tested by examining differences in scale scores between patients who had spent less than 1 and 1 hour or longer receiving various types of transplant education. RESULTS Item Response Theory modeling suggested that 15 items should be retained for the KART. This scale had a marginal reliability of 0.75 and evidenced acceptable reliability (>0.70) across most of its range. Construct validity was supported by the KART's ability to distinguish patients who had spent less than 1 and 1 hour or longer receiving different types of kidney transplant education, including talking to doctors/medical staff (effect size [ES], 0.61; P < 0.001), reading brochures (ES, 0.45; P < 0.001), browsing the internet (ES, 0.56; P < 0.001), and watching videos (ES, 0.56; P < 0.001). CONCLUSIONS The final 15-item KART can be used to determine the kidney transplant knowledge levels of ESRD patients and plan appropriate interventions to ensure informed transplant decision making occurs.
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10
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Kayler LK, Keller MM, Crenesse-Cozien N, Dolph B, Cadzow R, Feeley TH. Development and preliminary evaluation of ilearnKAS: An animated video about kidney allocation to support transplant decision-making. Clin Transplant 2019; 33:e13638. [PMID: 31206193 DOI: 10.1111/ctr.13638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 05/28/2019] [Accepted: 06/07/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND We aimed to develop and feasibility test an educational video culturally targeted to African American (AA) patients regarding kidney allocation. METHODS We iteratively refined an animated video for AAs with multiple stakeholder input and conducted a one-group, pre-post study with 50 kidney transplant candidates to assess video feasibility and acceptability. A mixed population was chosen to obtain race-specific acceptability data and efficacy estimates for a larger study. RESULTS Median participant age was 56 years, and 50% were AA. Comparing pre-post video scores, large knowledge effect sizes were found for the cohort (r = 0.7) and in the context of AA race (r = 0.8), low health literacy (r = 0.6), low educational achievement (r = 0.7), age >55 years (r = 0.6), dialysis vintage ≥1 year (r = 0.8), low income (r = 0.7) and low technology access (r = 0.8). Over 87% of participants provided positive ratings on each of the seven acceptability items. The frequency of positive responses increased pre-post video for kidney allocation understanding (78% vs 94%, P = 0.008), decisional self-efficacy (64% vs 88%, P < 0.001) and belief in fairness (76% vs 90%, P = 0.02). CONCLUSIONS In collaboration with key stakeholders, a culturally targeted educational video was developed that was well received. Results are promising to impact kidney allocation knowledge among AA and non-AA kidney transplant candidates.
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Affiliation(s)
- Liise K Kayler
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York.,Department of Surgery, University at Buffalo, Buffalo, New York.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York
| | - Maria M Keller
- Department of Community Health and Health Behavior, State University of New York, University at Buffalo, Buffalo, New York
| | - Natalia Crenesse-Cozien
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York
| | - Beth Dolph
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York
| | - Renee Cadzow
- Department of Health Services Administration, D'Youville College, Buffalo, New York
| | - Thomas H Feeley
- Department of Communication, State University of New York, University at Buffalo, Buffalo, New York
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11
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Mucsi I, Novak M, Toews D, Waterman A. Explore Transplant Ontario: Adapting the Explore Transplant Education Program to Facilitate Informed Decision Making About Kidney Transplantation. Can J Kidney Health Dis 2018; 5:2054358118789369. [PMID: 30057772 PMCID: PMC6058418 DOI: 10.1177/2054358118789369] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/05/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose: In this article, we describe a province-wide collaborative project in which we adapted the Explore Transplant (ET) education program for use in Ontario, Canada, to develop Explore Transplant Ontario (ETO). Kidney transplantation (KT), especially living donor kidney transplantation (LDKT), is the best treatment for many patients with end-stage kidney disease (ESKD), with the best patient survival and quality of life and also reduced health care costs. Yet KT and LDKT are underutilized both internationally and in Canada. Research has demonstrated that patients with ESKD who receive personalized transplant education are more likely to complete the transplant evaluation process and to receive LDKT compared with patients who do not receive this education. Sources of information: Research expertise of the lead authors and Medline search of studies assessing the impact of education interventions on access to KT and LDKT. Methods: The ET program, developed by Dr Amy Waterman, has been used in thousands of patients with ESKD in the United States to enhance KT and LDKT knowledge. To adapt this program for use in Ontario, we convened a working group, including patient representatives, nephrologists, transplant coordinators, dialysis nurses, and patient educators from all Ontario KT centers and selected dialysis units. In an iterative process concluding in a consensus workshop, the working group reviewed and edited the text of the original ET program and suggested changes to the videos. Key findings: The adapted program reflects the Ontario health care environment and responds to the specific needs of patients with chronic kidney disease (CKD) in the province. The videos feature Ontario transplant nephrologists, transplant coordinators, and patients, representative of the ethnic diversity in Ontario, sharing their transplant experience and expertise. Despite the changes, ETO is consistent with the quality and style of the original ET program. At the end of this article, we summarize subsequent steps to test and utilize ETO. Those projects, specifically the ETO pilot study and a multicomponent quality improvement initiative to increase utilization of KT and LDKT across Ontario, will be described in full in future papers. Limitations: This article describes a provincial initiative; therefore, our findings may not be fully generalizable without further considerations. The adapted education program has not yet been tested in large trial for effectiveness. Implications: As a program grounded in the theoretical model of behavior change, ETO places patients with ESKD at the center of a complex process of navigating renal replacement therapy modalities and acknowledges a broad range of patient values, priorities, and states of readiness to pursue KT.
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Affiliation(s)
- Istvan Mucsi
- Division of Nephrology, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network and University of Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, ON, Canada
| | - Deanna Toews
- Division of Nephrology, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network and University of Toronto, ON, Canada
| | - Amy Waterman
- Division of Nephrology, University of California, Los Angeles, CA, USA.,Terasaki Research Institute, Los Angeles, CA, USA
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12
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Waterman AD, Peipert JD. An Explore Transplant Group Randomized Controlled Education Trial to Increase Dialysis Patients' Decision-Making and Pursuit of Transplantation. Prog Transplant 2018; 28:174-183. [PMID: 29699451 DOI: 10.1177/1526924818765815] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Dialysis centers must provide transplant education to patients but often do not address the risks and benefits of living and deceased donor transplant. RESEARCH QUESTIONS In a group randomized controlled trial of 20 dialysis centers and 253 patients, we assessed whether the Explore Transplant education program increased patients' readiness to pursue transplant, transplant knowledge, informed transplant decision-making, discussions about transplant with potential living donors, pursuit and receipt of living or deceased donor transplant, and whether these effects varied by race. METHODS Patients at participating dialysis centers were randomized to receive either (1) a 4-module Explore Transplant education program, including videos, printed materials, and transplant educator discussions or (2) standard-of-care transplant education provided by dialysis centers. The trial had 3 phases: (1) pre- and postsurveying and dialysis center education (2007-2008), (2) follow-up to determine whether patients restarted or began transplant evaluation (2008-2010), and (3) assessment of participants' receipt of a renal transplant (2012-2015). RESULTS Compared to patients in standard-of-care dialysis centers, patients who received the intervention were more likely to increase in their stage of readiness for living donor transplantation (odds ratio: 2.50; 95% confidence interval: 1.10-5.66), had greater increases in their transplant knowledge ( P < .001), and were more likely to call to restart/begin transplant evaluation (38% vs 24%, P = .006). When analyses were stratified by race, black patients were more likely to take several steps toward transplant in comparison to whites. DISCUSSION The Explore Transplant helps dialysis patients make informed decisions and increases their pursuit of transplant, particularly among black patients.
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Affiliation(s)
- Amy D Waterman
- 1 Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,2 Terasaki Research Institute, Los Angeles, CA, USA
| | - John Devin Peipert
- 1 Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,2 Terasaki Research Institute, Los Angeles, CA, USA
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13
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Hamoda RE, Gander JC, McPherson LJ, Arriola KJ, Cobb L, Pastan SO, Plantinga L, Browne T, Hartmann E, Mulloy L, Zayas C, Krisher J, Patzer RE. Process evaluation of the RaDIANT community study: a dialysis facility-level intervention to increase referral for kidney transplantation. BMC Nephrol 2018; 19:13. [PMID: 29334900 PMCID: PMC5769303 DOI: 10.1186/s12882-017-0807-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/21/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Reducing Disparities in Access to kidNey Transplantation Community Study (RaDIANT) was an End-Stage Renal Disease (ESRD) Network 6-developed, dialysis facility-level randomized trial testing the effectiveness of a 1-year multicomponent education and quality improvement intervention in increasing referral for kidney transplant evaluation among selected Georgia dialysis facilities. METHODS To assess implementation of the RaDIANT intervention, we conducted a process evaluation at the conclusion of the intervention period (January-December 2014). We administered a 20-item survey to the staff involved with transplant education in 67 dialysis facilities randomized to participate in intervention activities. Survey items assessed facility participation in the intervention (fidelity and reach), helpfulness and willingness to continue intervention activities (sustainability), suggestions for improving intervention components (sustainability), and factors that may have influenced participation and study outcomes (context). We defined high fidelity to the intervention as completing 11 or more activities, and high participation in an activity as having at least 75% participation across intervention facilities. RESULTS Staff from 65 of the 67 dialysis facilities completed the questionnaire, and more than half (50.8%) reported high adherence (fidelity) to RaDIANT intervention requirements. Nearly two-thirds (63.1%) of facilities reported that RaDIANT intervention activities were helpful or very helpful, with 90.8% of facilities willing to continue at least one intervention component beyond the study period. Intervention components with high participation emphasized staff and patient-level education, including in-service staff orientations, patient and family education programs, and patient educational materials. Suggested improvements for intervention activities emphasized addressing financial barriers to transplantation, with financial education materials perceived as most helpful among RaDIANT educational materials. Variation in facility-level fidelity of the RADIANT intervention did not significantly influence the mean difference in proportion of patients referred pre- (2013) and post-intervention (2014). CONCLUSIONS We found high fidelity to the RaDIANT multicomponent intervention at the majority of intervention facilities, with sustainability of select intervention components at intervention facilities and feasibility for dissemination across ESRD Networks. Future modification of the intervention should emphasize financial education regarding kidney transplantation and amend intervention components that facilities perceive as time-intensive or non-sustainable. TRIAL REGISTRATION Clinicaltrials.gov number NCT02092727 . Registered 13 Mar 2014 (retrospectively registered).
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Affiliation(s)
- Reem E Hamoda
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 1629 Pierce Dr. NE, 30322, Atlanta, Georgia, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jennifer C Gander
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 1629 Pierce Dr. NE, 30322, Atlanta, Georgia, USA
| | - Laura J McPherson
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 1629 Pierce Dr. NE, 30322, Atlanta, Georgia, USA
| | - Kimberly J Arriola
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Loren Cobb
- Department of Biology, Spelman College, Atlanta, Georgia, USA
| | - Stephen O Pastan
- Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Plantinga
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Department of Medicine, Division of Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, South Carolina, USA
| | | | - Laura Mulloy
- Division of Nephrology, Hypertension, and Transplant, Augusta University, Augusta, Georgia, USA
| | - Carlos Zayas
- Division of Nephrology, Hypertension, and Transplant, Augusta University, Augusta, Georgia, USA
| | - Jenna Krisher
- Southeastern Kidney Transplant Coalition, End Stage Renal Disease Network 6, Raleigh, North Carolina, USA
| | - Rachel E Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 1629 Pierce Dr. NE, 30322, Atlanta, Georgia, USA. .,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.
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14
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Lipford KJ, McPherson L, Hamoda R, Browne T, Gander JC, Pastan SO, Patzer RE. Dialysis facility staff perceptions of racial, gender, and age disparities in access to renal transplantation. BMC Nephrol 2018; 19:5. [PMID: 29316901 PMCID: PMC5761143 DOI: 10.1186/s12882-017-0800-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 12/18/2017] [Indexed: 11/30/2022] Open
Abstract
Background Racial/ethnic, gender, and age disparities in access to renal transplantation among end-stage renal disease (ESRD) patients have been well documented, but few studies have explored health care staff attitudes towards these inequalities. Staff perceptions can influence patient care and outcomes, and identifying staff perceptions on disparities could aid in the development of potential interventions to address these health inequities. The objective of this study was to investigate dialysis staff (n = 509), primarily social workers and nurse managers, perceptions of renal transplant disparities in the Southeastern United States. Methods This is a mixed methods study that uses both deductive and inductive qualitative analysis of a dialysis staff survey conducted in 2012 using three open-ended questions that asked staff to discuss their perceptions of factors that may contribute to transplant disparities among African American, female, and elderly patients. Results Study results suggested that the majority of staff (n = 255, 28%) perceived patients’ low socioeconomic status as the primary theme related to why renal transplant disparities exist between African Americans and non-Hispanic whites. Staff cited patient perception of old age as a primary contributor (n = 188, 23%) to the disparity between young and elderly patients. The dialysis staff responses on gender transplant disparities suggested that staff were unaware of differences due to limited experience and observation (n = 76, 14.7%) of gender disparities. Conclusions These findings suggest that dialysis facilities should educate staff on existing renal transplantation disparities, particularly gender disparities, and collaboratively work with transplant facilities to develop strategies to actively address modifiable patient barriers for transplant.
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Affiliation(s)
- Kristie J Lipford
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 1639 Pierce Dr. NE, Atlanta, GA, 30322, USA.
| | - Laura McPherson
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 1639 Pierce Dr. NE, Atlanta, GA, 30322, USA
| | - Reem Hamoda
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 1639 Pierce Dr. NE, Atlanta, GA, 30322, USA
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Jennifer C Gander
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 1639 Pierce Dr. NE, Atlanta, GA, 30322, USA
| | - Stephen O Pastan
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 1639 Pierce Dr. NE, Atlanta, GA, 30322, USA
| | - Rachel E Patzer
- Department of Surgery, Division of Transplantation, Emory University School of Medicine, 1639 Pierce Dr. NE, Atlanta, GA, 30322, USA
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15
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Weng FL, Peipert JD, Holland BK, Brown DR, Waterman AD. A Clustered Randomized Trial of an Educational Intervention During Transplant Evaluation to Increase Knowledge of Living Donor Kidney Transplant. Prog Transplant 2017; 27:377-385. [PMID: 29187135 DOI: 10.1177/1526924817732021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Maximizing education about living donor kidney transplant (LDKT) during the in-person evaluation at the transplant center may increase the numbers of kidney patients pursuing LDKT. Research Questions and Design: To test the effectiveness of a 1-time LDKT educational intervention, we performed a cluster-randomized trial among 499 patients who presented for evaluation of kidney transplant. We compared usual care education (n = 250) versus intensive LDKT education (n = 249), which was implemented only on the evaluation day and consisted of viewing a 25-minute video of information and stories about LDKT and discussion of LDKT possibilities with an educator. Our primary outcome was knowledge of LDKT, 1 week after the transplant evaluation. RESULTS One week after evaluation, patients who received intensive education had higher knowledge than patients who received usual care (12.7 vs. 11.7; P = .0008), but there were no differences in postevaluation readiness for LDKT. Among patients who had not previously identified a potential living donor, receiving intensive education was associated with increased willingness to take steps toward LDKT. DISCUSSION In conclusion, expansion of LDKT education within the evaluation day may be helpful, but interventions that are implemented at multiple times and for greater duration may be necessary to ensure larger and long-term behavioral changes in pursuit of LDKT.
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Affiliation(s)
- Francis L Weng
- 1 Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA.,2 Rutgers School of Public Health, Piscataway, NJ, USA
| | - John D Peipert
- 3 Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Diane R Brown
- 2 Rutgers School of Public Health, Piscataway, NJ, USA
| | - Amy D Waterman
- 3 Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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16
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Gillespie A, Fink EL, Traino HM, Uversky A, Bass SB, Greener J, Hunt J, Browne T, Hammer H, Reese PP, Obradovic Z. Hemodialysis Clinic Social Networks, Sex Differences, and Renal Transplantation. Am J Transplant 2017; 17:2400-2409. [PMID: 28316126 DOI: 10.1111/ajt.14273] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 03/01/2017] [Accepted: 03/09/2017] [Indexed: 01/25/2023]
Abstract
This study describes patient social networks within a new hemodialysis clinic and models the association between social network participation and kidney transplantation. Survey and observational data collected between August 2012 and February 2015 were used to observe the formation of a social network of 46 hemodialysis patients in a newly opened clinic. Thirty-two (70%) patients formed a social network, discussing health (59%) and transplantation (44%) with other patients. While transplant-eligible women participated in the network less often than men (56% vs. 90%, p = 0.02), women who participated discussed their health more often than men (90% vs. 45.5%, p = 0.02). Patients in the social network completed a median of two steps toward transplantation compared with a median of 0 for socially isolated patients (p = 0.003). Patients also completed more steps if network members were closely connected (β = 2.23, 95% confidence interval [CI] 0.16-4.29, p = 0.03) and if network members themselves completed more steps (β = 2.84, 95% CI 0.11-5.57, p = 0.04). The hemodialysis clinic patient social network had a net positive effect on completion of transplant steps, and patients who interacted with each other completed a similar number of steps.
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Affiliation(s)
- A Gillespie
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - E L Fink
- Department of Communication and Social Influence, Temple University, Philadelphia, PA
| | - H M Traino
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - A Uversky
- Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, PA
| | - S B Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - J Greener
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA
| | - J Hunt
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - T Browne
- College of Social Work, University of South Carolina, Columbia, SC
| | - H Hammer
- Abt Associates, Silver Spring, MD
| | - P P Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Z Obradovic
- Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, PA
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17
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Waterman AD, Robbins ML, Peipert JD. Educating Prospective Kidney Transplant Recipients and Living Donors about Living Donation: Practical and Theoretical Recommendations for Increasing Living Donation Rates. CURRENT TRANSPLANTATION REPORTS 2016; 3:1-9. [PMID: 27347475 PMCID: PMC4918088 DOI: 10.1007/s40472-016-0090-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A promising strategy for increasing living donor kidney transplant (LDKT) rates is improving education about living donation for both prospective kidney transplant recipients and living donors to help overcome the proven knowledge, psychological, and socioeconomic barriers to LDKT. A recent Consensus Conference on Best Practices in Live Kidney Donation recommended that comprehensive LDKT education be made available to patients at all stages of chronic kidney disease (CKD). However, in considering how to implement this recommendation across different healthcare learning environments, the current lack of available guidance regarding how to design, deliver, and measure the efficacy of LDKT education programs is notable. In the current article, we provide an overview of how one behavior change theory, the Transtheoretical Model of Behavior Change, can guide the delivery of LDKT education for patients at various stages of CKD and readiness for LDKT. We also discuss the importance of creating educational programs for both potential kidney transplant recipients and living donors, and identify key priorities for educational research to reduce racial disparities in LDKT and increase LDKT rates.
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Affiliation(s)
- Amy D. Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA 90024, USA
| | | | - John D. Peipert
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA 90024, USA
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18
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Waterman AD, Peipert JD, Goalby CJ, Dinkel KM, Xiao H, Lentine KL. Assessing Transplant Education Practices in Dialysis Centers: Comparing Educator Reported and Medicare Data. Clin J Am Soc Nephrol 2015; 10:1617-25. [PMID: 26292696 DOI: 10.2215/cjn.09851014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 05/22/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The Centers for Medicare & Medicaid Services (CMS) requires that dialysis centers inform new patients of their transplant options and document compliance using the CMS-2728 Medical Evidence Form (Form-2728). This study compared reports of transplant education for new dialysis patients reported to CMS with descriptions from transplant educators (predominantly dialysis nurses and social workers) of their centers' quantity of and specific educational practices. The goal was to determine what specific transplant education occurred and whether provision of transplant education was associated with center-level variation in transplant wait-listing rates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Form-2728 data were drawn for 1558 incident dialysis patients at 170 centers in the Heartland Kidney Network (Iowa, Kansas, Missouri, and Nebraska) in 2009-2011; educators at these centers completed a survey describing their transplant educational practices. Educators' own survey responses were compared with Form-2728 reports for patients at each corresponding center. The association of quantity of transplant education practices used with wait-listing rates across dialysis centers was examined using multivariable negative binomial regression. RESULTS According to Form-2728, 77% of patients (n=1203) were informed of their transplant options within 45 days. Educators, who reported low levels of transplant knowledge themselves (six of 12 questions answered correctly), most commonly reported giving oral recommendations to begin transplant evaluation (988 informed patients educated, 81% of centers) and referrals to external transplant education programs (959 informed patients educated, 81% of centers). Only 18% reported having detailed discussions about transplant with their patients. Compared with others, centers that used more than three educational activities (incident rate ratio, 1.36; 95% confidence interval, 1.07 to 1.73) had higher transplant wait-listing rates. CONCLUSIONS While most educators inform new patients that transplant is an option, dialysis centers with higher wait-listing rates use multiple transplant education strategies.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri;
| | - John D Peipert
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Christina J Goalby
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | | | - Huiling Xiao
- Center for Outcomes Research and Abdominal Transplantation Center, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Krista L Lentine
- Center for Outcomes Research and Abdominal Transplantation Center, Saint Louis University School of Medicine, St. Louis, Missouri
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19
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Waterman AD, Morgievich M, Cohen DJ, Butt Z, Chakkera HA, Lindower C, Hays RE, Hiller JM, Lentine KL, Matas AJ, Poggio ED, Rees MA, Rodrigue JR, LaPointe Rudow D. Living Donor Kidney Transplantation: Improving Education Outside of Transplant Centers about Live Donor Transplantation--Recommendations from a Consensus Conference. Clin J Am Soc Nephrol 2015; 10:1659-69. [PMID: 26116651 DOI: 10.2215/cjn.00950115] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Living donor kidney transplantation (LDKT) offers better quality of life and clinical outcomes, including patient survival, compared with remaining on dialysis or receiving a deceased donor kidney transplant. Although LDKT education within transplant centers for both potential recipients and living donors is very important, outreach and education to kidney patients in settings other than transplant centers and to the general public is also critical to increase access to this highly beneficial treatment. In June 2014, the American Society of Transplantation's Live Donor Community of Practice, with the support of 10 additional sponsors, convened a consensus conference to determine best practices in LDKT, including a workgroup focused on developing a set of recommendations for optimizing outreach and LDKT education outside of transplant centers. Members of this workgroup performed a structured literature review, conducted teleconference meetings, and met in person at the 2-day conference. Their efforts resulted in consensus around the following recommendations. First, preemptive transplantation should be promoted through increased LDKT education by primary care physicians and community nephrologists. Second, dialysis providers should be trained to educate their own patients about LDKT and deceased donor kidney transplantation. Third, partnerships between community organizations, organ procurement organizations, religious organizations, and transplant centers should be fostered to support transplantation. Fourth, use of technology should be improved or expanded to better educate kidney patients and their support networks. Fifth, LDKT education and outreach should be improved for kidney patients in rural areas. Finally, a consensus-driven, evidence-based public message about LDKT should be developed. Discussion of the effect and potential for implementation around each recommendation is featured, particularly regarding reducing racial and socioeconomic disparities in access to LDKT. To accomplish these recommendations, the entire community of professionals and organizations serving kidney patients must work collaboratively toward ensuring accurate, comprehensive, and up-to-date LDKT education for all patients, thereby reducing barriers to LDKT access and increasing LDKT rates.
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Affiliation(s)
- Amy D Waterman
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material.
| | - Marie Morgievich
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - David J Cohen
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Zeeshan Butt
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Harini A Chakkera
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Carrie Lindower
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Rebecca E Hays
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Janet M Hiller
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Krista L Lentine
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Arthur J Matas
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Emilio D Poggio
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Michael A Rees
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - James R Rodrigue
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Dianne LaPointe Rudow
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
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20
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Skelton SL, Waterman AD, Davis LA, Peipert JD, Fish AF. Applying best practices to designing patient education for patients with end-stage renal disease pursuing kidney transplant. Prog Transplant 2015; 25:77-84. [PMID: 25758805 PMCID: PMC4489708 DOI: 10.7182/pit2015415] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite the known benefits of kidney transplant, less than 30% of the 615 000 patients living with end-stage renal disease (ESRD) in the United States have received a transplant. More than 100 000 people are presently on the transplant waiting list. Although the shortage of kidneys for transplant remains a critical factor in explaining lower transplant rates, another important and modifiable factor is patients' lack of comprehensive education about transplant. The purpose of this article is to provide an overview of known best practices from the broader literature that can be used as an evidence base to design improved education for ESRD patients pursuing a kidney transplant. Best practices in chronic disease education generally reveal that education that is individually tailored, understandable for patients with low health literacy, and culturally competent is most beneficial. Effective education helps patients navigate the complex health care process successfully. Recommendations for how to incorporate these best practices into transplant education design are described. Providing more ESRD patients with transplant education that encompasses these best practices may improve their ability to make informed health care decisions and increase the numbers of patients interested in pursuing transplant.
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Affiliation(s)
| | - Amy D Waterman
- David Geffen School of Medicine at UCLA Los Angeles, California
| | | | - John D Peipert
- David Geffen School of Medicine at UCLA Los Angeles, California
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21
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Patzer RE, Gander J, Sauls L, Amamoo MA, Krisher J, Mulloy LL, Gibney E, Browne T, Plantinga L, Pastan SO. The RaDIANT community study protocol: community-based participatory research for reducing disparities in access to kidney transplantation. BMC Nephrol 2014; 15:171. [PMID: 25348614 PMCID: PMC4230631 DOI: 10.1186/1471-2369-15-171] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/23/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Southeastern United States has the lowest kidney transplant rates in the nation, and racial disparities in kidney transplant access are concentrated in this region. The Southeastern Kidney Transplant Coalition (SEKTC) of Georgia, North Carolina, and South Carolina is an academic and community partnership that was formed with the mission to improve access to kidney transplantation and reduce disparities among African American (AA) end stage renal disease (ESRD) patients in the Southeastern United States. METHODS/DESIGN We describe the community-based participatory research (CBPR) process utilized in planning the Reducing Disparities In Access to kidNey Transplantation (RaDIANT) Community Study, a trial developed by the SEKTC to reduce health disparities in access to kidney transplantation among AA ESRD patients in Georgia, the state with the lowest kidney transplant rates in the nation. The SEKTC Coalition conducted a needs assessment of the ESRD population in the Southeast and used results to develop a multicomponent, dialysis facility-randomized, quality improvement intervention to improve transplant access among dialysis facilities in GA. A total of 134 dialysis facilities are randomized to receive either: (1) standard of care or "usual" transplant education, or (2) the multicomponent intervention consisting of transplant education and engagement activities targeting dialysis facility leadership, staff, and patients within dialysis facilities. The primary outcome is change in facility-level referral for kidney transplantation from baseline to 12 months; the secondary outcome is reduction in racial disparity in transplant referral. DISCUSSION The RaDIANT Community Study aims to improve equity in access to kidney transplantation for ESRD patients in the Southeast. TRIAL REGISTRATION Clinicaltrials.gov number NCT02092727.
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Affiliation(s)
- Rachel E Patzer
- />Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
- />Emory Transplant Center, Atlanta, GA USA
| | - Jennifer Gander
- />Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA USA
| | | | | | | | - Laura L Mulloy
- />Department of Medicine, Section of Nephrology, Hypertension, and Transplant Medicine, Georgia Regents University, Augusta, GA USA
| | - Eric Gibney
- />Piedmont Transplant Institute, Atlanta, GA USA
| | - Teri Browne
- />College of Social Work, University of South Carolina, Columbia, SC USA
| | - Laura Plantinga
- />Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
| | - Stephen O Pastan
- />Emory Transplant Center, Atlanta, GA USA
- />Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, GA USA
| | - on behalf of the Southeastern Kidney Transplant Coalition
- />Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA USA
- />Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
- />Emory Transplant Center, Atlanta, GA USA
- />Southeastern Kidney Council, Inc, Raleigh, NC USA
- />Department of Medicine, Section of Nephrology, Hypertension, and Transplant Medicine, Georgia Regents University, Augusta, GA USA
- />Piedmont Transplant Institute, Atlanta, GA USA
- />College of Social Work, University of South Carolina, Columbia, SC USA
- />Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, GA USA
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Waterman AD, Robbins ML, Paiva AL, Peipert JD, Kynard-Amerson CS, Goalby CJ, Davis LA, Thein JL, Schenk EA, Baldwin KA, Skelton SL, Amoyal NR, Brick LA. Your Path to Transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant. BMC Nephrol 2014; 15:166. [PMID: 25315644 PMCID: PMC4213461 DOI: 10.1186/1471-2369-15-166] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients' knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention. METHODS/DESIGN Nine hundred Black, Hispanic, and White ESRD patients presenting for transplant evaluation at University of California, Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) will be randomly assigned to one of two education conditions, YPT or Usual Care Control Education (UC). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored telephonic coaching sessions, feedback reports, video and print transplant education resources, and assistance with reducing any known socioeconomic barriers to LDKT. Patients receiving UC will only receive transplant education provided by UCLA-KPTP. Changes in transplant knowledge, readiness, pros and cons, and self-efficacy to pursue LDKT will be assessed prior to presenting at the transplant center (baseline), during transplant evaluation, and 4- and 8-months post-baseline, while completion of transplant evaluation and receipt of LDKTs will be assessed at 18-months post-baseline. The RCT will determine, compared to UC, whether Black, Hispanic, and White patients receiving YPT increase in their readiness to pursue LDKT and transplant knowledge, and become more likely to complete transplant medical evaluation and pursue LDKT. It will also examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with YPT to affect patients' transplant decision-making and behavior. Statistical analyses will be performed under an intent-to-treat approach. DISCUSSION At the conclusion of the study, we will have assessed the effectiveness of an innovative and cost-effective YPT intervention that could be utilized to tailor LDKT discussion and education based on the needs of individual patients of different races in many healthcare settings. TRIAL REGISTRATION ClinicalTrials.gov, number NCT02181114.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine at the University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA 90024, USA.
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Weng FL, Brown DR, Peipert JD, Holland B, Waterman AD. Protocol of a cluster randomized trial of an educational intervention to increase knowledge of living donor kidney transplant among potential transplant candidates. BMC Nephrol 2013; 14:256. [PMID: 24245948 PMCID: PMC3840671 DOI: 10.1186/1471-2369-14-256] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 11/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background The best treatment option for end-stage renal disease is usually a transplant, preferably a live donor kidney transplant (LDKT). The most effective ways to educate kidney transplant candidates about the risks, benefits, and process of LDKT remain unknown. Methods/design We report the protocol of the Enhancing Living Donor Kidney Transplant Education (ELITE) Study, a cluster randomized trial of an educational intervention to be implemented during initial transplant evaluation at a large, suburban U.S. transplant center. Five hundred potential transplant candidates are cluster randomized (by date of visit) to receive either: (1) standard-of-care (“usual”) transplant education, or (2) intensive education that is based upon the Explore Transplant series of educational materials. Intensive transplant education includes viewing an educational video about LDKT, receiving print education, and meeting with a transplant educator. The primary outcome consists of knowledge of the benefits, risks, and process of LDKT, assessed one week after the transplant evaluation. As a secondary outcome, knowledge and understanding of LDKT are assessed 3 months after the evaluation. Additional secondary outcomes, assessed one week and 3 months after the evaluation, include readiness, self-efficacy, and decisional balance regarding transplant and LDKT, with differences assessed by race. Although the unit of randomization is the date of the transplant evaluation visit, the unit of analysis will be the individual potential transplant candidate. Discussion The ELITE Study will help to determine how education in a transplant center can best be designed to help Black and non-Black patients learn about the option of LDKT. Trial registration Clinicaltrials.gov number NCT01261910
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Affiliation(s)
- Francis L Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, 94 Old Short Hills Road, East Wing, Suite 305, Livingston, NJ 07039, USA.
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Purnell TS, Hall YN, Boulware LE. Understanding and overcoming barriers to living kidney donation among racial and ethnic minorities in the United States. Adv Chronic Kidney Dis 2012; 19:244-51. [PMID: 22732044 PMCID: PMC3385991 DOI: 10.1053/j.ackd.2012.01.008] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 01/27/2012] [Accepted: 01/30/2012] [Indexed: 01/04/2023]
Abstract
In the United States, racial-ethnic minorities experience disproportionately high rates of ESRD, but they are substantially less likely to receive living donor kidney transplants (LDKT) compared with their majority counterparts. Minorities may encounter barriers to LDKT at several steps along the path to receiving it, including consideration, pursuit, completion of LDKT, and the post-LDKT experience. These barriers operate at different levels related to potential recipients and donors, health care providers, health system structures, and communities. In this review, we present a conceptual framework describing various barriers that minorities face along the path to receiving LDKT. We also highlight promising recent and current initiatives to address these barriers, as well as gaps in initiatives, which may guide future interventions to reduce racial-ethnic disparities in LDKT.
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Affiliation(s)
- Tanjala S. Purnell
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD
| | - Yoshio N. Hall
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington
| | - L. Ebony Boulware
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
- Johns Hopkins Center to Eliminate Cardiovascular Health Disparities, Baltimore, MD
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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25
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Kutner NG, Johansen KL, Zhang R, Huang Y, Amaral S. Perspectives on the new kidney disease education benefit: early awareness, race and kidney transplant access in a USRDS study. Am J Transplant 2012; 12:1017-23. [PMID: 22226386 PMCID: PMC5844184 DOI: 10.1111/j.1600-6143.2011.03898.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Education services for Stage-IV chronic kidney disease patients were added in 2010 as a Part B covered benefit under the Medicare Improvements for Patients and Providers Act. Desired outcomes include early pursuit of kidney transplantation by more patients and reduction of racial disparities in access to transplantation. During 2005-2007, a United States Renal Data System (USRDS) special study surveyed 1123 patients in a national cohort who had recently started dialysis, identified themselves as black or white, and were reported by their physician as potentially eligible transplant candidates. Patients were asked if kidney transplantation had been discussed with them before they initiated renal replacement therapy, and survey responses were linked with subsequent wait listing and transplant events in USRDS registry files. Kaplan-Meier analyses showed a significant association between early transplant awareness and subsequent wait listing. Adjusted Cox models showed a significant race/early transplant awareness interaction, however, with the impact of early awareness on wait listing much stronger for whites. Ongoing support and education about kidney transplantation for patients after dialysis start could help to build on early education and foster greater quality improvement in patient outcomes.
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Affiliation(s)
- N. G. Kutner
- United States Renal Data System, Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, GA,Corresponding author: Nancy G. Kutner,
| | - K. L. Johansen
- United States Renal Data System, Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, GA,Nephrology Section, San Francisco VA Medical Center and Department of Medicine, University of California, San Francisco, CA
| | - R. Zhang
- United States Renal Data System, Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, GA
| | - Y. Huang
- United States Renal Data System, Rehabilitation/Quality of Life Special Studies Center, Emory University, Atlanta, GA
| | - S. Amaral
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA
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