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Calvelli H, Gardiner H, Gadegbeku C, Reese P, Obradovic Z, Fink E, Gillespie A. A Social Network Analysis of Hemodialysis Clinics: Attitudes Toward Living Donor Kidney Transplant among Influential Patients. KIDNEY360 2024; 5:577-588. [PMID: 38324254 PMCID: PMC11093547 DOI: 10.34067/kid.0000000000000383] [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: 10/11/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
Key Points Hemodialysis clinic social networks spread attitudes and behaviors toward kidney transplants. Identifying and characterizing influential patients is a first step in future hemodialysis clinic social network interventions to promote kidney transplantation. Background Hemodialysis clinics help develop patient social networks that may spread kidney transplant (KT) attitudes and behaviors. Identifying influential social network members is an important first step to increase KT rates. We mapped the social networks of two hemodialysis facilities to identify which patients were influential using in-degree centrality as a proxy for popularity and influence. Methods In this cross-sectional study, we performed a sociocentric social network analysis of patients on hemodialysis in two geographically and demographically different hemodialysis facilities. Statistical and social network analyses were performed using R statistical software. Results More patients at facility 1 (N =71) were waitlisted/evaluating living donor KT (50.7% versus 20.0%, P = 0.021), considered KT as very important (70.4% versus 45.0%, P = 0.019), and knew people who received a successful KT (1.0 versus 0.0, P = 0.003). Variables predicting relationship formation at facility 1 were the same shift (β =1.87, 95% confidence interval [CI] [1.19 to 2.55]; P < 0.0001), same sex (β =0.51, 95% CI [0.01 to 1.00]; P = 0.045), younger age (β =−0.03, 95% CI [−0.05 to −0.01]; P = 0.004), different lengths of time on hemodialysis (β =−0.49, 95% CI [−0.86 to −0.12]; P = 0.009), and knowing more people who received a successful KT (β =0.12, 95% CI [0.03 to 0.21]; P = 0.009). Predictive variables at facility 2 (N =40) were the same race (β =2.52, 95% CI [0.39 to 4.65]; P = 0.021) and knowing fewer people with successful KT (β =−0.92, 95% CI [−1.82 to −0.02]; P = 0.045). In-degree centrality was higher at facility 1 (1.1±1.2) compared with facility 2 (0.6±0.9). Conclusions Social networks differed between the hemodialysis clinics in structure and prevalent transplant attitudes. Influential patients at facility 1 (measured by in-degree centrality) had positive attitudes toward KT, whereas influential patients at facility 2 had negative attitudes.
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Affiliation(s)
- Hannah Calvelli
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Heather Gardiner
- Temple University College of Public Health, Philadelphia, Pennsylvania
| | - Crystal Gadegbeku
- Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio
| | - Peter Reese
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zoran Obradovic
- Temple University Center for Data Analytics and Biomedical Informatics, Philadelphia, Pennsylvania
| | - Edward Fink
- Temple University School of Media and Communication, Philadelphia, Pennsylvania
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Buford J, Retzloff S, Wilk AS, McPherson L, Harding JL, Pastan SO, Patzer RE. Race, Age, and Kidney Transplant Waitlisting Among Patients Receiving Incident Dialysis in the United States. Kidney Med 2023; 5:100706. [PMID: 37753250 PMCID: PMC10518364 DOI: 10.1016/j.xkme.2023.100706] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Rationale & Objective Patients with kidney failure from racial and ethnic minority groups and older patients have reduced access to the transplant waitlist relative to White and younger patients. Although racial disparities in the waitlisting group have declined after the 2014 kidney allocation system change, whether there is intersectionality of race and age in waitlisting access is unknown. Study Design Retrospective cohort study. Setting & Participants 439,455 non-Hispanic White and non-Hispanic Black US adults initiating dialysis between 2015 and 2019 were identified from the United States Renal Data System, and followed through 2020. Exposures Patient race and ethnicity (non-Hispanic White and non-Hispanic Black) and age group (18-29, 30-49, 50-64, and 65-80 years). Outcomes Placement on the United Network for Organ Sharing deceased donor waitlist. Analytical Approach Age- and race-stratified waitlisting rates were compared. Multivariable Cox proportional hazards models, censored for death, examined the association between race and waitlisting, and included interaction term for race and age. Results Over a median follow-up period of 1 year, the proportion of non-Hispanic White and non-Hispanic Black patients waitlisted was 20.7% and 20.5%, respectively. In multivariable models, non-Hispanic Black patients were 14% less likely to be waitlisted (aHR, 0.86, 95% CI, 0.77-0.95). Relative differences between non-Hispanic Black and non-Hispanic White patients were different by age group. Non-Hispanic Black patients were 27%, 12%, and 20% less likely to be waitlisted than non-Hispanic White patients for ages 18-29 years (aHR, 0.73; 95% CI, 0.61-0.86), 50-64 (aHR, 0.88; 95% CI, 0.80-0.98), and 65-80 years (aHR, 0.80; 95% CI, 0.71-0.90), respectively, but differences were attenuated among patients aged 30-49 years (aHR, 0.89; 95% CI, 0.77-1.02). Limitations Race and ethnicity data is physician reported, residual confounding, and analysis is limited to non-Hispanic White and non-Hispanic Black patients. Conclusions Racial disparities in waitlisting exist between non-Hispanic Black and non-Hispanic White individuals and are most pronounced among younger patients with kidney failure. Results suggest that interventions to address inequalities in waitlisting may need to be targeted to younger patients with kidney failure. Plain-Language Summary Research has shown that patients from racial and ethnic minority groups and older patients have reduced access to transplant waitlisting relative to White and younger patients; nevertheless, how age impacts racial disparities in waitlisting is unknown. We compared waitlisting between non-Hispanic Black and non-Hispanic White patients with incident kidney failure, within age strata, using registry data for 439,455 US adults starting dialysis (18-80 years) during 2015-2019. Overall, non-Hispanic Black patients were less likely to be waitlisted and relative differences between the two racial groups differed by age. After adjusting for patient-level factors, the largest disparity in waitlisting was observed among adults aged 18-29 years. These results suggest that interventions should target younger adults to reduce disparities in access to kidney transplant waitlisting.
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Affiliation(s)
- Jade Buford
- Regenstrief Institute, Indianapolis, Indiana
| | - Samantha Retzloff
- HIV Surveillance Branch (HSB), Division of HIV Prevention (DHP), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adam S. Wilk
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Emory University School of Medicine, Atlanta, Georgia
| | - Laura McPherson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Emory University, Emory University School of Medicine, Atlanta, Georgia
| | - Jessica L. Harding
- Department of Epidemiology, Rollins School of Public Health, Emory University, Emory University, Emory University School of Medicine, Atlanta, Georgia
- Division of Transplantation, Department of Surgery, Emory University, Emory University School of Medicine, Atlanta, Georgia
- Health Services Research Center, Emory University School of Medicine, Emory University, Emory University School of Medicine, Atlanta, Georgia
| | - Stephen O. Pastan
- Department of Medicine, Renal Division, Emory University, Emory University School of Medicine, Atlanta, Georgia
| | - Rachel E. Patzer
- Regenstrief Institute, Indianapolis, Indiana
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Gillespie A, Daw J, Brown R, Cappiello J, Lee BE, Fink EL, Gardiner HM, Reese PP, Gadegbeku CA, Obradovic Z. Dialysis Patients' Social Networks and Living Donation Offers. Kidney Med 2023; 5:100640. [PMID: 37235041 PMCID: PMC10206208 DOI: 10.1016/j.xkme.2023.100640] [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] [Indexed: 05/28/2023] Open
Abstract
Rationale & Objective Most living kidney donors are members of a hemodialysis patient's social network. Network members are divided into core members, those strongly connected to the patient and other members; and peripheral members, those weakly connected to the patient and other members. We identify how many hemodialysis patients' network members offered to become kidney donors, whether these offers were from core or peripheral network members, and whose offers the patients accepted. Study Design A cross-sectional interviewer-administered hemodialysis patient social network survey. Setting & Participants Prevalent hemodialysis patients in 2 facilities. Predictors Network size and constraint, a donation from a peripheral network member. Outcomes Number of living donor offers, accepting an offer. Analytical Approach We performed egocentric network analyses for all participants. Poisson regression models evaluated associations between network measures and number of offers. Logistic regression models determined the associations between network factors and accepting a donation offer. Results The mean age of the 106 participants was 60 years. Forty-five percent were female, and 75% self-identified as Black. Fifty-two percent of participants received at least one living donor offer (range 1-6); 42% of the offers were from peripheral members. Participants with larger networks received more offers (incident rate ratio [IRR], 1.26; 95% CI, 1.12-1.42; P = 0.001), including networks with more peripheral members (constraint, IRR, 0.97; 95% CI, 0.96-0.98; P < 0.001). Participants who received a peripheral member offer had 3.6 times greater odds of accepting an offer (OR, 3.56; 95% CI, 1.15-10.8; P = 0.02) than those who did not receive a peripheral member offer. Limitations A small sample of only hemodialysis patients. Conclusions Most participants received at least one living donor offer, often from peripheral network members. Future living donor interventions should focus on both core and peripheral network members.
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Affiliation(s)
- Avrum Gillespie
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jonathan Daw
- Department of Sociology and Demography, College of Liberal Arts, Penn State, Philadelphia, Pennsylvania
| | - Riley Brown
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Jamie Cappiello
- Department of Social & Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Briana Eugene Lee
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Edward L. Fink
- Department of Communication and Social Influence, Klein College of Media and Communication, Temple University, Philadelphia, Pennsylvania
| | - Heather M. Gardiner
- Department of Social & Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Peter P. Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Zoran Obradovic
- Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, Pennsylvania
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Browne T, Tindall J. Expanding Access to Living Donor Kidney Transplants Through Social Networks. Kidney Med 2023; 5:100654. [PMID: 37250502 PMCID: PMC10209734 DOI: 10.1016/j.xkme.2023.100654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Affiliation(s)
- Teri Browne
- Address for Correspondence: Teri Browne, PhD, MSW, College of Social Work, University of South Carolina, 1512 Pendleton St, Columbia, SC 29208.
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Aljurbua R, Gillespie A, Obradovic Z. The company we keep. Using hemodialysis social network data to classify patients' kidney transplant attitudes with machine learning algorithms. BMC Nephrol 2022; 23:414. [PMID: 36581930 PMCID: PMC9798634 DOI: 10.1186/s12882-022-03049-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/20/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Hemodialysis clinic patient social networks may reinforce positive and negative attitudes towards kidney transplantation. We examined whether a patient's position within the hemodialysis clinic social network could improve machine learning classification of the patient's positive or negative attitude towards kidney transplantation when compared to sociodemographic and clinical variables. METHODS We conducted a cross-sectional social network survey of hemodialysis patients in two geographically and demographically different hemodialysis clinics. We evaluated whether machine learning logistic regression models using sociodemographic or network data best predicted the participant's transplant attitude. Models were evaluated for accuracy, precision, recall, and F1-score. RESULTS The 110 surveyed participants' mean age was 60 ± 13 years old. Half (55%) identified as male, and 74% identified as Black. At facility 1, 69% of participants had a positive attitude towards transplantation whereas at facility 2, 45% of participants had a positive attitude. The machine learning logistic regression model using network data alone obtained a higher accuracy and F1 score than the sociodemographic and clinical data model (accuracy 65% ± 5% vs. 61% ± 7%, F1 score 76% ± 2% vs. 70% ± 7%). A model with a combination of both sociodemographic and network data had a higher accuracy of 74% ± 3%, and an F1-score of 81% ± 2%. CONCLUSION Social network data improved the machine learning algorithm's ability to classify attitudes towards kidney transplantation, further emphasizing the importance of hemodialysis clinic social networks on attitudes towards transplant.
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Affiliation(s)
- Rafaa Aljurbua
- grid.264727.20000 0001 2248 3398Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, USA ,grid.412602.30000 0000 9421 8094Department of Computer Science, College of Computer, Qassim University, Buraydah, Saudi Arabia
| | - Avrum Gillespie
- grid.264727.20000 0001 2248 3398Division of Nephrology, Department of Medicine, Lewis Katz School of Medicine, Hypertension, and Kidney Transplantation, Temple University, Philadelphia, USA
| | - Zoran Obradovic
- grid.264727.20000 0001 2248 3398Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, USA
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A scoping review of inequities in access to organ transplant in the United States. Int J Equity Health 2022; 21:22. [PMID: 35151327 PMCID: PMC8841123 DOI: 10.1186/s12939-021-01616-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Abstract
Background Organ transplant is the preferred treatment for end-stage organ disease, yet the majority of patients with end-stage organ disease are never placed on the transplant waiting list. Limited access to the transplant waiting list combined with the scarcity of the organ pool result in over 100,000 deaths annually in the United States. Patients face unique barriers to referral and acceptance for organ transplant based on social determinants of health, and patients from disenfranchised groups suffer from disproportionately lower rates of transplantation. Our objective was to review the literature describing disparities in access to organ transplantation based on social determinants of health to integrate the existing knowledge and guide future research. Methods We conducted a scoping review of the literature reporting disparities in access to heart, lung, liver, pancreas and kidney transplantation based on social determinants of health (race, income, education, geography, insurance status, health literacy and engagement). Included studies were categorized based on steps along the transplant care continuum: referral for transplant, transplant evaluation and selection, living donor identification/evaluation, and waitlist outcomes. Results Our search generated 16,643 studies, of which 227 were included in our final review. Of these, 34 focused on disparities in referral for transplantation among patients with chronic organ disease, 82 on transplant selection processes, 50 on living donors, and 61 on waitlist management. In total, 15 studies involved the thoracic organs (heart, lung), 209 involved the abdominal organs (kidney, liver, pancreas), and three involved multiple organs. Racial and ethnic minorities, women, and patients in lower socioeconomic status groups were less likely to be referred, evaluated, and added to the waiting list for organ transplant. The quality of the data describing these disparities across the transplant literature was variable and overwhelmingly focused on kidney transplant. Conclusions This review contextualizes the quality of the data, identifies seminal work by organ, and reports gaps in the literature where future research on disparities in organ transplantation should focus. Future work should investigate the association of social determinants of health with access to the organ transplant waiting list, with a focus on prospective analyses that assess interventions to improve health equity. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01616-x.
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Non-medical barriers in access to early steps of kidney transplantation in the United States - A scoping review. Transplant Rev (Orlando) 2021; 35:100654. [PMID: 34597944 DOI: 10.1016/j.trre.2021.100654] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND In the United States (US), barriers in access to later steps in the kidney transplantation process (i.e. waitlisting) have been well documented. Barriers in access to earlier steps (i.e. referral and evaluation) are less well described due to the lack of national surveillance data. In this review, we summarize the available literature on non-medical barriers in access to kidney transplant referral and evaluation. METHODS Following PRISMA guidelines, we conducted a scoping review of the literature through June 3, 2021. We included all studies (quantitative and qualitative) reporting on barriers to kidney transplant referral and evaluation in the US published from 1990 onwards in English and among adult end-stage kidney disease (ESKD) patients (PROSPERO registration number: CRD42014015027). We narratively synthesized results across studies. RESULTS We retrieved information from 33 studies published from 1990 to 2021 (reporting data between 1990 and 2018). Most studies (n = 28, 85%) described barriers among patient populations, three (9%) among provider populations, and two (6%) included both patients and providers. Key barriers were identified across multiple levels and included patient- (e.g. demographic, socioeconomic, sociocultural, and knowledge), provider- (e.g. miscommunication, staff availability, provider perceptions and attitudes), and system- (e.g. geography, distance to care, healthcare logistics) level factors. CONCLUSIONS A multi-pronged approach (e.g. targeted and systemwide interventions, and policy change) implemented at multiple levels of the healthcare system will be necessary to reduce identified barriers in access to early kidney transplant steps. Collection of national surveillance data on these early kidney transplant steps is also needed to enhance our understanding of barriers to referral and evaluation.
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Kayler LK, Dolph B, Ranahan M, Keller M, Cadzow R, Feeley TH. Kidney Transplant Evaluation and Listing: Development and Preliminary Evaluation of Multimedia Education for Patients. Ann Transplant 2021; 26:e929839. [PMID: 33649286 PMCID: PMC7936469 DOI: 10.12659/aot.929839] [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] [Indexed: 11/09/2022] Open
Abstract
Background Patient knowledge gaps about the evaluation and waitlisting process for kidney transplantation lead to delayed and incomplete testing, which compromise transplant access. We aimed to develop and evaluate a novel video education approach to empower patients to proceed with the transplant evaluation and listing process and to increase their knowledge and motivation. Material/Methods We developed 2 theory-informed educational animations about the kidney transplantation evaluation and listing process with input from experts in transplantation and communication, 20 candidates/recipients, 5 caregivers, 1 anthropologist, 3 community advocates, and 36 dialysis or transplant providers. We then conducted an online pre-post study with 28 kidney transplantation candidates to measure the acceptability and feasibility of the 2 videos to improve patients’ evaluation and listing knowledge, understanding, and concerns. Results Compared with before intervention, the mean knowledge score increased after intervention by 38% (5.7 to 7.9; P<0.001). Increases in knowledge effect size were large across age group, health literacy, education, technology access, and duration of pretransplant dialysis. The proportion of positive responses increased from before to after animation viewing for understanding the evaluation process (25% to 61%; P=0.002) and waitlist placement (32% to 86%; P<0.001). Concerns about list placement decreased (32% to 7%; P=0.039). After viewing the animations, >90% of responses indicated positive ratings on trusting the information, comfort level with learning, and engagement. Conclusions In partnership with stakeholders, we developed 2 educational animations about kidney transplant evaluation and listing that were positively received by patients and have the potential to improve patient knowledge and understanding and reduce patient concerns.
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Affiliation(s)
- Liise K Kayler
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
| | - Beth Dolph
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Molly Ranahan
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
| | - Maria Keller
- Department of Community Health and Health Behavior, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Renee Cadzow
- Department of Health Administration and Public Health, D'Youville College, Buffalo, NY, USA
| | - Thomas H Feeley
- Department of Communication, University at Buffalo, State University of New York, Buffalo, NY, USA
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Gillespie A, Fink EL, Gardiner HM, Gadegbeku CA, Reese PP, Obradovic Z. Does Whom Patients Sit Next to during Hemodialysis Affect Whether They Request a Living Donation? KIDNEY360 2021; 2:507-518. [PMID: 35369020 PMCID: PMC8785989 DOI: 10.34067/kid.0006682020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 01/13/2021] [Indexed: 02/04/2023]
Abstract
Background The seating arrangement of in-center hemodialysis is conducive to patients forming a relationship and a social network. We examined how seating in the in-center hemodialysis clinic affected patients forming relationships, whether patients formed relationships with others who have similar transplant behaviors (homophily), and whether these relationships influenced patients (social contagion) to request a living donation from family and friends outside of the clinic. Methods In this 30-month, prospective cohort study, we observed the relationships of 46 patients on hemodialysis in a hemodialysis clinic. Repeated participant surveys assessed in-center transplant discussions and living-donor requests. A separable temporal exponential random graph model estimated how seating, demographics, in-center transplant discussions, and living-donor requests affected relationship formation via sociality and homophily. We examined whether donation requests spread via social contagion using a susceptibility-infected model. Results For every seat apart, the odds of participants forming a relationship decreased (OR, 0.74; 95% CI, 0.61 to 0.90; P=0.002). Those who requested a living donation tended to form relationships more than those who did not (sociality, OR, 1.6; 95% CI, 1.02 to 2.6; P=0.04). Participants who discussed transplantation in the center were more likely to form a relationship with another participant who discussed transplantation than with someone who did not discuss transplantation (homophily, OR, 1.9; 95% CI, 1.03 to 3.5; P=0.04). Five of the 36 susceptible participants made a request after forming a relationship with another patient. Conclusions Participants formed relationships with those they sat next to and had similar transplant behaviors. The observed increase in in-center transplant discussions and living-donation requests by the members of the hemodialysis-clinic social network was not because of social contagion. Instead, participants who requested a living donation were more social, formed more relationships within the clinic, and discussed transplantation with each other as a function of health-behavior homophily.
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Affiliation(s)
- Avrum Gillespie
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Edward L. Fink
- Department of Communication and Social Influence, Klein College of Media and Communication, Temple University, Philadelphia, Pennsylvania
| | - Heather M. Gardiner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Crystal A. Gadegbeku
- Division of Nephrology, Hypertension, and Kidney Transplantation, Department of Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Peter P. Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zoran Obradovic
- Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, Pennsylvania
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Wong K, Owen-Smith A, Caskey F, MacNeill S, Tomson CR, Dor FJ, Ben-Shlomo Y, Bouacida S, Idowu D, Bailey P. Investigating Ethnic Disparity in Living-Donor Kidney Transplantation in the UK: Patient-Identified Reasons for Non-Donation among Family Members. J Clin Med 2020; 9:E3751. [PMID: 33233422 PMCID: PMC7700269 DOI: 10.3390/jcm9113751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
There is ethnic inequity in access to living-donor kidney transplants in the UK. This study asked kidney patients from Black, Asian and minority ethnic groups why members of their family were not able to be living kidney donors. Responses were compared with responses from White individuals. This questionnaire-based mixed-methods study included adults transplanted between 1/4/13-31/3/17 at 14 UK hospitals. Participants were asked to indicate why relatives could not donate, selecting all options applicable from: Age; Health; Weight; Location; Financial/Cost; Job; Blood group; No-one to care for them after donation. A box entitled 'Other-please give details' was provided for free-text entries. Multivariable logistic regression was used to analyse the association between the likelihood of selecting each reason for non-donation and the participant's self-reported ethnicity. Qualitative responses were analysed using inductive thematic analysis. In total, 1240 questionnaires were returned (40% response). There was strong evidence that Black, Asian and minority ethnic group individuals were more likely than White people to indicate that family members lived too far away to donate (adjusted odds ratio (aOR) = 3.25, 95% Confidence Interval (CI) 2.30-4.58), were prevented from donating by financial concerns (aOR = 2.95, 95% CI 2.02-4.29), were unable to take time off work (aOR = 1.88, 95% CI 1.18-3.02), were "not the right blood group" (aOR = 1.65, 95% CI 1.35-2.01), or had no-one to care for them post-donation (aOR = 3.73, 95% CI 2.60-5.35). Four qualitative themes were identified from responses from Black, Asian and minority ethnic group participants: 'Burden of disease within the family'; 'Differing religious interpretations'; 'Geographical concerns'; and 'A culture of silence'. Patients perceive barriers to living kidney donation in the UK Black, Asian and minority ethnic population. If confirmed, these could be targeted by interventions to redress the observed ethnic inequity.
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Affiliation(s)
- Katie Wong
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - Amanda Owen-Smith
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
| | - Fergus Caskey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - Stephanie MacNeill
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
| | - Charles R.V. Tomson
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK;
| | | | - Yoav Ben-Shlomo
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
| | - Soumeya Bouacida
- Bristol Health Partners’ Chronic Kidney Disease Health Integration Team, Bristol BS1 2NT, UK
| | - Dela Idowu
- Gift of Living Donation (GOLD), London NW10 0NS, UK
| | - Pippa Bailey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
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Educational Animations to Inform Transplant Candidates About Deceased Donor Kidney Options: An Efficacy Randomized Trial. Transplant Direct 2020; 6:e575. [PMID: 32766430 PMCID: PMC7339360 DOI: 10.1097/txd.0000000000001026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 11/01/2022] Open
Abstract
Background Transplant candidates struggle making decisions about accepting kidneys with variable kidney donor profile index (KDPI) and increased risk donor (IRD) status. Methods This single site, pilot randomized controlled trial evaluated the efficacy of 2 animations to improve KDPI/IRD knowledge, decisional self-efficacy, and willingness. Kidney candidates were randomly assigned to animation viewing plus standard nurse discussion (intervention) or standard nurse discussion alone (control). Linear regression was used to test the significance of animation exposure after controlling for covariates (α < 0.1). Results Mean age was 60 years, and 27% were African American. Both intervention (n = 42) and control (n = 38) groups received similar education at similar duration (12.8 versus 11.8 min, respectively), usually by the same dedicated nurse educator (85% versus 75%, respectively). On multivariate analysis, the intervention group (versus control) exhibited significantly increased knowledge (β = 0.23; 95% confidence interval, 0.66-1.77) and IRD willingness (β = 0.22; 95% confidence interval, 0.05-0.86). There were no between-group differences in KDPI >85% willingness or distribution of KDPI/IRD decisional self-efficacy. Over 90% of participants provided positive ratings on each of 11 acceptability items. Conclusions Supporting conventional IRD and KDPI education with educational animations can improve knowledge and IRD willingness compared with standard methods.
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12
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Shirey TE, Morris AA. Different Lenses for the Same Story: Examining How Implicit Bias Can Lead Us to Different Clinical Decisions for the "Same" Patient. J Am Heart Assoc 2019; 8:e014355. [PMID: 31707941 PMCID: PMC6915292 DOI: 10.1161/jaha.119.014355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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13
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Wilkinson E, Brettle A, Waqar M, Randhawa G. Inequalities and outcomes: end stage kidney disease in ethnic minorities. BMC Nephrol 2019; 20:234. [PMID: 31242862 PMCID: PMC6595597 DOI: 10.1186/s12882-019-1410-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 06/06/2019] [Indexed: 02/08/2023] Open
Abstract
Background The international evidence about outcomes of End Stage Kidney Disease (ESKD) for ethnic minorities was reviewed to identify gaps and make recommendations for researchers and policy makers. Methods Nine databases were searched systematically with 112 studies from 14 different countries included and analysed to produce a thematic map of the literature. Results Reviews (n = 26) highlighted different mortality rates and specific causes between ethnic groups and by stage of kidney disease associated with individual, genetic, social and environmental factors. Primary studies focussing on uptake of treatment modalities (n = 19) found ethnic differences in access. Research evaluating intermediate outcomes and quality of care in different treatment phases (n = 35) e.g. dialysis adequacy, transplant evaluation and immunosuppression showed ethnic minorities were disadvantaged. This is despite a survival paradox for some ethnic minorities on dialysis seen in studies of longer term outcomes (n = 29) e.g. in survival time post-transplant and mortality. There were few studies which focussed on end of life care (n = 3) and ethnicity. Gaps identified were: limited evidence from all stages of the ESKD pathway, particularly end of life care; a lack of system oriented studies with a reliance on national routine datasets which are limited in scope; a dearth of qualitative studies; and a lack studies from many countries with limited cross country comparison and learning. Conclusions Differences between ethnic groups occur at various points and in a variety of outcomes throughout the kidney care system. The combination of individual factors and system related variables affect ethnic groups differently indicating a need for culturally intelligent policy informed by research to prevent disadvantage.
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Affiliation(s)
- Emma Wilkinson
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Alison Brettle
- School of Health and Society, University of Salford, Manchester, UK
| | - Muhammad Waqar
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - Gurch Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK.
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14
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Gillespie A. Together We Can Improve Outcomes in Kidney Failure: Examining Social Networks in Hemodialysis. Kidney Med 2019; 1:79-82. [PMID: 32734941 PMCID: PMC7380405 DOI: 10.1016/j.xkme.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
- Avrum Gillespie
- Division of Nephrology, Hypertension, and Kidney Transplantation, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
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15
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Gehlert S, Andrews C, Browne T. Establishing the Place of Health Social Work. HEALTH & SOCIAL WORK 2019; 44:69-71. [PMID: 30900724 DOI: 10.1093/hsw/hlz011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Sarah Gehlert
- Sarah Gehlert, PhD, MSW, MA, is dean; Christina Andrews, PhD, MSW, is assistant professor; and Teri Browne, PhD, MSW, NSW-C, is associate professor, College of Social Work, University of South Carolina, Columbia
| | - Christina Andrews
- Sarah Gehlert, PhD, MSW, MA, is dean; Christina Andrews, PhD, MSW, is assistant professor; and Teri Browne, PhD, MSW, NSW-C, is associate professor, College of Social Work, University of South Carolina, Columbia
| | - Teri Browne
- Sarah Gehlert, PhD, MSW, MA, is dean; Christina Andrews, PhD, MSW, is assistant professor; and Teri Browne, PhD, MSW, NSW-C, is associate professor, College of Social Work, University of South Carolina, Columbia
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16
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Ladin K, Emerson J, Berry K, Butt Z, Gordon EJ, Daniels N, Lavelle TA, Hanto DW. Excluding patients from transplant due to social support: Results from a national survey of transplant providers. Am J Transplant 2019; 19:193-203. [PMID: 29878515 PMCID: PMC6427829 DOI: 10.1111/ajt.14962] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/08/2018] [Accepted: 05/31/2018] [Indexed: 01/25/2023]
Abstract
Social support is used to determine transplant eligibility despite lack of an evidence base and vague regulatory guidance. It is unknown how many patients are disqualified from transplantation due to inadequate support, and whether providers feel confident using these subjective criteria to determine eligibility. Transplant providers (n = 551) from 202 centers estimated that, on average, 9.6% (standard deviation = 9.4) of patients evaluated in the prior year were excluded due to inadequate support. This varied significantly by United Network for Organ Sharing region (7.6%-12.2%), and by center (21.7% among top quartile). Significantly more providers used social support in listing decisions than believed it ought to be used (86.3% vs 67.6%). Nearly 25% believed that using social support in listing determinations was unfair or were unsure; 67.3% felt it disproportionately impacted patients of low socioeconomic status. Overall, 42.4% were only somewhat or not at all confident using social support to determine transplant suitability. Compared to surgical/medical transplant providers, psychosocial providers had 2.13 greater odds of supporting the criteria (P = .03). Furthermore, 69.2% supported revised guidelines for use of social support in listing decisions. Social support criteria should be reconsidered in light of the limited evidence, potential for disparities, practice variation, low provider confidence, and desire for revised guidelines.
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Affiliation(s)
- Keren Ladin
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, MA, USA,Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, MA, USA
| | - Joanna Emerson
- Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, MA, USA
| | - Kelsey Berry
- Interfaculty Initiative on Health Policy, Harvard University, Cambridge, MA, USA
| | - Zeeshan Butt
- Departments of Medical Social Sciences, Surgery, and Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Elisa J. Gordon
- Departments of Medical Social Sciences, Surgery, and Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Norman Daniels
- Department of Global Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tara A. Lavelle
- Center for the Evaluation of Value and Risk, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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17
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Lewis L, Dolph B, Said M, Feeley TH, Kayler LK. Enabling Conversations: African American Patients' Changing Perceptions of Kidney Transplantation. J Racial Ethn Health Disparities 2018; 6:536-545. [PMID: 30547301 DOI: 10.1007/s40615-018-00552-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/22/2018] [Accepted: 11/27/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Racial disparities in access to kidney transplantation (KTX) among African Americans (AAs) have been attributed in part to insufficient patient education. Interventions are needed to provide AAs with culturally sensitive, understandable information that increases their capacity to pursue KTX. Research about the factors that activated patients to pursue KTX is necessary to inform such interventions; however, few studies have yielded this type of information. METHODS We conducted focus groups and one-on-one interviews with 26 AA referred, listed, or transplanted patients and 3 nephrologists to explore decisional factors that foster pursuit of KTX. Interviews were recorded and transcribed, and qualitative analytic methods to identify themes and subthemes were applied in an effort to inform message content for a future educational video intervention. RESULTS Three themes emerged from thematic content analysis: (1) healthcare provider communication, (2) exposure to peer transplant success, and (3) family encouragement. Enabling provider communication techniques include repetition about the KTX option, optimistic messaging about KTX access, and comforting conversations about the KTX process. CONCLUSION We identified information based on patient views and experiences to help inspire and develop animated videos designed to activate patients towards KTX. Interventions are needed that address informational gaps and focus on emotion to improve patients' experiences and ability to understand transplant opportunities.
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Affiliation(s)
- Lauren Lewis
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 462 Grider Street, Buffalo, NY, 14215, USA.
| | - Beth Dolph
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 462 Grider Street, Buffalo, NY, 14215, USA
| | - Meriem Said
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
| | - Thomas H Feeley
- Department of Communication, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Liise K Kayler
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 462 Grider Street, Buffalo, NY, 14215, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
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18
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Ladin K, Emerson J, Butt Z, Gordon EJ, Hanto DW, Perloff J, Daniels N, Lavelle TA. How important is social support in determining patients' suitability for transplantation? Results from a National Survey of Transplant Clinicians. JOURNAL OF MEDICAL ETHICS 2018; 44:666-674. [PMID: 29954874 PMCID: PMC6425471 DOI: 10.1136/medethics-2017-104695] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/16/2018] [Accepted: 05/10/2018] [Indexed: 05/17/2023]
Abstract
BACKGROUND National guidelines require programmes use subjective assessments of social support when determining transplant suitability, despite limited evidence linking it to outcomes. We examined how transplant providers weigh the importance of social support for kidney transplantation compared with other factors, and variation by clinical role and personal beliefs. METHODS The National survey of the American Society of Transplant Surgeons and the Society of Transplant Social Work in 2016. Using a discrete choice approach, respondents compared two hypothetical patient profiles and selected one for transplantation. Conditional logistic regression estimated the relative importance of each factor; results were stratified by clinical role (psychosocial vs medical/surgical providers) and beliefs (outcomes vs equity). RESULTS Five hundred and eighy-four transplant providers completed the survey. Social support was the second most influential factor among transplant providers. Providers were most likely to choose a candidate who had social support (OR=1.68, 95% CI 1.50 to 1.86), always adhered to a medical regimen (OR=1.64, 95% CI 1.46 to 1.88), and had a 15 years life expectancy with transplant (OR=1.61, 95% CI 1.42 to 1.85). Psychosocial providers were more influenced by adherence and quality of life compared with medical/surgical providers, who were more influenced by candidates' life expectancy with transplant (p<0.05). For providers concerned with avoiding organ waste, social support was the most influential factor, while it was the least influential for clinicians concerned with fairness (p<0.05). CONCLUSIONS Social support is highly influential in listing decisions and may exacerbate transplant disparities. Providers' beliefs and reliance on social support in determining suitability vary considerably, raising concerns about transparency and justice.
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Affiliation(s)
- Keren Ladin
- Departments of Occupational Therapy and Community, Tufts University, Medford, Massachusetts, USA
- Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, Massachusetts, USA
| | - Joanna Emerson
- Research on Ethics, Aging, and Community Health (REACH Lab), Tufts University, Medford, Massachusetts, USA
| | - Zeeshan Butt
- Department of Surgery, Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Elisa J Gordon
- Department of Surgery, Division of Transplantation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Douglas W Hanto
- Department of Surgery, Vanderbilt Transplant Center, Vanderbilt University Medical Center, Boston, Massachusetts, USA
| | - Jennifer Perloff
- Heller School of Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
| | - Norman Daniels
- Department of Global Health and Population, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
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19
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Harhay MN, Harhay MO, Ranganna K, Boyle SM, Levin Mizrahi L, Guy S, Malat GE, Xiao G, Reich DJ, Patzer RE. Association of the kidney allocation system with dialysis exposure before deceased donor kidney transplantation by preemptive wait-listing status. Clin Transplant 2018; 32:e13386. [PMID: 30132986 DOI: 10.1111/ctr.13386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/08/2018] [Accepted: 08/16/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND It is unknown whether the new kidney transplant allocation system (KAS) has attenuated the advantages of preemptive wait-listing as a strategy to minimize pretransplant dialysis exposure. METHODS We performed a retrospective study of adult US deceased donor kidney transplant (DDKT) recipients between December 4, 2011-December 3, 2014 (pre-KAS) and December 4, 2014-December 3, 2017 (post-KAS). We estimated pretransplant dialysis durations by preemptive listing status in the pre- and post-KAS periods using multivariable gamma regression models. RESULTS Among 65 385 DDKT recipients, preemptively listed recipients (21%, n = 13 696) were more likely to be white (59% vs 34%, P < 0.001) and have private insurance (64% vs 30%, P < 0.001). In the pre- and post-KAS periods, average adjusted pretransplant dialysis durations for preemptively listed recipients were <2 years in all racial groups. Compared to recipients who were listed after starting dialysis, preemptively listed recipients experienced 3.85 (95% Confidence Interval [CI] 3.71-3.99) and 4.53 (95% CI 4.32-4.74) fewer average years of pretransplant dialysis in the pre- and post-KAS periods, respectively (P < 0.001 for all comparisons). CONCLUSIONS Preemptively wait-listed DDKT recipients continue to experience substantially fewer years of pretransplant dialysis than recipients listed after dialysis onset. Efforts are needed to improve both socioeconomic and racial disparities in preemptive wait-listing.
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Affiliation(s)
- Meera N Harhay
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania.,Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karthik Ranganna
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Suzanne M Boyle
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Lissa Levin Mizrahi
- Division of Nephrology and Hypertension, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Stephen Guy
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Gregory E Malat
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Gary Xiao
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - David J Reich
- Division of Multi-Organ Transplantation and Hepatobiliary Surgery, Department of Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Rachel E Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
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20
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Ladin K, Daniels A, Osani M, Bannuru RR. Is social support associated with post-transplant medication adherence and outcomes? A systematic review and meta-analysis. Transplant Rev (Orlando) 2018; 32:16-28. [PMID: 28495070 PMCID: PMC5658266 DOI: 10.1016/j.trre.2017.04.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 11/18/2022]
Abstract
Although social support is used to determine transplant eligibility, the relationship between social support, medication adherence, and survival among transplant recipients remains unclear. We estimated the relationship between social support and post-transplant medication adherence and outcomes using 10 electronic databases from inception to January 2016. Study quality was assessed and all review stages were conducted independently by 2 reviewers. Systematic review and meta-analysis were conducted. Thirty-two studies (9102 participants) met inclusion criteria: 21 assessed medication adherence (5197 participants), and 13 assessed clinical outcomes (3905 participants). Among high quality studies, neither social support nor marital status was predictive of medication adherence or post-transplant outcomes. Social support was not associated with medication adherence. It was associated with superior post-transplant outcomes, but the relationship was not significant among high quality studies. Compared to unmarried recipients, married recipients were more likely to adhere to medication post-transplant, but this relationship was not significant among high quality studies. Marital status was not significantly associated with transplant success. Social support is weakly and inconsistently associated with post-transplant adherence and outcomes. Larger prospective studies using consistent and validated measures are needed to justify the use of inadequate social support as a contraindication to transplantation.
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Affiliation(s)
- Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, MA; Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA; Research on Ethics, Aging, and Community Health (REACH Lab).
| | - Alexis Daniels
- Department of Occupational Therapy, Tufts University, Medford, MA; Research on Ethics, Aging, and Community Health (REACH Lab)
| | - Mikala Osani
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Tufts Medical Center, Boston, MA
| | - Raveendhara R Bannuru
- Center for Treatment Comparison and Integrative Analysis (CTCIA), Tufts Medical Center, Boston, MA
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21
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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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22
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Browne T, Amamoo A, Patzer RE, Krisher J, Well H, Gander J, Pastan SO. Everybody needs a cheerleader to get a kidney transplant: a qualitative study of the patient barriers and facilitators to kidney transplantation in the Southeastern United States. BMC Nephrol 2016; 17:108. [PMID: 27476111 PMCID: PMC4967312 DOI: 10.1186/s12882-016-0326-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/27/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Kidney transplantation (KTx) disparity is a significant problem in the United States, particularly in the Southeastern region. In response to this phenomenon, the Southeastern Kidney Transplant Coalition was created in 2011 to increase the KTx rate, and to reduce disparities in access to transplantation in the Southeast, by identifying and reducing barriers in the transplant process. METHODS To determine perceived barriers and facilitators to KTx that dialysis patients in this region experience, we conducted three focus groups with 40 total patients in Georgia, North Carolina, and South Carolina. RESULTS We identified two novel themes specific to Southeastern dialysis patients that describe the major barriers and facilitators to kidney transplantation: dialysis center approaches to patient education about KTx, and dialysis center advocacy and encouragement for KTx. In addition, themes related to barriers and facilitators of KTx were evident that were previously mentioned in the literature such as age, fear, knowing other patients with good or bad experiences with KTx, distrust of the KTx process equity, financial concerns and medical barriers. CONCLUSIONS Dialysis providers are encouraged to enhance their delivery of information and active assistance to underserved patients related to KTx.
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Affiliation(s)
- Teri Browne
- College of Social Work, University of South Carolina, 12 Hamilton, Columbia, SC, 29208, USA.
| | - Ahinee Amamoo
- Southeastern Kidney Council, 1000 St. Albans Drive, Suite 270, Raleigh, NC, 27609, USA
| | - Rachel E Patzer
- School of Medicine, Emory University, 101 Woodruff Circle, 5105 WMB, Atlanta, GA, 30322, USA
| | - Jenna Krisher
- Southeastern Kidney Council, 1000 St. Albans Drive, Suite 270, Raleigh, NC, 27609, USA
| | - Henry Well
- National Kidney Foundation, 508 Hampton Street, Columbia, SC, 29201, USA
| | - Jennifer Gander
- School of Medicine, Emory University, 101 Woodruff Circle, 5105 WMB, Atlanta, GA, 30322, USA
| | - Stephen O Pastan
- School of Medicine, Emory University, 101 Woodruff Circle, 5105 WMB, Atlanta, GA, 30322, USA
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23
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iChoose Kidney: A Clinical Decision Aid for Kidney Transplantation Versus Dialysis Treatment. Transplantation 2016; 100:630-9. [PMID: 26714121 DOI: 10.1097/tp.0000000000001019] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite a significant survival advantage of kidney transplantation compared with dialysis, nearly one third of end-stage renal disease (ESRD) patients are not educated about kidney transplantation as a treatment option at the time of ESRD diagnosis. Access to individualized, evidence-based prognostic information is needed to facilitate and encourage shared decision making about the clinical implications of whether to pursue transplantation or long-term dialysis. METHODS We used a national cohort of incident ESRD patients in the US Renal Data System surveillance registry from 2005 to 2011 to develop and validate prediction models for risk of 1- and 3-year mortality among dialysis versus kidney transplantation. Using these data, we developed a mobile clinical decision aid that provides estimates of risks of death and survival on dialysis compared with kidney transplantation patients. RESULTS Factors included in the mortality risk prediction models for dialysis and transplantation included age, race/ethnicity, dialysis vintage, and comorbidities, including diabetes, hypertension, cardiovascular disease, and low albumin. Among the validation cohorts, the discriminatory ability of the model for 3-year mortality was moderate (c statistic, 0.7047; 95% confidence interval, 0.7029-0.7065 for dialysis and 0.7015; 95% confidence interval, 0.6875-0.7155 for transplant). We used these risk prediction models to develop an electronic, user-friendly, mobile (iPad, iPhone, and website) clinical decision aid called iChoose Kidney. CONCLUSIONS The use of a mobile clinical decision aid comparing individualized mortality risk estimates for dialysis versus transplantation could enhance communication between ESRD patients and their clinicians when making decisions about treatment options.
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24
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Browne T, Patzer RE, Gander J, Amamoo MA, Krisher J, Sauls L, Pastan S. Kidney transplant referral practices in southeastern dialysis units. Clin Transplant 2016; 30:365-71. [PMID: 26782140 DOI: 10.1111/ctr.12693] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND The Southeastern Kidney Transplant Coalition was created in 2010 to improve kidney transplant (KTx) rates in Georgia, North Carolina, and South Carolina. To identify dialysis staff-reported barriers to transplant, the Coalition developed a survey of dialysis providers in the region. METHODS All dialysis units in the ESRD Network (n = 586) were sent a survey to be completed by the professional responsible for helping patients get transplants. RESULTS One staff member at almost all (n = 546) of the dialysis units in Network 6 completed the survey (93% response rate). Almost all respondents reported being very comfortable (51.47%) or comfortable (46.89%) discussing the KTx process with patients. Just over half (56%) of facilities reported discussing KTx as a treatment option with patients on an annual basis. Fewer than one quarter of respondents (19%) perceived that more than 50% of their patients were interested in kidney transplant, and most of the staff surveyed (68%) reported that <25% of their dialysis patients completed the evaluation process and been wait-listed for a kidney transplant. CONCLUSION The survey results provide insight into KTx referral practices in southeastern dialysis units that may be contributing to low KTx rates in this region.
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Affiliation(s)
- Teri Browne
- University of South Carolina, Columbia, SC, USA
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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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Marlow NM, Simpson KN, Kazley AS, Balliet WE, Chavin KD, Baliga PK. Variations in coping stages for individuals with chronic kidney disease: Results from an exploratory study with patient navigators. J Health Psychol 2014; 21:1299-310. [PMID: 25293971 DOI: 10.1177/1359105314551776] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Using a cross-sectional design, we examined coping stages (Kübler-Ross) among patients with end-stage renal disease at nephrology practices incorporating professional social workers as patient navigators, providing person-centered education and support (N = 420). We evaluated associations with behavioral counseling constructs (assess-advise-agree-assist-arrange). Coping stages comprised denial = 35.24 percent, acceptance = 24.05 percent, depression = 21.43 percent, bargaining = 12.86 percent, and anger = 6.43 percent. Compared to denial, other coping stages showed increased odds ratios for transplant referral agreement, transplant referral evaluations, understanding treatments, understanding donation procedures, plans to recruit donors, active donor recruitment, and potential living donor(s). Assessment of coping stages, and strategies to influence these, may be key factors in guiding patients to living donor kidney transplantation.
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Gillespie A, Hammer H, Kolenikov S, Polychronopoulou A, Ouzienko V, Obradovic Z, Urbanski MA, Browne T, Silva P. Sex differences and attitudes toward living donor kidney transplantation among urban black patients on hemodialysis. Clin J Am Soc Nephrol 2014; 9:1764-72. [PMID: 25125384 DOI: 10.2215/cjn.12531213] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Living donor kidney transplantation, the treatment of choice for ESRD, is underused by women and blacks. To better understand sex differences in the context of potential barriers to living donor kidney transplantation, the Dialysis Patient Transplant Questionnaire was administered in two urban, predominantly black hemodialysis units. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Dialysis Patient Transplant Questionnaire was designed to study barriers to kidney transplantation from previously validated questions. Between July of 2008 and January of 2009, the Dialysis Patient Transplant Questionnaire was administered to 116 patients on hemodialysis, including potentially eligible and ineligible living donor kidney transplantation candidates. Of 101 patients who self-identified as black or African American, 50 (49.5%) patients had the questionnaire entirely administered by the researcher or assistant, 25 (24.8%) patients required some assistance, and 26 (25.7%) patients completed the Dialysis Patient Transplant Questionnaire entirely by themselves. Multiple logistic regression methods were used to determine if the observed bivariate associations and differences persisted when controlled for potential confounders. RESULTS Women were less likely to want living donor kidney transplantation compared with men (58.5% versus 87.5%, P=0.003), despite being nearly two times as likely as men to receive unsolicited offers for kidney transplant (73.2% versus 43.2%, P=0.02). They were also less likely to have been evaluated for a kidney transplant (28.3% versus 52.2%, P=0.01). The multiple logistic regression analysis showed that sex was a statistically significant predictor of wanting living donor kidney transplantation (women versus men odds ratio, 0.13; 95% confidence interval, 0.04 to 0.46), controlling for various factors known to influence transplant decisions. A sensitivity analysis indicated that mode of administration did not bias these results. CONCLUSIONS In contrast to previous studies, the study found that black women were less likely to want living donor kidney transplantation compared with black men. Black women were also less likely to be evaluated for a kidney transplant, although they were more likely to receive an unsolicited living donor kidney transplantation offer.
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Affiliation(s)
- Avrum Gillespie
- Department of Medicine, Section of Nephrology and Kidney Transplantation, Temple University School of Medicine, Philadelphia, Pennsylvania;
| | | | | | | | - Vladimir Ouzienko
- Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, Pennsylvania
| | - Zoran Obradovic
- Center for Data Analytics and Biomedical Informatics, Temple University, Philadelphia, Pennsylvania
| | - Megan A Urbanski
- Department of Abdominal Organ Transplantation, Temple University Hospital, Philadelphia, Pennsylvania; and
| | - Teri Browne
- College of Social Work, University of South Carolina, Columbia, South Carolina
| | - Patricio Silva
- Department of Medicine, Section of Nephrology and Kidney Transplantation, Temple University School of Medicine, Philadelphia, Pennsylvania
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Martin P. Living donor kidney transplantation: preferences and concerns amongst patients waiting for transplantation in New Zealand. J Health Serv Res Policy 2013; 19:138-144. [PMID: 24366157 DOI: 10.1177/1355819613514957] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES There are multiple barriers to kidney transplantation from a living donor for patients. A critical factor is their own approach to pursuing opportunities for transplantation, including their preferences for living or deceased donation and their concerns about living donation. As part of a wider study into barriers to living donor transplantation in New Zealand, our aim was to examine the preferences and concerns of New Zealand patients who are waiting for kidney transplantation. METHODS Mixed methods were used, incorporating a mailed survey of patients on the waiting list for a deceased donor transplant, followed by in-depth semi-structured interviews. The survey included questions about preferences for living or deceased donation, willingness to accept a kidney from a potential donor if offered and concerns about aspects of living donation. Responses were received from 193 (38.2%) patients. These issues were explored in more depth in follow-up interviews with 17 patients. RESULTS The majority of patients were positive about living donor transplantation with only a few actively preferring a deceased donor. The vast majority would accept an offer from a potential donor. Donors being financially out-of-pocket and being upset if the transplant failed were the highest ranked concerns. Impacts on donor health were also a significant concern for patients. Positive views about living donor transplantation and stated willingness to accept offers could be undermined by deep, unresolved concerns and could result in patients declining offers from potential donors. Being well-informed about the risks to donors and having confidence in the donor evaluation process were important for reducing patients' concerns. CONCLUSIONS The preferences and concerns of patients in New Zealand are similar to those reported elsewhere. Education needs to address the concerns of patients and ensure they have accurate knowledge about living donation. Concerns about financial impacts on donors, however, arise from New Zealand's policy of not fully reimbursing living donors for lost income and cannot be addressed through improved education.
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Affiliation(s)
- Paula Martin
- PhD, Health Services Research Centre, School of Government, Victoria University of Wellington, New Zealand
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Jackson FLC, Niculescu MD, Jackson RT. Conceptual shifts needed to understand the dynamic interactions of genes, environment, epigenetics, social processes, and behavioral choices. Am J Public Health 2013; 103 Suppl 1:S33-42. [PMID: 23927503 DOI: 10.2105/ajph.2013.301221] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Social and behavioral research in public health is often intimately tied to profound, but frequently neglected, biological influences from underlying genetic, environmental, and epigenetic events. The dynamic interplay between the life, social, and behavioral sciences often remains underappreciated and underutilized in addressing complex diseases and disorders and in developing effective remediation strategies. Using a case-study format, we present examples as to how the inclusion of genetic, environmental, and epigenetic data can augment social and behavioral health research by expanding the parameters of such studies, adding specificity to phenotypic assessments, and providing additional internal control in comparative studies. We highlight the important roles of gene-environment interactions and epigenetics as sources of phenotypic change and as a bridge between the life and social and behavioral sciences in the development of robust interdisciplinary analyses.
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Affiliation(s)
- Fatimah L C Jackson
- Fatimah L. C. Jackson, and Mihai D. Niculescu are with the University of North Carolina at Chapel Hill. Robert T. Jackson is with the University of Maryland at College Park
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