1
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Rasheed HA, Pensler M, Diaz S, Roney E, Barrett M, Sonnenberg EM. Organ Offer Review Cards: Improving Transparency on the Kidney Transplant Waitlist. Clin Transplant 2024; 38:e15388. [PMID: 38990103 DOI: 10.1111/ctr.15388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 06/01/2024] [Accepted: 06/06/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION The 2022 National Academy of Sciences, Engineering, and Medicine report on equity in organ transplantation highlighted limited transparency and accountability for organ offer declines and recommended prioritizing patient engagement in decisions regarding organ offers. Yet, there is no guidance on how to incorporate patients in organ offers. We elected to study the experiences of patients on the waitlist and their perception of a novel Organ Offer Review Card (OORC). METHODS A prototype OORC was created using Donornet refusal codes. Sixty randomly selected kidney waitlist patients at a single center were asked to participate in a web-based survey focusing on current medical decision-making preferences and perceptions of the prototype OORC. RESULTS Among the 43 patients reached, 17 (39.5%) completed the survey. Most participants (88.2%) expressed it was important to be involved in the decision-making about organ offers, with 100.0% of respondents wanting to know why an organ was declined. Regarding the prototype OORC, 94.1% thought it helped them understand the factors and priorities considered when selecting an organ, and 88.2% said it increased their belief that their team was acting in their best interest. CONCLUSION An OORC could increase transparency and communication during the waitlist process while enhancing trust in the transplant team.
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Affiliation(s)
| | | | - Sarah Diaz
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Emily Roney
- University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Meredith Barrett
- Department of Surgery, Section of Transplant Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth M Sonnenberg
- Department of Surgery, Division of Abdominal Transplant Surgery University of Pennsylvania, Philadelphia, Pennsylvania, USA
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2
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Reese PP, Powe NR, Lo B. Engineering Equity Into the Promise of Xenotransplantation. Am J Kidney Dis 2024; 83:677-683. [PMID: 37992981 DOI: 10.1053/j.ajkd.2023.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/24/2023]
Abstract
Two of the greatest challenges facing kidney transplantation are the lack of donated organs and inequities in who receives a transplant. Xenotransplantation holds promise as a treatment approach that could solve the supply problem. Major advances in gene-editing procedures have enabled several companies to raise genetically engineered pigs for organ donation. These porcine organs lack antigens and have other modifications that should reduce the probability of immunological rejection when transplanted into humans. The US Food and Drug Administration and transplantation leaders are starting to chart a path to test xenotransplants in clinical trials and later integrate them into routine clinical care. Here we provide a framework that industry, regulatory authorities, payers, transplantation professionals, and patient groups can implement to promote equity during every stage in this process. We also call for immediate action. Companies developing xenotransplant technology should assemble patient advocacy boards to bring the concerns of individuals with end-stage kidney disease to the forefront. For trials, xenotransplantation companies should partner with transplant programs with substantial patient populations of racial and ethnic minority groups and that have reciprocal relationships with those communities. Those companies and transplant programs should reach out now to those communities to inform them about xenotransplantation and try to address their concerns. These actions have the potential to make these communities full partners in the promise of xenotransplantation.
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Affiliation(s)
- Peter P Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine and Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Neil R Powe
- Department of Medicine, University of California San Francisco at the Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, San Francisco, CA; Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Bernard Lo
- Department of Medicine, University of California San Francisco, San Francisco, CA
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3
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Affdal A, Issa M, Ballesteros F, Malo MF, Thind G, Atkinson T, Coldwell K, Grewal K, Wong K, Lan JH, Fortin MC. Kidney transplant candidates' perspectives on the implementation of a Canadian Willingness to Cross program: A strategy to increase access to kidney transplantation for highly sensitized patients. Clin Transplant 2024; 38:e15338. [PMID: 38762787 DOI: 10.1111/ctr.15338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/29/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Kidney transplantation is the optimal treatment for end-stage renal disease. However, highly sensitized patients (HSPs) have reduced access to transplantation, leading to increased morbidity and mortality on the waiting list. The Canadian Willingness to Cross (WTC) program proposes allowing transplantation across preformed donor specific antibodies (DSA) determined to be at a low risk of rejection under the adaptive design framework. This study collected patients' perspectives on the development of this program. METHODS Forty-one individual interviews were conducted with kidney transplant candidates from three Canadian transplant centers in 2022. The interviews were digitally recorded and transcribed for subsequent analyses. RESULTS Despite limited familiarity with the adaptive design, participants demonstrated trust in the researchers. They perceived the WTC program as a pathway for HSPs to access transplantation while mitigating transplant-related risks. HSPs saw the WTC program as a source of hope and an opportunity to leave dialysis, despite acknowledging inherent uncertainties. Some non-HSPs expressed concerns about fairness, anticipating increased waiting times and potential compromise in kidney graft longevity due to higher rejection risks. Participants recommended essential strategies for implementing the WTC program, including organizing informational meetings and highlighting the necessity for psychosocial support. CONCLUSION The WTC program emerges as a promising strategy to enhance HSPs' access to kidney transplantation. While HSPs perceived this program as a source of hope, non-HSPs voiced concerns about distributive justice issues. These results will help develop a WTC program that is ethically sound for transplant candidates.
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Affiliation(s)
- Aliya Affdal
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Canada
- Bioethics Program, École de santé publique de l'Université de Montréal, Montréal, Canada
| | - Mohamad Issa
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Fabian Ballesteros
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Canada
| | - Marie-Françoise Malo
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Canada
- Bioethics Program, École de santé publique de l'Université de Montréal, Montréal, Canada
| | - Gurvir Thind
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Teresa Atkinson
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kristi Coldwell
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Transplant Research Foundation of British Columbia, Vancouver, Canada
| | - Kuljit Grewal
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - KaYee Wong
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - James H Lan
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Canada
- Bioethics Program, École de santé publique de l'Université de Montréal, Montréal, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Canada
- Faculté de médecine, Université de Montréal, Montréal, Canada
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4
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Ford CG, Leyva Y, Kruger ES, Zhu Y, Croswell E, Kendall K, Puttarajapa C, Dew MA, Ng YH, Unruh ML, Myaskovsky L. Predicting Kidney Transplant Evaluation Non-attendance. J Clin Psychol Med Settings 2024; 31:153-162. [PMID: 36959431 PMCID: PMC10035980 DOI: 10.1007/s10880-023-09953-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/25/2023]
Abstract
Non-attendance to kidney transplant evaluation (KTE) appointments is a barrier to optimal care for those with kidney failure. We examined the medical and socio-cultural factors that predict KTE non-attendance to identify opportunities for integrated medical teams to intervene. Patients scheduled for KTE between May, 2015 and June, 2018 completed an interview before their initial KTE appointment. The interview assessed various social determinants of health, including demographic (e.g., income), medical (e.g. co-morbidities), transplant knowledge, cultural (e.g., medical mistrust), and psychosocial (e.g., social support) factors. We used multiple logistic regression analysis to determine the strongest predictor of KTE non-attendance. Our sample (N = 1119) was 37% female, 76% non-Hispanic White, median age 59.4 years (IQR 49.2-67.5). Of note, 142 (13%) never attended an initial KTE clinic appointment. Being on dialysis predicted higher odds of KTE non-attendance (OR 1.76; p = .02; 64% of KTE attendees on dialysis vs. 77% of non-attendees on dialysis). Transplant and nephrology teams should consider working collaboratively with dialysis units to better coordinate care, (e.g., resources to attend appointment or outreach to emphasize the importance of transplant) adjusting the KTE referral and evaluation process to address access issues (e.g., using tele-health) and encouraging partnership with clinical psychologists to promote quality of life for those on dialysis.
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Affiliation(s)
- C Graham Ford
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Yuridia Leyva
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Eric S Kruger
- Department of Physical Therapy, University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Yiliang Zhu
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
| | - Emilee Croswell
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | | | - Chethan Puttarajapa
- Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Mary Amanda Dew
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Yue Harn Ng
- Department of Internal Medicine, University of Washington, Seattle, USA
| | - Mark L Unruh
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, USA
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center, Albuquerque, USA.
- Department of Internal Medicine, School of Medicine, University of New Mexico, Albuquerque, USA.
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5
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Harding KE, Lewis AK, Taylor NF. 'I just need a plan': Consumer perceptions of waiting for healthcare. J Eval Clin Pract 2023; 29:976-983. [PMID: 36861145 DOI: 10.1111/jep.13821] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/05/2023] [Accepted: 02/07/2023] [Indexed: 03/03/2023]
Abstract
RATIONALE Wait lists are common in the provision of publicly funded services in outpatient and community settings. AIMS AND OBJECTIVES We aimed to explore the experiences of consumers on wait lists across a broad range of services and to understand the impact of delays in access to services on people's lives. METHODS Consumers with experience of being on a wait list for an outpatient or community-based health service participated in one of three focus groups. Data were transcribed and analysed inductively using a thematic approach. RESULTS Waiting for healthcare has detrimental impacts on health and well-being. Consumers on wait lists want their health needs addressed, but they also want the ability to plan, clear communication and to feel like someone cares. Instead, they feel forgotten by impersonal and inflexible systems with very little communication, with emergency departments and general practitioners often left to fill in the gaps. CONCLUSIONS More consumer-centred approaches are needed for access systems for outpatient and community services, featuring honesty about what services can realistically be provided, early access to initial assessment and information and clear lines of communication.
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Affiliation(s)
- Katherine E Harding
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
- School of Allied Health, Health Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Annie K Lewis
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
- School of Allied Health, Health Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Nicholas F Taylor
- Eastern Health, Allied Health Clinical Research Office, Box Hill, Victoria, Australia
- School of Allied Health, Health Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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6
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Jones EL, Shakespeare K, McLaughlin L, Noyes J. Understanding people's decisions when choosing or declining a kidney transplant: a qualitative evidence synthesis. BMJ Open 2023; 13:e071348. [PMID: 37562929 PMCID: PMC10423837 DOI: 10.1136/bmjopen-2022-071348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES To synthesise qualitative research exploring patients' perspectives, experiences and factors influencing their decision-making preferences when choosing or declining kidney transplantation. DESIGN A qualitative evidence synthesis. DATA SOURCES Electronic databases were searched from 2000 to June 2021: PubMed, MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, ProQuest Core Databases for Dissertations and Theses, and Google Scholar. ELIGIBILITY CRITERIA Qualitative studies exploring and reporting decision-making preferences of people with kidney disease, which reported influencing factors when choosing or declining kidney transplantation, published in English from high-income and middle-income countries. DATA EXTRACTION AND SYNTHESIS Titles were screened against the inclusion criteria. Thematic synthesis was done with the use of the Critical Appraisal Skills Programme qualitative checklist to assess study quality, and assessment of confidence in the qualitative findings was done using the Grading of Recommendation, Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research. FINDINGS 37 studies from 11 countries reported the perspectives of 1366 patients with kidney disease. Six descriptive themes were developed: decisional preferences influenced patients' readiness to pursue kidney transplantation, gathering sufficient information to support decision-making, navigating the kidney transplant assessment pathway, desire for kidney transplantation, opposed to kidney transplantation and uncertainties while waiting for the kidney transplant. A new enhanced theoretical model was developed to aid understanding of the complexities of decision-making in people with kidney disease, by integrating the Theory of Planned Behaviour and the Adaptive Decision Maker Framework to incorporate the novel findings. CONCLUSION The synthesis provides a better understanding of the extremely complex decision-making processes of people with kidney disease, which are aligned to their kidney transplantation preferences. Further research is needed to better understand the reasons for declining kidney transplantation, and to underpin development of personalised information, interventions and support for patients to make informed decisions when presented with kidney replacement options. PROSPERO REGISTRATION NUMBER CRD42021272588.
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Affiliation(s)
- Emma Louise Jones
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Kate Shakespeare
- Betsi Cadwaladr University Health Board, Clinical Psychology Dept, Royal Alexandra Hospital, Rhyl, UK
| | - Leah McLaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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7
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Senteio CR, Ackerman MK. Count Me Out: Perceptions of Black Patients Who are on Dialysis but Who are Not on a Transplant Waitlist. HEALTH COMMUNICATION 2022; 37:1167-1179. [PMID: 34320893 DOI: 10.1080/10410236.2021.1940017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
End-stage renal disease (ESRD) is characterized by racial inequity; Blacks are 3 times more likely to develop ESRD than Whites. Transplant is the preferred treatment option since transplanted patients experience better clinical outcomes. Racial inequities persist at each of the steps required for transplantation. Despite the vast literature describing these racial inequities, it does not include dialysis patients' awareness and understanding of treatment options, specifically for transplant. To address this gap, we purposely sampled Blacks in Detroit who were receiving dialysis and who were not active on any transplant waitlist to investigate their understanding and perceptions of transplants. We used uncertainty management theory (UMT) to better understand perceived barriers to getting and remaining on a transplant waitlist. We aimed to address a critical gap in the literature to inform approaches addressing this enduring inequity. For this qualitative study, we conducted individual, semi-structured interviews with 24 Black ESRD patients, aged 34-73 years: 9 male and 15 female. Participants shared their experiences of being on dialysis, perceptions, and understanding of transplants. We describe two key findings: 1) uncertainty for these patients is prevalent and multi-layered and 2) social support can both dissuade an individual from pursuing transplant (i.e., reluctance to ask family members to be donors) and it can result in decreasing uncertainty (e.g., participants wanting to pursue transplant to be with family). We highlight the specific need to improve patient education regarding treatment options and enhancing how relevant health information can be communicated.
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8
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Naesens M, Loupy A, Hilbrands L, Oberbauer R, Bellini MI, Glotz D, Grinyó J, Heemann U, Jochmans I, Pengel L, Reinders M, Schneeberger S, Budde K. Rationale for Surrogate Endpoints and Conditional Marketing Authorization of New Therapies for Kidney Transplantation. Transpl Int 2022; 35:10137. [PMID: 35669977 PMCID: PMC9163307 DOI: 10.3389/ti.2022.10137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/10/2022] [Indexed: 12/13/2022]
Abstract
Conditional marketing authorization (CMA) facilitates timely access to new drugs for illnesses with unmet clinical needs, such as late graft failure after kidney transplantation. Late graft failure remains a serious, burdensome, and life-threatening condition for recipients. This article has been developed from content prepared by members of a working group within the European Society for Organ Transplantation (ESOT) for a Broad Scientific Advice request, submitted by ESOT to the European Medicines Agency (EMA), and reviewed by the EMA in 2020. The article presents the rationale for using surrogate endpoints in clinical trials aiming at improving late graft failure rates, to enable novel kidney transplantation therapies to be considered for CMA and improve access to medicines. The paper also provides background data to illustrate the relationship between primary and surrogate endpoints. Developing surrogate endpoints and a CMA strategy could be particularly beneficial for studies where the use of primary endpoints would yield insufficient statistical power or insufficient indication of long-term benefit following transplantation.
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Affiliation(s)
- Maarten Naesens
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
- *Correspondence: Maarten Naesens,
| | - Alexandre Loupy
- Paris Translational Research Center for Organ Transplantation, Hôpital Necker, Paris, France
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Rainer Oberbauer
- Department of Nephrology and Dialysis, Medical University of Vienna, Vienna, Austria
| | | | - Denis Glotz
- Paris Translational Research Center for Organ Transplantation, Hôpital Saint Louis, Paris, France
| | | | - Uwe Heemann
- Department of Nephrology, Technical University of Munich, Munich, Germany
| | - Ina Jochmans
- Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium
| | - Liset Pengel
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Marlies Reinders
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Stefan Schneeberger
- Department of General, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité Universitätsmedizin Berlin, Berlin, Germany
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9
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Khalili M, Cardinal H, Ballesteros F, Fortin MC. Kidney transplant candidates' and recipients' perspectives on the decision-making process to accept or refuse a deceased donor kidney offer: Trust and graft survival matter. Clin Transplant 2022; 36:e14604. [PMID: 35099833 DOI: 10.1111/ctr.14604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/13/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The decision to accept a kidney from a deceased donor can be a difficult one. This study aims to capture the perspectives of transplant candidates (TCs) and kidney transplant recipients (KTRs) on the decision-making process when a deceased kidney is offered. METHODS We conducted six focus groups with KTRs and TCs. The content of the focus groups was analyzed using the qualitative thematic method. RESULTS KTRs reported that the experience of being offered a kidney could be difficult because of the circumstances of the offer and unpreparedness to participate in the discussion. Both KTRs and TCs trusted the medical expertise. Age and having experience with dialysis could influence the decision to accept an offer. In order to engage in the discussion, patients wanted to obtain estimates of expected graft survival. Patients did not express interest for a web-based calculator for patient use, but expected transplant physicians to summarize and explain the information that would impact graft survival time. CONCLUSION TCs and KTRs wanted to be involved in the decision to accept a deceased donor kidney. Tools that can help physicians communicate the risks and benefits of accepting an offer could improve patient participation in the decision-making process.
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Affiliation(s)
- Myriam Khalili
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Héloïse Cardinal
- Faculty of Medicine, Université de Montréal, Montreal, Canada.,Department of Medicine, Centre de recherche du CHUM, Montreal, Canada.,Department of Medicine, Canadian Donation and Transplantation Research Program, Edmonton, Canada
| | | | - Marie-Chantal Fortin
- Faculty of Medicine, Université de Montréal, Montreal, Canada.,Department of Medicine, Centre de recherche du CHUM, Montreal, Canada.,Department of Medicine, Canadian Donation and Transplantation Research Program, Edmonton, Canada
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10
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Proust-Lima C, Philipps V, Perrot B, Blanchin M, Sébille V. Modeling repeated self-reported outcome data: a continuous-time longitudinal Item Response Theory model. Methods 2022; 204:386-395. [PMID: 35041926 DOI: 10.1016/j.ymeth.2022.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 01/03/2022] [Accepted: 01/10/2022] [Indexed: 12/28/2022] Open
Abstract
Item Response Theory (IRT) models have received growing interest in health science for analyzing latent constructs such as depression, anxiety, quality of life or cognitive functioning from the information provided by each individual's items responses. However, in the presence of repeated item measures, IRT methods usually assume that the measurement occasions are made at the exact same time for all patients. In this paper, we show how the IRT methodology can be combined with the mixed model theory to provide a longitudinal IRT model which exploits the information of a measurement scale provided at the item level while simultaneously handling observation times that may vary across individuals and items. The latent construct is a latent process defined in continuous time that is linked to the observed item responses through a measurement model at each individual- and occasion-specific observation time; we focus here on a Graded Response Model for binary and ordinal items. The Maximum Likelihood Estimation procedure of the model is available in the R package lcmm. The proposed approach is contextualized in a clinical example in end-stage renal disease, the PREDIALA study. The objective is to study the trajectories of depressive symptomatology (as measured by 7 items of the Hospital Anxiety and Depression scale) according to the time from registration on the renal transplant waiting list and the renal replacement therapy. We also illustrate how the method can be used to assess Differential Item Functioning and lack of measurement invariance over time.
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Affiliation(s)
- Cécile Proust-Lima
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, F-33000 Bordeaux, France.
| | - Viviane Philipps
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, UMR1219, F-33000 Bordeaux, France
| | - Bastien Perrot
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France; Methodology and Biostatistics Unit, CHU Nantes, Nantes, France
| | - Myriam Blanchin
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France
| | - Véronique Sébille
- Université de Nantes, Université de Tours, INSERM, SPHERE U1246, Nantes, France; Methodology and Biostatistics Unit, CHU Nantes, Nantes, France
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11
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A Randomized Controlled Trial of a Pretransplant Educational Intervention in Kidney Patients. Transplant Direct 2021; 7:e753. [PMID: 34514108 PMCID: PMC8425830 DOI: 10.1097/txd.0000000000001202] [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: 04/09/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/18/2022] Open
Abstract
Supplemental Digital Content is available in the text. Poor patient knowledge about transplantation is a significant problem following kidney transplant. A video-based educational intervention was developed to supplement standard education provided by transplant teams.
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12
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Martin DE, Muller E. In Defense of Patient Autonomy in Kidney Failure Care When Treatment Choices Are Limited. Semin Nephrol 2021; 41:242-252. [PMID: 34330364 DOI: 10.1016/j.semnephrol.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Respect for patient autonomy is a primary ethical obligation of health care providers. In kidney health care, clinical practice recommendations commonly include strategies to promote shared decision making with patients and their families about treatment options to promote patient autonomy and improve patient outcomes. However, for many people with kidney failure, treatment options may be unavailable or inaccessible. In these circumstances some clinicians may act paternalistically and withhold information from patients because of a fear of causing harm or because clinicians believe that patient autonomy is not a relevant consideration. In this article, we reflect on the concept of autonomy in the context of clinical decision making in kidney failure care, with particular attention to resource-constrained settings and the disclosure of information to patients for whom treatment may be inaccessible. We examine and address key concerns that patient autonomy may be impossible, irrelevant, or harmful in the context of limited treatment choices, and discuss factors that may influence paternalistic practices in such settings. We conclude that respect for autonomy is intrinsically and instrumentally valuable, and argue that in neglecting patient autonomy in resource-constrained settings, clinicians may exacerbate and entrench the structural inequalities and health inequities they are committed to addressing.
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Affiliation(s)
| | - Elmi Muller
- Department of Surgery, University of Cape Town, Cape Town, South Africa
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13
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McKinney WT, Bruin MJ, Kurschner S, Partin MR, Hart A. Identifying Needs and Barriers to Engage Family Members in Transplant Candidate Care. Prog Transplant 2021; 31:142-151. [PMID: 33754928 DOI: 10.1177/15269248211002794] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Friends and family members provide critical support to patients on the waitlist for deceased donor kidney transplantation. However, little is known about how best to support and engage them effectively to improve patient outcomes. METHODS We conducted 5 focus groups with the family members of patients on the waitlist for a deceased donor kidney (n=23) to identify individual- and group-level targets for an intervention. Discussions encouraged participants to reflect on their support roles, experiences at the transplant evaluation, interactions with providers, knowledge of transplant options and expected outcomes. Transcripts of study sessions were coded using an iterative and inductive process. RESULTS The thematic analysis produced two main themes related to experiences providing care to patients on the waitlist for kidney transplantation. First, participants revealed that supporting a patient on the waitlist created challenges that reverberate through their entire social structure. Family members discussed frustrations with adapting to their patient's kidney health needs, feelings of isolation, and barriers to identifying and building effective support networks. Second, participants described multiple challenges that prevented their patient-family unit from making informed decisions about transplant care. These challenges included communication with their patient, patients resisting help, difficulty understanding the information, and feeling helpless. CONCLUSION Family members providing care to patients with end-stage kidney disease require targeted support to overcome the unique challenges associated with their role in helping to meet their patient's clinical needs. Interventions to engage friends and family members in the care of kidney transplant candidates need to effectively address these challenges.
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Affiliation(s)
- Warren T McKinney
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA.,Clinical and Translational Science Institute, University of Minnesota (UMN), Minneapolis, MN, USA
| | | | | | - Melissa R Partin
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA.,Department of Medicine, UMN, Minneapolis, MN, USA
| | - Allyson Hart
- Nephrology Department, 5532Hennepin Healthcare, Minneapolis, MN, USA.,Chronic Disease Research Group (CDRG), 5532Hennepin Healthcare Research Institute, Minneapolis, MN, USA
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14
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Seaman S, Brown D, Eno A, Yu S, Massie AB, Tobian AAR, Durand CM, Segev DL, Wu AW, Sugarman J. Development of a Patient Reported Measure of Experimental Transplants with HIV and Ethics in the United States (PROMETHEUS). J Patient Rep Outcomes 2021; 5:28. [PMID: 33738660 PMCID: PMC7973329 DOI: 10.1186/s41687-021-00297-y] [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: 11/27/2020] [Accepted: 02/16/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Transplantation of HIV-positive (HIV+) donor organs for HIV+ recipients (HIV D+/R+) is now being performed as research in the United States, but raises ethical concerns. While patient-reported outcome measures are increasingly used to evaluate clinical interventions, there is no published measure to aptly capture patients' experiences in the unique context of experimental HIV D+/R+ transplantation. Therefore, we developed PROMETHEUS (patient-reported measure of experimental transplants with HIV and ethics in the United States). To do so, we created a conceptual framework, drafted a pilot battery using existing and new measures related to this context, and refined it based on cognitive and pilot testing. PROMETHEUS was administered 6-months post-transplant in a clinical trial evaluating these transplants. We analyzed data from the first 20 patient-participants for reliability and validity by calculating Cronbach's alpha and reviewing item performance characteristics. RESULTS PROMETHEUS 1.0 consisted of 29 items with 5 putative subscales: Emotions; Trust; Decision Making; Transplant; and Decision Satisfaction. Overall, responses were positive. Cronbach's alpha was > 0.8 for all subscales except Transplant, which was 0.38. Two Transplant subscale items were removed due to poor reliability and construct validity. CONCLUSIONS We developed PROMETHEUS to systematically capture patient-reported experiences with this novel experimental transplantation program, nested it in an actual clinical trial, and obtained preliminary data regarding its performance.
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Affiliation(s)
- Shanti Seaman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diane Brown
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann Eno
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sile Yu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Aaron A R Tobian
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christine M Durand
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Albert W Wu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jeremy Sugarman
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Berman Institute of Bioethics, Johns Hopkins University, 1809 Ashland Ave, Baltimore, MD, 21205, USA.
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15
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Sokas C, Cooper Z, Salim A, Rodrigue JR, Adler JT. Wait expectations: The impact of delisting as an outcome from the kidney transplant waitlist. Clin Transplant 2021; 35:e14250. [PMID: 33565145 DOI: 10.1111/ctr.14250] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/08/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND While kidney transplantation is optimal for the treatment of end-stage kidney disease, available organs do not meet demand. Little is known about the outcomes of patients who are delisted (removed from the waitlist) and unable to benefit from transplant. We describe patients who are delisted and their life expectancy after delisting. METHODS Patients ≥ 18 years listed for deceased donor kidney transplant between 01/2003 and 12/2013 were identified in the Scientific Registry of Transplant Recipients and followed through 12/2018. A competing risk model was used to measure the association of demographic and clinical factors with waitlist outcomes of delisting, transplant, and death. Multivariate Cox modeling was used to evaluate factors associated with death after delisting. RESULTS Of 324,582 patients listed, 18.0% were delisted, most common reasons were "too sick" or "other." After delisting, half (49.7%) had died by end of follow-up; time to death after removal was 5 years. Increasing age and public insurance were associated with increased risk of death. CONCLUSIONS Nearly one in five patients will be delisted from the kidney transplant waitlist. These patients live a surprisingly long time after removal. Much remains unknown about these patients, which could be improved through data collection. Delisting is an important patient outcome that warrants further exploration.
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Affiliation(s)
- Claire Sokas
- Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Zara Cooper
- Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Ali Salim
- Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - James R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joel T Adler
- Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA.,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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16
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Butler CR, Wightman A, Richards CA, Laundry RS, Taylor JS, Hebert PL, Liu CF, O'Hare AM. Thematic Analysis of the Health Records of a National Sample of US Veterans With Advanced Kidney Disease Evaluated for Transplant. JAMA Intern Med 2021; 181:212-219. [PMID: 33226419 PMCID: PMC7684522 DOI: 10.1001/jamainternmed.2020.6388] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE To be considered for a kidney transplant, patients with advanced kidney disease must participate in a formal evaluation and selection process. Little is known about how this process proceeds in real-world clinical settings. OBJECTIVE To characterize the transplant evaluation process among a representative national sample of US veterans with advanced kidney disease who were referred to a kidney transplant center. DESIGN, SETTING, AND PARTICIPANTS This qualitative study was a thematic analysis of clinician notes in the electronic health records of US veterans referred for kidney transplant evaluation. In a random sample of 4000 patients with advanced kidney disease between January 1, 2004, and December 31, 2014, cared for in the US Department of Veterans Affairs (VA) health care system, there were 211 patients who were referred to a transplant center during the follow-up period. This group was included in the qualitative analysis and was followed up until their date of death or the end of the follow-up period on October 8, 2019. MAIN OUTCOMES AND MEASURES Dominant themes pertaining to the kidney transplant evaluation and selection process identified through thematic analysis. RESULTS Among 211 study patients, the mean (SD) age was 57.9 (9.5) years, and 202 patients (95.7%) were male. The following 4 dominant themes regarding the transplant evaluation process emerged: (1) far-reaching and inflexible medical evaluation, in which patients were expected to complete an extensive evaluation that could have substantial physical and emotional consequences, made little accommodation for their personal values and needs, and impacted other aspects of their care; (2) psychosocial valuation, in which the psychosocial component of the transplant assessment could be subjective and intrusive and could place substantial demands on patients' family members; (3) surveillance over compliance, in which the patients' ability and willingness to follow medical recommendations was an important criterion for transplant candidacy and their adherence to a wide range of recommendations and treatments was closely monitored; and (4) disempowerment and lack of transparency, in which patients and their local clinicians were often unsure about what to expect during the evaluation process or about the rationale for selection decisions. For the evaluation process to proceed, local clinicians had to follow transplant center requirements even when they believed the requirements did not align with best practices or the patients' needs. CONCLUSIONS AND RELEVANCE In this qualitative study of US veterans with advanced kidney disease evaluated for transplant, clinician documentation in the medical record indicated that, to be considered for a kidney transplant, patients were required to participate in a rigid, demanding, and opaque evaluation and selection process over which they and their local clinicians had little control. These findings highlight the need for a more evidence-based, individualized, and collaborative approach to kidney transplant evaluation.
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Affiliation(s)
- Catherine R Butler
- Division of Nephrology, Department of Medicine, University of Washington, Seattle.,Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington
| | - Aaron Wightman
- Department of Pediatrics, University of Washington School of Medicine, Seattle.,Treuman Katz Center for Pediatric Bioethics, Seattle Children's Hospital, Seattle, Washington
| | - Claire A Richards
- Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington.,School of Nursing, University of Washington, Seattle
| | - Ryan S Laundry
- Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington
| | - Janelle S Taylor
- Department of Anthropology, University of Toronto, Toronto, Ontario, Canada
| | - Paul L Hebert
- Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington.,Department of Health Services Research, University of Washington, Seattle
| | - Chuan-Fen Liu
- Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington.,Department of Health Services Research, University of Washington, Seattle
| | - Ann M O'Hare
- Division of Nephrology, Department of Medicine, University of Washington, Seattle.,Hospital and Specialty Medicine, Geriatrics and Extended Care and Seattle-Denver Health Services Research and Development Center of Innovation, VA Puget Sound Health Care System, Seattle, Washington
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17
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Mathilde N, Catherine P, Pascale V, Xavier G. [Narrative inquiries from kidney transplant patients: From the onset of the disease to the transplant]. Nephrol Ther 2020; 16:359-363. [PMID: 33222804 DOI: 10.1016/j.nephro.2020.07.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In 2018, we counted 14 291 patients on the French kidney transplantation waiting list, and 3546 grafted. The law applies the presumed consent and public surveys shows a desire for information. The objective of this research was to describe transplanted patients' lives history in order to cope with this need for information. METHODS Qualitative study, narrative inquiries, of French Auvergne-Rhône-Alpes transplanted patients' life story, between December 2016 and February 2019. Interviews were fully transcribed and analyzed by two researchers. The sampling was defined by gender, age, dialysis time and socio-professional categories. Notification to the French data protection authority was carried out. RESULTS With the ninth interview, sufficient data was collected. The start of the disease could be insidious or brutal. All interviewees changed lifestyle habits. Sometimes, the dialysis made the recovery of certain autonomy possible, but had nutritional and organizational constraints. Transplantation, without complications, reduced significantly the burden of the disease and its treatment. The difficult and agonizing expectancy of the transplant was then replaced by the patients' feeling of Damocles sword due to the uncertainty around the graft's life expectancy. The dialysis burdens were replaced by the immunosuppressive side effects. The patients' dependence on the graft resonated with a moral duty towards the donor, their relatives and themselves. CONCLUSION Renal insufficiency comprises alternations of autonomy and dependence.
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Affiliation(s)
- Naro Mathilde
- Département de médecine générale de la faculté Jacques Lisfranc de médecine de Saint-Étienne, France
| | - Plotton Catherine
- Département de médecine générale de la faculté Jacques Lisfranc de médecine de Saint-Étienne, France
| | - Vassal Pascale
- Service de soins palliatifs, Centre hospitalier universitaire de Saint-Étienne, avenue Albert Raimond, 42270 Saint-Priest-en-Jarez, France
| | - Gocko Xavier
- Département de médecine générale de la faculté Jacques Lisfranc de médecine de Saint-Étienne, France; Laboratoire SNA-EPIS EA4607, 42055 Saint-Étienne cedex 2, France; Health Services and Performance Research (HESPER), EA7425, 42055 Saint-Etienne cedex 2, France.
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18
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Does Racial Disparity in Kidney Transplant Waitlisting Persist After Accounting for Social Determinants of Health? Transplantation 2020; 104:1445-1455. [PMID: 31651719 DOI: 10.1097/tp.0000000000003002] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND African Americans (AA) have lower rates of kidney transplantation (KT) compared with Whites (WH), even after adjusting for demographic and medical factors. In this study, we examined whether the racial disparity in KT waitlisting persists after adjusting for social determinants of health (eg, cultural, psychosocial, and knowledge). METHODS We prospectively followed a cohort of 1055 patients who were evaluated for KT between 3 of 10 to 10 of 12 and followed through 8 of 18. Participants completed a semistructured telephone interview shortly after their first KT evaluation appointment. We used the Wilcoxon rank-sum and Pearson chi-square tests to examine race differences in the baseline characteristics. We then assessed racial differences in the probability of waitlisting while accounting for all predictors using cumulative incidence curves and Fine and Gray proportional subdistribution hazards models. RESULTS There were significant differences in the baseline characteristics between non-Hispanic AA and non-Hispanic WH. AA were 25% less likely (95% confidence interval, 0.60-0.96) to be waitlisted than WH even after adjusting for medical factors and social determinants of health. In addition, being older, having lower income, public insurance, more comorbidities, and being on dialysis decreased the probability of waitlisting while having more social support and transplant knowledge increased the probability of waitlisting. CONCLUSIONS Racial disparity in kidney transplant waitlisting persisted even after adjusting for medical factors and social determinants of health, suggesting the need to identify novel factors that impact racial disparity in transplant waitlisting. Developing interventions targeting cultural and psychosocial factors may enhance equity in access to transplantation.
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Tennankore KK, Gunaratnam L, Suri RS, Yohanna S, Walsh M, Tangri N, Prasad B, Gogan N, Rockwood K, Doucette S, Sills L, Kiberd B, Keough-Ryan T, West K, Vinson A. Frailty and the Kidney Transplant Wait List: Protocol for a Multicenter Prospective Study. Can J Kidney Health Dis 2020; 7:2054358120957430. [PMID: 32963793 PMCID: PMC7488612 DOI: 10.1177/2054358120957430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/15/2020] [Indexed: 01/06/2023] Open
Abstract
Background: Understanding how frailty affects patients listed for transplantation has
been identified as a priority research need. Frailty may be associated with
a high risk of death or wait-list withdrawal, but this has not been
evaluated in a large multicenter cohort of Canadian wait-listed
patients. Objective: The primary objective is to evaluate whether frailty is associated with death
or permanent withdrawal from the transplant wait list. Secondary objectives
include assessing whether frailty is associated with hospitalization,
quality of life, and the probability of being accepted to the wait list. Design: Prospective cohort study. Setting: Seven sites with established renal transplant programs that evaluate patients
for the kidney transplant wait list. Patients: Individuals who are being considered for the kidney transplant wait list. Measurements: We will assess frailty using the Fried Phenotype, a frailty index, the Short
Physical Performance Battery, and the Clinical Frailty Scale at the time of
listing for transplantation. We will also assess frailty at the time of
referral to the wait list and annually after listing in a subgroup of
patients. Methods: The primary outcome of the composite of time to death or permanent wait-list
withdrawal will be compared between patients who are frail and those who are
not frail and will account for the competing risks of deceased and live
donor transplantation. Secondary outcomes will include number of
hospitalizations and length of stay, and in a subset, changes in frailty
severity over time, change in quality of life, and the probability of being
listed. Recruitment of 1165 patients will provide >80% power to identify
a relative hazard of ≥1.7 comparing patients who are frail to those who are
not frail for the primary outcome (2-sided α = .05), whereas a more
conservative recruitment target of 624 patients will provide >80% power
to identify a relative hazard of ≥2.0. Results: Through December 2019, 665 assessments of frailty (inclusive of those for the
primary outcome and all secondary outcomes including repeated measures) have
been completed. Limitations: There may be variation across sites in the processes of referral and listing
for transplantation that will require consideration in the analysis and
results. Conclusions: This study will provide a detailed understanding of the association between
frailty and outcomes for wait-listed patients. Understanding this
association is necessary before routinely measuring frailty as part of the
wait-list eligibility assessment and prior to ascertaining the need for
interventions that may modify frailty. Trial Registration: Not applicable as this is a protocol for a prospective observational
study.
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Affiliation(s)
- Karthik K Tennankore
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
| | - Lakshman Gunaratnam
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
| | - Rita S Suri
- Division of Nephrology and Research Institute, Department of Medicine, McGill University/Centre de Recherche de l'Université de Montréal, QC, Canada
| | | | - Michael Walsh
- Departments of Medicine and Health Research Methods, Evidence & Impact, McMaster University, Hamilton, ON, Canada.,Population Health Research Institute, Hamilton Health Sciences/McMaster University, ON, Canada.,St. Joseph's Healthcare Hamilton, ON, Canada
| | - Navdeep Tangri
- Department of Medicine and Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Nessa Gogan
- Division of Nephrology, Department of Medicine, Horizon Health Network, Dalhousie University, Saint John, NB, Canada
| | - Kenneth Rockwood
- Division of Geriatric Medicine, Department of Medicine, Department of Community Health and Epidemiology, School of Health Administration, Halifax, NS, Canada
| | - Steve Doucette
- Research Methods Unit, Nova Scotia Health Authority, Halifax, Canada
| | - Laura Sills
- Multi-Organ Transplant Program, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | | | - Tammy Keough-Ryan
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
| | - Kenneth West
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
| | - Amanda Vinson
- Division of Nephrology, Department of Medicine, Dalhousie University & Nova Scotia Health Authority, Halifax, Canada
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Butler CR, Reese PP, Perkins JD, Hall YN, Curtis JR, Kurella Tamura M, O'Hare AM. End-of-Life Care among US Adults with ESKD Who Were Waitlisted or Received a Kidney Transplant, 2005-2014. J Am Soc Nephrol 2020; 31:2424-2433. [PMID: 32908000 DOI: 10.1681/asn.2020030342] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/22/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The care of patients in the United States who have ESKD is often shaped by their hopes and prognostic expectations related to kidney transplant. Little is known about how patients' engagement in the transplant process might relate to patterns of end-of-life care. METHODS We compared six measures of intensity of end-of-life care among adults in the United States with ESKD who died between 2005 and 2014 after experiencing differing exposure to the kidney transplant process. RESULTS Of 567,832 decedents with ESKD, 27,633 (5%) had a functioning kidney transplant at the time of death, 14,653 (3%) had a failed transplant, 16,490 (3%) had been removed from the deceased donor waitlist, 17,010 (3%) were inactive on the waitlist, 11,529 (2%) were active on the waitlist, and 480,517 (85%) had never been waitlisted for or received a transplant (reference group). In adjusted analyses, compared with the reference group, patients exposed to the transplant process were significantly more likely to have been admitted to an intensive care unit and to have received an intensive procedure in the last 30 days of life; they were also significantly more likely to have died in the hospital. Those who died on the transplant waitlist were also less likely than those in the reference group to have been enrolled in hospice and to have discontinued dialysis before death. CONCLUSIONS Patients who had engaged in the kidney transplant process received more intensive patterns of end-of-life care than other patients with ESKD. These findings support the relevance of advance care planning, even for this relatively healthy segment of the ESKD population.
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Affiliation(s)
- Catherine R Butler
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, Department of Medicine and Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Perkins
- Division of Transplant Surgery, Department of Surgery, University of Washington, Seattle, Washington
| | - Yoshio N Hall
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine and the Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington
| | - Manjula Kurella Tamura
- Division of Nephrology, Geriatric Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Ann M O'Hare
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, Seattle, Washington.,Division of Nephrology, Department of Medicine, Veterans Affairs Puget Sound Heath Care System, Seattle, Washington
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21
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Walker CB, Moore HB, Nydam TL, Schulick AC, Yaffe H, Pomposelli JJ, Wachs M, Bak T, Conzen K, Adams M, Pshak T, Choudhury R, Chapman MP, Pomfret EA, Kennealey P. The use of thromboelastography to assess post-operative changes in coagulation and predict graft function in renal transplantation. Am J Surg 2020; 220:1511-1517. [PMID: 32878689 PMCID: PMC7450953 DOI: 10.1016/j.amjsurg.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 06/28/2020] [Accepted: 08/19/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND End stage renal disease (ESRD) is associated with elevated fibrinogen levels and fibrinolysis inhibition. However, there is a paucity of data on how renal transplantation impacts coagulation. we hypothesize that renal transplantation recipients with good functioning grafts will have improved fibrinolytic activity following surgery. METHODS Kidney recipients were analyzed pre-operatively and on post-operative day 1(POD1) using three different TEG assays with and without two concentration of tissue-plasminogen activator (t-PA). TEG indices and percent reduction in creatinine from pre-op to POD1 were measured, with >50% defining "good" graft function. Follow up was done at 6, 12, and 24 months. RESULTS Percent lysis(LY30) on POD1 the t-PA TEG was significantly correlated to change creatinine from pre-op to POD-1(p = 0.006). A LY30 ≥ 23% was associated with good early graft function, and lower creatinine at 24-months(p = 0.028) compared to recipients with low POD1 LY30. CONCLUSIONS Post-operative tPA-TEG LY30 is associated with favorable early and late outcomes in kidney transplant.
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Affiliation(s)
- Carson B Walker
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Hunter B Moore
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA.
| | - Trevor L Nydam
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Alexander C Schulick
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Hillary Yaffe
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - James J Pomposelli
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Michael Wachs
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Thomas Bak
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Kendra Conzen
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Megan Adams
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Thomas Pshak
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Rashikh Choudhury
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Michael P Chapman
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Elizabeth A Pomfret
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
| | - Peter Kennealey
- Department of Surgery, Division of Transplant Surgery, University of Colorado, USA
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22
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Butler CR, Taylor JS, Reese PP, O'Hare AM. Thematic analysis of the medical records of patients evaluated for kidney transplant who did not receive a kidney. BMC Nephrol 2020; 21:300. [PMID: 32711468 PMCID: PMC7382039 DOI: 10.1186/s12882-020-01951-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 07/15/2020] [Indexed: 01/11/2023] Open
Abstract
Background A potential pitfall of policies intended to promote referral for kidney transplant is that greater numbers of patients may be evaluated for transplant without experiencing the intended benefit of receiving a kidney. Little is known about the potential implications of this experience for patients. Methods We performed a thematic analysis of clinician documentation in the electronic medical records of all adults at a single medical center with advanced kidney disease who were referred to the local transplant coordinator for evaluation between 2008 and 2018 but did not receive a kidney. Results 148 of 209 patients referred to the local kidney transplant coordinator at our center (71%) had not received a kidney by the end of follow-up. Three dominant themes emerged from qualitative analysis of documentation in the medical records of these patients: 1) Forward momentum: patients found themselves engaged in an iterative process of testing and treatment that tended to move forward unless an absolute contraindication to transplant was identified or patients disengaged; 2) Potential for transplant shapes other medical decisions: engagement in the transplant evaluation process could impact many other aspects of patients’ care; and 3) Personal responsibility and psychological burden for patients and families: clinician documentation suggested that patients felt personally responsible for the course of their evaluation and that the process could take an emotional toll on them and their family members. Conclusions Engagement in the kidney transplant evaluation process can be a significant undertaking for patients and families and may impact many other aspects of their care. Policies to promote referral for kidney transplant should be coupled with efforts to strengthen shared decision-making to ensure that the decision to undergo transplant evaluation is framed as an explicit choice with benefits, risks, and alternatives and patients have an opportunity to shape their involvement in this process.
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Affiliation(s)
- Catherine R Butler
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, 1959 NE Pacific St, Campus Box 356521, Seattle, WA, 98195, USA.
| | - Janelle S Taylor
- Department of Anthropology, University of Toronto, Toronto, Canada
| | - Peter P Reese
- Renal-Electrolyte & Hypertension Division and Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ann M O'Hare
- Division of Nephrology, Department of Medicine and the Kidney Research Institute, University of Washington, 1959 NE Pacific St, Campus Box 356521, Seattle, WA, 98195, USA.,Nephrology Section, Hospital and Specialty Medicine and Seattle-Denver Health Services Research and Development Center of Innovation, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
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23
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Development of a Patient-specific Search of Transplant Program Outcomes and Characteristics: Feedback From Kidney Transplant Patients. Transplant Direct 2020; 6:e585. [PMID: 32766433 PMCID: PMC7371071 DOI: 10.1097/txd.0000000000001036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 05/15/2020] [Accepted: 06/10/2020] [Indexed: 01/19/2023] Open
Abstract
Background. Patients face obstacles in finding a transplant program that meets their healthcare needs. Acceptance criteria and waiting times vary by region and program. The Scientific Registry of Transplant Recipients provides program-specific information, but it is unclear what patients and referring physicians need to know. Methods. We examined variability in program-specific characteristics that could influence access to transplantation. We also conducted 20 interviews and 16 focus groups with transplant candidates, recipients, and their family members. Participants were shown prototypes of a patient-specific search tool and evaluated its capacity to identify programs tailored to the needs of individual patients. Results. The distribution of recipient and donor characteristics that may impact access to transplantation, such as recipients on Medicaid, varied across programs (all with P < 0.01). Several themes emerged related to impressions of access to transplantation and the usability of patient-specific search functions. Perceptions of the prototypes and results varied, but were positive overall and support providing an individualized search of program level data. Participants revealed significant barriers to identifying and evaluating transplant programs and suggest that patient-specific search results reduce the anxiety associated with selecting a program. Conclusions. Providing patient-specific tools is valued by patients and important to maximizing access to transplant.
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Walker RC, Abel S, Reynolds A, Palmer SC, Walker C, Tipene-Leach DC. Experiences, perspectives and values of Indigenous peoples regarding kidney transplantation: systematic review and thematic synthesis of qualitative studies. Int J Equity Health 2019; 18:204. [PMID: 31888651 PMCID: PMC6937677 DOI: 10.1186/s12939-019-1115-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background Kidney transplantation is considered best practice treatment for end stage kidney disease (ESKD), however Indigenous patients are substantially less likely to receive either a deceased or live donor kidney transplant than non-Indigenous patients. We describe Indigenous peoples’ experiences and perspectives including traditional values around kidney transplantation to inform international transplant programs. Methods We conducted a systematic review of qualitative studies involving Indigenous adults who have experience with or perceptions of kidney transplantation. We searched MEDLINE, Embase, PsychINFO, and CINAHL, in conjunction with analysis of Google Scholar and reference lists of related studies till July 2019. We utilised thematic synthesis to analyse data. Completeness of reporting in studies was evaluated using the Consolidated Criteria for Reporting Qualitative Studies (COREQ) framework. Results Eight studies involving 225 Indigenous participants were included. Five themes were identified: strong desire for transplantation (seeking normality and freedom from dialysis, wanting to reduce burden of disease within community); lack of partnership in shared decision-making (receiving inadequate information, ineffective communication); barriers to live kidney donation (difficulty asking, apprehension about impact on donor, avoiding additional financial burden and fear of complications); cultural considerations (influence of traditional values and beliefs, reconciling traditional values with pragmatic need); and experiencing lack of cultural competence in clinical care (struggling with prejudice and ignorance, mistrust of clinicians and health system). Conclusion Indigenous participants had a strong desire for a kidney transplant and recognised the need for more readily available kidney transplants for others in their communities with ESKD. However, they faced prejudice and a lack of cultural competence by health workers as well as wider barriers to transplantation in systems that did not support effective and culturally appropriate delivery of information and care. Traditional cultural values also influenced decisions regarding kidney transplantation but such values were moderated when considering transplantation. Transplantation programs need to identify and mitigate barriers, such as the financial burden, promote cultural safety and incorporate traditional values into the promotion of transplantation in order to address inequitable transplantation rates. Registration Not applicable.
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Affiliation(s)
- Rachael C Walker
- School of Nursing, Eastern Institute of Technology, 501 Gloucester Street, Taradale, Napier, Hawke's Bay, 4112, New Zealand.
| | - Sally Abel
- Kaupapa Consulting Ltd, Napier, 4110, New Zealand
| | - Annie Reynolds
- Department of Medicine, Hawke's Bay District Health Board, Hastings, 4130, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago, Christchurch, 8140, New Zealand
| | - Curtis Walker
- Department of Medicine, Midcentral District Health Board, Palmerston North, 4442, New Zealand
| | - David C Tipene-Leach
- Research and Innovation Centre, Eastern Institute of Technology, Napier, 4112, New Zealand
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25
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McGuire C, Kannathasan S, Lowe M, Dow T, Bezuhly M. Patient survival following renal transplantation in Indigenous populations: A systematic review. Clin Transplant 2019; 34:e13760. [PMID: 31788873 DOI: 10.1111/ctr.13760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 11/12/2019] [Accepted: 11/20/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Inequities in health care predispose Indigenous populations to poor health outcomes. The objective of this study was to examine patient survival and other post-transplant outcomes of kidney transplantation among Indigenous patients compared with non-Indigenous populations. METHODS A systematic review of MEDLINE, EMBASE, and Google Scholar was undertaken from inception to September 30, 2019, using a computerized search. Publication descriptors and methodological and statistical details were extracted. Articles were assessed using the methodological index for non-randomized studies (MINORS) scale. RESULTS Twelve studies were included. All studies were retrospective and published between 2004 and 2018. Mean Indigenous patient age was 40 (range: 8-76), while non-Indigenous was 41 (range: 6-74). Mean sample size for Indigenous populations was 398 (range: 24-1459), while for non-Indigenous patients was 1102 (range: 53-7555). Eight studies examined indigenous populations in Australia, two in Canada, one in the United States, and one in New Zealand. All studies were considered of high methodological quality and clinically homogenous. Results indicated that patient survival, graft survival, and delayed graft function were significantly reduced among Indigenous populations compared with non-Indigenous populations. CONCLUSIONS Post-transplant outcomes among various Indigenous populations are significantly worse compared with non-Indigenous populations. The reasons for poor outcomes are likely multifactorial. Improved standardized reporting of transplant outcomes of Indigenous patients is necessary to better inform healthcare services and improve clinical outcomes.
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Affiliation(s)
- Connor McGuire
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Matthew Lowe
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd Dow
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Bezuhly
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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26
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Comparison of longitudinal quality of life outcomes in preemptive and dialyzed patients on waiting list for kidney transplantation. Qual Life Res 2019; 29:959-970. [PMID: 31784856 DOI: 10.1007/s11136-019-02372-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The waiting list period for kidney transplantation can be lengthy and associated with a deteriorated health-related quality of life (HRQoL). It might also be experienced differently depending on the experience of renal replacement therapy (preemptive or dialyzed patients), and the type of dialysis. The main objective of this study is to measure and compare HRQoL changes in preemptive, hemodialysis (HD), and peritoneal dialysis (PD) patients during the waiting list period for kidney transplantation. METHODS A sample of adult patients on kidney transplant waiting list from three French University Hospital centers was recruited. HRQoL was measured using the SF-36 and a specific questionnaire (ReTransQol), which were collected every 6 months before transplantation in preemptive, HD, and PD patients. Mixed-effects models taking into account time and possible confounding factors were used to compare HRQoL changes between the three groups. RESULTS Preemptive (n = 230), HD (n = 177), and PD patients (n = 39) were enrolled. The renal replacement therapy modalities, time (time on waiting list and age at registration), and gender were associated with HRQoL changes. The HD and PD patients had a significantly lower perceived HRQoL on Role Physical, Social Functioning, and Role Emotional dimensions than the preemptive patients, with lower scores for PD compared to HD patients. The HRQoL scores of all patients were lower compared to the French general population for all dimensions. CONCLUSIONS A better understanding of pre-transplantation patients' experience can help improving patient care with adapted educational programs and psychological support depending on the type of renal replacement therapy.
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27
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Nielsen C, Agerskov H, Bistrup C, Clemensen J. 'The hospital and everyday life are two worlds': Patients' and healthcare professionals' experiences and perspectives on collaboration in the kidney transplantation process. Nurs Open 2019; 6:1491-1500. [PMID: 31660177 PMCID: PMC6805260 DOI: 10.1002/nop2.349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/09/2019] [Accepted: 07/10/2019] [Indexed: 01/01/2023] Open
Abstract
AIM To explore patients' and healthcare professionals' experiences and perspectives on collaboration in the kidney transplantation process. DESIGN A qualitative study with a phenomenological-hermeneutic approach. METHOD Participant observation and interviews were conducted with 18 patients, together with a focus group with eight healthcare professionals from April 2016-January 2017. The data analysis was inspired by Ricoeur's theory. RESULTS While patients acknowledged that the healthcare professionals were experts, they also requested an everyday life approach to treatment and care, because both professional knowledge and everyday life experiences were needed to manage everyday life. A contrast between patients' experiences and healthcare professionals' knowledge was identified, and the empowerment approach could be a way to combine the different perspectives.
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Affiliation(s)
- Charlotte Nielsen
- Department of NephrologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Hanne Agerskov
- Department of NephrologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Claus Bistrup
- Department of NephrologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Jane Clemensen
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- HCA ResearchOdense University HospitalOdenseDenmark
- Centre for Innovative Medical TechnologyOdense University HospitalOdenseDenmark
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28
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Schmidt-Busby J, Wiles J, Exeter D, Kenealy T. Self-management action and motivation of Pacific adults in New Zealand with end-stage renal disease. PLoS One 2019; 14:e0222642. [PMID: 31545828 PMCID: PMC6756531 DOI: 10.1371/journal.pone.0222642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Accepted: 09/04/2019] [Indexed: 12/12/2022] Open
Abstract
AIMS To explore actions and motivations for self-management practices of Pacific adults following diagnosis of end stage renal disease (ESRD). METHODS Focused ethnography using in-depth interviews with 16 Pacific people on haemodialysis for diabetic ESRD, in Auckland, New Zealand. Study participants were of Samoan, Cook Islander, Tongan, Niuean, or Tokelauan ethnicity and aged between 30 to 69 years old. Thematic analysis was used to code and identify emergent themes. RESULTS All participants assumed active responsibility for their self-management following their diagnosis of ESRD. They reported positive differences in their current self-management behaviours, compared to pre-ESRD diagnosis. In the face of their terminal diagnosis, participant's motivations to self-manage their health were fuelled by hope; the hope to live long enough to change their family legacy of diabetes and ESRD. To achieve this, there was a dependency upon family members as a resource for self-management support. Yet at the same time, family members also had health concerns (including diabetes), and several participants themselves were carers for sick or elderly family members. CONCLUSION The growing number of members (within family units) progressing from moderate to late-stage diabetes raises concerns about the sustainability of future family support in Pacific families in New Zealand with histories of diabetes, ESRD, and other chronic diseases. While the burden upon informal carers (family) has been well documented throughout the past few decades, the dynamics of bi-directional carer support between (two or more) sick family members and their families have had less exposure. This has potentially significant implications for Pacific peoples in New Zealand, considering the increases in diabetes prevalence within their families.
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Affiliation(s)
- Jacqueline Schmidt-Busby
- Counties Manukau Health, Middlemore Hospital, Auckland, New Zealand
- Department of Social and Community Health, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- Department of Social and Community Health, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Daniel Exeter
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Timothy Kenealy
- School of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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29
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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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30
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Crenesse-Cozien N, Dolph B, Said M, Feeley TH, Kayler LK. Kidney Transplant Evaluation: Inferences from Qualitative Interviews with African American Patients and their Providers. J Racial Ethn Health Disparities 2019; 6:917-925. [DOI: 10.1007/s40615-019-00592-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/13/2019] [Accepted: 04/09/2019] [Indexed: 11/25/2022]
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31
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Schaffhausen CR, Bruin MJ, McKinney WT, Snyder JJ, Matas AJ, Kasiske BL, Israni AK. How patients choose kidney transplant centers: A qualitative study of patient experiences. Clin Transplant 2019; 33:e13523. [PMID: 30861199 DOI: 10.1111/ctr.13523] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/12/2019] [Accepted: 02/22/2019] [Indexed: 12/20/2022]
Abstract
Little is known about how patients make the critical decision of choosing a transplant center. In the United States, acceptance criteria, waiting times, and mortality vary significantly by geography and center. We sought to understand patients' experiences and perspectives when selecting transplant centers. We included 82 kidney transplant patients in 20 semi-structured interviews, nine focus groups with local candidates, and three focus groups with national recipients. Sites included two local transplant centers in Minneapolis, Minnesota, and national recipients from across the United States. Transcripts were analyzed by two researchers using a thematic analysis. Several themes emerged related to priorities and barriers when choosing a center. Patients were often unfamiliar with options, even with multiple local centers. Patients described being referred to a specific center by a trusted provider. Patients prioritized perceived reputation, comfort, and convenience. Insurance coverage was both a source of information and a barrier to options. Patients underestimated differences across centers and the effects on being waitlisted and receiving a transplant. Barriers in decision making included an overwhelming scope of information and difficulty locating information relevant to patients with unique medical needs. Informed decisions could be improved by the dissemination of understandable information better tailored to individual patient needs.
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Affiliation(s)
| | - Marilyn J Bruin
- College of Design, University of Minnesota, Minneapolis, Minnesota
| | | | - Jon J Snyder
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota
| | - Arthur J Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Bertram L Kasiske
- Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.,Department of Medicine, Hennepin Healthcare, University of Minnesota (UMN), Minneapolis, Minnesota
| | - Ajay K Israni
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota.,Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, Minnesota.,Department of Medicine, Hennepin Healthcare, University of Minnesota (UMN), Minneapolis, Minnesota
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32
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Hart A, Bruin M, Chu S, Matas A, Partin MR, Israni AK. Decision support needs of kidney transplant candidates regarding the deceased donor waiting list: A qualitative study and conceptual framework. Clin Transplant 2019; 33:e13530. [PMID: 30865323 DOI: 10.1111/ctr.13530] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 02/22/2019] [Accepted: 03/06/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Kidney transplant candidates face complex decisions about transplant options such as living donation or acceptance of lower quality kidneys. We sought to characterize knowledge and decision support needs regarding kidney transplant outcomes and options. METHODS We conducted 10 interviews and four focus groups of 28 adult kidney transplant candidates from two centers in Minnesota. Transcripts were analyzed thematically using a grounded theory approach. RESULTS We identified four themes: First, candidates have a limited understanding of treatment options and demonstrate confusion or a lack of awareness about waiting list outcomes and prognosis. Second, candidates desired frank discussions about likely outcomes and individualized prognosis. Third, emotional barriers impact how patients make informed decisions. Finally, participants relied on the support of family and friends to help process information, and many favored the medical community engaging their family and friends in their medical decisions. These findings were incorporated into a conceptual model to support kidney transplant candidates in medical decision making. CONCLUSIONS Transplant candidates had limited understanding about treatment options and outcomes on the kidney transplant waiting list. Individualized risk information and cognitive approaches that recognize how patients process information and balance competing risks may improve informed decision making.
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Affiliation(s)
- Allyson Hart
- Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota
| | - Marilyn Bruin
- Department of Design, Housing, and Apparel, College of Design, University of Minnesota, Minneapolis, Minnesota
| | - Sauman Chu
- Department of Design, Housing, and Apparel, College of Design, University of Minnesota, Minneapolis, Minnesota
| | - Arthur Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Melissa R Partin
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - Ajay K Israni
- Department of Medicine, Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota
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33
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Nielsen C, Clemensen J, Bistrup C, Agerskov H. Balancing everyday life-Patients' experiences before, during and four months after kidney transplantation. Nurs Open 2019; 6:443-452. [PMID: 30918695 PMCID: PMC6419113 DOI: 10.1002/nop2.225] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/11/2018] [Accepted: 11/09/2018] [Indexed: 12/11/2022] Open
Abstract
AIM To explore patients' experiences before, during and four months after kidney transplantation as a coherent process. DESIGN A qualitative explorative study with a phenomenological-hermeneutic approach. METHODS Participant observations and semi-structured interviews were used complementary. In total, 18 kidney recipients were included. Data were analysed in accordance with Ricoeur's theory of interpretation, on three levels: naïve reading, structural analysis and critical interpretation and discussion. RESULTS Three themes emerged: waiting time and hope during everyday life, transformation during the kidney transplantation process and towards a new everyday life with positive prospects. Going through the kidney transplantation process was challenging for the patients. Everyday life was affected through the process, and the patients had to balance the associated challenges like hope, positive prospects and health-related issues.
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Affiliation(s)
- Charlotte Nielsen
- Department of NephrologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Centre for Innovative Medical TechnologyOdense University HospitalOdenseDenmark
| | - Jane Clemensen
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
- Centre for Innovative Medical TechnologyOdense University HospitalOdenseDenmark
- HCA ResearchHans Christian Andersen Children’s Hospital, Odense University HospitalOdenseDenmark
| | - Claus Bistrup
- Department of NephrologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
| | - Hanne Agerskov
- Department of NephrologyOdense University HospitalOdenseDenmark
- Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
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34
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Oztek-Celebi FZ, Herle M, Ritschl V, Kaltenegger L, Stamm T, Aufricht C, Boehm M. High Rate of Living Kidney Donation to Immigrant Children Despite Disparities-An Epidemiological Paradox? Front Pediatr 2019; 7:25. [PMID: 30809513 PMCID: PMC6379308 DOI: 10.3389/fped.2019.00025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 01/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Kidney transplantation is the preferred treatment modality for children with end-stage renal disease. In the adult population, migration-related modifiable factors were associated with low living donation rates; no such data are available on the pediatric population. This pilot study therefore compares donation modality, communication, knowledge, and attitudes/beliefs between families of immigrant and non-immigrant descent. Methods: Demographic and clinical characteristics of a cohort of children from 77 families of immigrant (32; 42%) and non-immigrant (45; 58%) descent who had undergone renal transplantation were assessed and related to donation modality at the Medical University of Vienna. In a representative subset, modifiable migration-related factors were assessed in a questionnaire-based study. Results: In immigrant families, information delay, limited communication, low knowledge levels, and self-reported conflicting beliefs were significantly more prevalent than in non-immigrants. The living kidney donation rate to children was high in both populations (immigrants: 63%, non-immigrants: 44%; p = 0.12). Living donation to children on dialysis was even significantly higher in immigrant families (immigrants: 13 out of 20; 57%, non-immigrants: 9 out of 33; 27%; p = 0.03). Conclusion: Contrary to expectations, migration-related disparities did not translate into decreased living donation rates in immigrant families, in particular to children on dialysis. Certain factors might therefore be less important for the living donation process in pediatric care structures and/or might be overcome by yet undefined protective factors. Larger pediatric studies including qualitative and quantitative methods are required to validate and refine current conceptual frameworks integrating the perspective of affected families.
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Affiliation(s)
- Fatma Zehra Oztek-Celebi
- Department of Pediatrics and Adolescent Medicine, Dr. Sami Ulus Obstetrics and Gynecology and Pediatrics Training and Research Hospital, Ankara, Turkey
| | - Marion Herle
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Lukas Kaltenegger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Christoph Aufricht
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Boehm
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
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35
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Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
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Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
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36
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Robinski M, Mau W, Wienke A, Girndt M. The Choice of Renal Replacement Therapy (CORETH) project: dialysis patients' psychosocial characteristics and treatment satisfaction. Nephrol Dial Transplant 2018; 32:315-324. [PMID: 28186578 DOI: 10.1093/ndt/gfv464] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/25/2015] [Indexed: 11/13/2022] Open
Abstract
Background Until today, research has underestimated the role of psychosocial conditions as contributing factors to dialysis modality choice. The novelty within the Choice of Renal Replacement Therapy (CORETH) project (German Clinical Trials Register #DRKS00006350) is its focus on the multivariate associations between these aspects and their consecutive significance regarding treatment satisfaction (TS) in peritoneal dialysis (PD) versus haemodialysis (HD) patients. In this article, we present the baseline results of a multicentre study, which is supported by a grant from the German Ministry for Education and Research. Methods Six to 24 months after initiation of dialysis, 780 patients from 55 dialysis centres all over Germany were surveyed. The questionnaire addressed psychosocial, physical, socio-demographic and shared decision-making (SDM) aspects. Furthermore, cognitive functioning was tested. After indexing the measures, two propensity score-matched groups (n = 482) were compared in a first step, after having chosen PD or HD. In a second step, a moderated multiple regression (n = 445) was conducted to initially investigate the multivariate impact of patient characteristics on TS. Results In comparison with HD patients, PD patients were more satisfied with their treatment (P < 0.001), had a more autonomy-seeking personality (P = 0.04), had better cognitive functioning (P = 0.001), indicated more satisfying SDM (P < 0.001) and had a larger living space (P < 0.001). All patients were more satisfied when they had a good psychological state and received SDM. Especially in HD patients, TS was higher when the patient had a less autonomous personality, lower cognitive functioning, more social support, a poorer physical state and poorer socio-demographic conditions (R2 = 0.26). Conclusions Psychosocial characteristics play a major role in TS in dialysis patients. Within a multivariate approach, these factors are even more important than physical or environment-related factors. In practice, focusing on SDM and screening patient characteristics at an early stage can foster patients’ TS. Changes will be examined in a 1-year follow-up.
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Affiliation(s)
- Maxi Robinski
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, C/o Institute of Rehabilitation Medicine, Halle (Saale), Germany.,Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Wilfried Mau
- Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, C/o Institute of Rehabilitation Medicine, Halle (Saale), Germany.,Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Wienke
- Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Institute of Medical Epidemiology, Biostatistics, and Informatics, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Girndt
- Centre for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.,Department of Internal Medicine II, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Goh ZS, Griva K. Anxiety and depression in patients with end-stage renal disease: impact and management challenges - a narrative review. Int J Nephrol Renovasc Dis 2018; 11:93-102. [PMID: 29559806 PMCID: PMC5856029 DOI: 10.2147/ijnrd.s126615] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Psychiatric disorders commonly co-exist with the diagnosis of chronic kidney disease (CKD). Research on depression and CKD has increased to a great extent. Multiple studies have demonstrated that depression is more prevalent in CKD and that end-stage renal disease is a robust risk factor for adverse outcomes such as hospitalization and mortality, yet these are often underdiagnosed or untreated. This review provides a selective overview on the prevalence rates of depression and anxiety in patients with CKD and across renal replacement therapies, the factors most consistently associated with symptoms of distress and their clinical implications. Finally, treatment and management strategies from relevant literature are appraised and discussed.
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Affiliation(s)
- Zhong Sheng Goh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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38
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Schaffhausen CR, Bruin MJ, Chesley D, McBride M, Snyder JJ, Kasiske BL, Israni AK. What patients and members of their support networks ask about transplant program data. Clin Transplant 2017; 31:10.1111/ctr.13125. [PMID: 28944568 PMCID: PMC5720923 DOI: 10.1111/ctr.13125] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
Transplant patients often seek specific data and statistics to inform medical decision making; however, for many relevant measures, patient-friendly information is not available. Development of patient-centered resources should be informed by patient needs. This study used qualitative document research methods to review 678 detailed Scientific Registry of Transplant Recipients (SRTR) entries and summary counts of 55 362 United Network for Organ Sharing (UNOS) entries to provide a better understanding of what was asked and what requests were most common. Incoming call and email logs maintained by SRTR and UNOS were reviewed for 2010-2015. Patients sought a wide range of information about outcomes, waiting times, program volumes, and willingness to perform transplants in candidates with specific diseases or demographics. Patients and members of their support networks requested explanation of complex information, such as actual-vs-expected outcomes, and of general transplant processes, such as registering on the waiting list or becoming a living donor. They sought transplant program data from SRTR and UNOS, but encountered gaps in the information they wanted and occasionally struggled to interpret some data. These findings were used to identify potential gaps in providing program-specific data and to enhance the SRTR website (www.srtr.org) with more patient-friendly information.
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Affiliation(s)
- Cory R. Schaffhausen
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota
| | - Marilyn J. Bruin
- College of Design, University of Minnesota, Minneapolis, Minnesota
| | - Daryl Chesley
- Organ Procurement and Transplantation Network, Richmond, Virginia
- United Network for Organ Sharing, Richmond, Virginia
| | - Maureen McBride
- Organ Procurement and Transplantation Network, Richmond, Virginia
- United Network for Organ Sharing, Richmond, Virginia
| | - Jon J. Snyder
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
| | - Bertram L. Kasiske
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
| | - Ajay K. Israni
- Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, Minnesota
- Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, Minnesota
- Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota
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39
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Burns T, Fernandez R, Stephens M. The experience of waiting for a kidney transplant: A qualitative study. J Ren Care 2017. [DOI: 10.1111/jorc.12209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
| | - Ritin Fernandez
- University of Wollongong Faculty of Science Medicine and Health; Wollongong NSW Australia
- Centre for Research in Nursing and Health; St George Hospital; Kogarah NSW Australia
| | - Moira Stephens
- University of Wollongong Faculty of Science Medicine and Health; Wollongong NSW Australia
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40
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Rosaasen N, Mainra R, Shoker A, Wilson J, Blackburn D, Mansell H. Education Before Kidney Transplantation. Prog Transplant 2017; 27:58-64. [DOI: 10.1177/1526924816685862] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context: Poor knowledge about immunosuppressive (IS) medications remains a major problem for patients in the posttransplant setting. Therefore, more effective educational strategies in the pretransplant setting are being considered as a possible method to improve knowledge and readiness for the challenges of posttransplant care. However, the most effective/relevant content of a pretransplant educational program is yet to be determined. Objective: To identify pretransplant education topics from the posttransplant patient perspective. Design: A focus group meeting was conducted among 7 high-functioning, stable adult kidney transplant recipients recruited from the Saskatchewan Transplant Program. Demographic information including age, gender, occupation, background/ethnicity, and time since transplant were recorded. A moderator, assistant moderator, and research assistant facilitated the 90-minute focus group meeting using a predetermined semistructured interview guide. The session was audio recorded and transcribed verbatim. Nvivo software was used to code the data and identify emerging themes exploring views of participants relating to the educational information required for pretransplant patients. Results: Patients were satisfied with the education they had received. Ideas were classified into the following major themes—patient satisfaction, transplant waitlist, surgery, medications, posttransplant complications, lifestyle and monitoring, knowledge acquisition, illusion of control, and life changes posttransplant. Knowledge gaps were identified in all areas of the transplantation process and were not exclusive to IS medications. Conclusion: Misconceptions regarding transplantation were identified by a group of high-functioning, stable adult recipients who were satisfied with their clinical care. Future educational strategies should aim to address the entire transplantation process and not be limited to medications.
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Affiliation(s)
- Nicola Rosaasen
- Saskatchewan Transplant Program, Saskatoon, Saskatchewan, Canada
| | - Rahul Mainra
- Saskatchewan Transplant Program, Saskatoon, Saskatchewan, Canada
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Ahmed Shoker
- Saskatchewan Transplant Program, Saskatoon, Saskatchewan, Canada
- Division of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jay Wilson
- College of Education, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - David Blackburn
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Crawford K, Low JK, Manias E, Williams A. Healthcare professionals can assist patients with managing post-kidney transplant expectations. Res Social Adm Pharm 2016; 13:1204-1207. [PMID: 27955977 DOI: 10.1016/j.sapharm.2016.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 12/11/2022]
Abstract
Kidney transplantation is the preferred treatment option for end-stage kidney disease. However, transplantation is not a cure and the prospective recipient needs to carefully evaluate the risks and benefits of receiving a transplant before agreeing to have the transplant. The objective of this commentary is to demonstrate that many kidney transplant recipients have unrealistic expectations of what life after transplantation involves. After monitoring participants in a randomised controlled trial through the first 12 months post-transplantation, we question whether patients understood the impact of receiving a transplant. In our study, participants were not prepared for the considerable time and effort involved in adhering to their medications. Participants felt challenged by the constant hospital, pathology and pharmacy visits; they were fearful that their transplant could reject; and they struggled with adapting to their new way of living. This paper offers new insights into understanding the life of patients post transplantation and the challenges of informing patients about the consequences of kidney transplantation. Understanding the challenges faced by new transplant recipients can help health professionals educate patients about life post-transplantation so patients have a genuine understanding of what they are consenting to, which is likely to enhance medication adherence and ultimately, graft success.
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Affiliation(s)
- Kimberley Crawford
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia.
| | - Jac Kee Low
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, Victoria, Australia; The Royal Melbourne Hospital, Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia; Melbourne School of Health Sciences, The University of Melbourne, Parkville, Victoria, Australia
| | - Allison Williams
- Faculty of Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
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Jones J, Rosaasen N, Taylor J, Mainra R, Shoker A, Blackburn D, Wilson J, Mansell H. Health Literacy, Knowledge, and Patient Satisfaction Before Kidney Transplantation. Transplant Proc 2016; 48:2608-2614. [DOI: 10.1016/j.transproceed.2016.07.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/26/2016] [Indexed: 10/20/2022]
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43
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Trivedi P, Rosaasen N, Mansell H. The Health-Care Provider's Perspective of Education Before Kidney Transplantation. Prog Transplant 2016; 26:322-327. [PMID: 27555072 DOI: 10.1177/1526924816664081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Adequate patient education is essential for preparing potential recipients for kidney transplantation. Health-care providers play a vital role in education and can identify gaps in patient understanding. OBJECTIVE To identify deficits in patient knowledge from the perspective of a transplant multidisciplinary care team and determine whether their perceptions align with patients who have previously undergone a transplant. DESIGN An open call was advertised for health-care providers to attend a focus group discussion regarding the educational needs of pretransplant patients in 1 Canadian center. A predetermined, semistructured set of questions was used to collect the views of transplant caregivers. A moderator, assistant moderator, and research assistant facilitated the discussion, which was transcribed verbatim. Paper surveys were distributed to collect opinions of those unable to attend or uncomfortable to voice their opinion in an open forum. Qualitative analysis software was used to identify any emergent themes. Results were compared to a previous study undertaken in transplant recipients. RESULTS Despite pre- and posttransplant education, specific themes emerged including misconceptions about the assessment process and time on the wait list and the surgery, incongruency between patient expectations and outcome, and confusion regarding medications. Health-care provider perceptions were remarkably consistent with transplant recipients. CONCLUSION Health-care providers identified gaps in patient understanding indicating that transplant candidates may not be internalizing what is taught. Innovative educational approaches may be needed to provide more successful patient education. Similarities between health-care provider and patient perceptions suggest that care providers are a valuable source of information.
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Affiliation(s)
- Paraag Trivedi
- 1 College of Pharmacy and Nutrition, University Of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Nicola Rosaasen
- 2 Saskatchewan Transplant Program, St Paul's Hospital, Saskatoon, Saskatchewan, Canada
| | - Holly Mansell
- 1 College of Pharmacy and Nutrition, University Of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Bircan HY, Özçelik Ü, Uysal N, Demirağ A, Haberal M. Development of an Information Model for Kidney Transplant Wait List. EXP CLIN TRANSPLANT 2015; 13 Suppl 3:58-61. [PMID: 26640914 DOI: 10.6002/ect.tdtd2015.p1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Deceased-donor kidney transplant is unique among surgical procedures that are an urgent procedure performed in an elective population. It has not been possible to accurately determine when a given patient will be called for transplant. Patients on the active transplant list can be called for a transplant at any time. As a result, every effort must be made to optimize their health according to best practices and published clinical practice guidelines. MATERIALS AND METHODS Once the patient is placed on the transplant wait list after undergoing an initial extensive evaluation, continued surveillance is required. Therefore, we developed a kidney transplant wait list surveillance software program that alerts organ transplant coordinator on time regarding which patients need a work-up. RESULTS The new designed software has a database of our waiting patients with their completed and pending controls. The software also has built-in functions to warn the responsible staff with an E-mail. If one of the controls of a recipient delayed, the software sends an automated E-mail to the staff regarding the patients delayed controls. The software is a Web application that works on any platform with a Web browser and Internet connection and allows access by multiple users. The software has been developed with NET platform. The database is SQL server. The software has the following functions: patient communication info, search, alert list, alert E-mail, control entry, and system management. CONCLUSIONS As of January 2014, a total of 21 000 patients were registered on the National Kidney Transplant wait list in Turkey and the kidney transplant wait list had been expanding by 2000 to 3000 patients each year. Therefore computerized wait list programs are crucial to help to transplant centers to keep their patients up-to-date on time.
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Affiliation(s)
- Hüseyin Yüce Bircan
- From the Department of General Surgery, Baskent University School of Medicine, Istanbul
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