1
|
Murray AN, Monahan K, Sacco A, Paiva A, Redding C, Robbins M. Development and Validation of a Measure of Self-Efficacy for Advance Care Planning. Am J Hosp Palliat Care 2024; 41:873-881. [PMID: 37879089 DOI: 10.1177/10499091231210504] [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] [Indexed: 10/27/2023] Open
Abstract
Medical care received at end-of-life is often not aligned with individuals' values and care preferences. Much can get in the way of an individual communicating and documenting their preferences to care providers and close others, even if it is a goal to do so. The objective of this work was to develop a measure of Advance Care Planning Self-Efficacy (ACP SE) focused on three important behaviors: completing a living will, documenting a healthcare agent, and discussing quality versus quantity of life issues. Measure development was framed by the Transtheoretical Model (TTM) of behavior change. Following the completion of focus groups and formative qualitative work, an independent sample (N = 310, adults aged 50+) was randomly split into two halves for exploratory and confirmatory factor analyses (EFA/CFA). Multivariate analyses examined relationships between ACP SE and other TTM constructs. Results of the CFA demonstrated excellent internal consistency (α = .95) and good model fit (CFI = .89, RMSEA = .13). Self-efficacy was framed by the TTM as situation-specific confidence. Through the measure development process, it was found that confidence to do ACP was impacted by various situational and attitudinal variables. ACP Self-Efficacy was found to differ significantly by Stage of Change. This study produced a reliable and valid measure of situation-specific confidence for ACP grounded within the TTM that could enhance future interventions aimed at increasing participation in ACP.
Collapse
Affiliation(s)
- Alexandra N Murray
- Digestive Disease & Surgical Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Katie Monahan
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Allegra Sacco
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Andrea Paiva
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Collen Redding
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Mark Robbins
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| |
Collapse
|
2
|
Lui E, Gill J, Hamid M, Wen C, Singh N, Okoh P, Xu X, Boakye P, James CE, Waterman AD, Edwards B, Mucsi I. Racialized and Immigrant Status and the Pursuit of Living Donor Kidney Transplant - a Canadian Cohort Study. Kidney Int Rep 2024; 9:960-972. [PMID: 38765593 PMCID: PMC11101831 DOI: 10.1016/j.ekir.2024.01.044] [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: 03/08/2023] [Revised: 01/12/2024] [Accepted: 01/22/2024] [Indexed: 05/22/2024] Open
Abstract
Introduction Both immigrant and racialized status may be associated with the pursuit of living donor kidney transplant (LDKT). Methods This study was a secondary analysis of a convenience cross-sectional sample of patients with kidney failure in Toronto, obtained from our "Comprehensive Psychosocial Research Data System" research database. The exposures included racialized, immigrant, and combined immigrant and racialized status (White nonimmigrant, racialized nonimmigrant, White immigrant and racialized immigrant). Outcomes include the following: (i) having spoken about LDKT with others, (ii) having a potential living donor (LD) identified, (iii) having allowed others to share the need for LDKT, (iv) having directly asked a potential donor to be tested, and (v) accept a hypothetical LDKT offer. We assessed the association between exposure and outcomes using univariable, and multivariable binary or multinominal logistic regression (reference: White or White nonimmigrant participants). Results Of the 498 participants, 281 (56%) were immigrants; 142 (28%) were African, Caribbean, and Black (ACB); 123 (25%) were Asian; and 233 (47%) were White. Compared to White nonimmigrants, racialized immigrants (relative risk ratio [RRR]: 2.98; 95% confidence interval [CI]: 1.76-5.03) and racialized nonimmigrants (RRR: 2.84; 95% CI: 1.22-6.65) were more likely not to have spoken about LDKT with others (vs. having spoken or planning to do so). Both racialized immigrant (odds ratio [OR]: 4.07; 95% CI: 2.50-6.34), racialized nonimmigrants (OR: 2.68; 95% CI: 1.31-5.51) and White immigrants (OR: 2.68; 95% CI: 1.43-5.05) were more likely not to have a potential LD identified. Conclusion Both racialized and immigrant status are associated with less readiness to pursue LDKT. Supporting patients to communicate their need for LDKT may improve equitable access to LDKT.
Collapse
Affiliation(s)
- Eric Lui
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Jasleen Gill
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marzan Hamid
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Stanford University School of Medicine, Stanford, California, USA
| | - Cindy Wen
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Navneet Singh
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Princess Okoh
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Xihui Xu
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla Boakye
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Carl E. James
- Faculty of Education, York University, Toronto, Ontario, Canada
| | - Amy D. Waterman
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Beth Edwards
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Istvan Mucsi
- Ajmera Transplant Center and Division of Nephrology Department, University Health Network, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Sacco A, Robbins ML, Paiva AL, Monahan K, Lindsey H, Reyes C, Rusnock A. Measuring Motivation for COVID-19 Vaccination: An Application of the Transtheoretical Model. Am J Health Promot 2023; 37:1109-1120. [PMID: 37612233 DOI: 10.1177/08901171231197899] [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] [Indexed: 08/25/2023]
Abstract
PURPOSE In the United States (US), individuals vary widely in their readiness to get vaccinated for COVID-19. The present study developed measures based on the transtheoretical model (TTM) to better understand readiness, decisional balance (DCBL; pros and cons), self-efficacy (SE), as well as other motivators for change such as myths and barriers for COVID-19 vaccination. DESIGN Cross-sectional measurement development. SETTING Online survey. SAMPLE 528 US adults ages 18-75. MEASURES Demographics, stage of change (SOC), DCBL, SE, myths, and barriers. ANALYSIS The sample was randomly split into halves for exploratory factor analysis using principal components analysis (EFA/PCA), followed by confirmatory factor analyses (CFA) to test measurement models. Correlation matrices were assessed and multivariate analyses examined relationships between constructs and sub-constructs. RESULTS For DCBL, EFA/PCA revealed three correlated factors (one pros, two cons) (n1 = 8, α = .97; n2 = 5, α = .93; n3 = 4, α = .84). For SE, two correlated factors were revealed (n1 = 12, α = .96; n2 = 3, α = .89). Single-factor solutions for Myths (n = 13, α = .94) and Barriers (n = 6, α = .82) were revealed. CFA confirmed models from EFAs/PCAs. Follow-up analyses of variance aligned with past theoretical predictions of the relationships between SOC, pros, cons, and SE, and the predicted relationships with myths and barriers. CONCLUSION This study produced reliable and valid measures of TTM constructs, myths, and barriers to understand motivation to receive COVID-19 vaccination that can be used in future research.
Collapse
Affiliation(s)
- Allegra Sacco
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Mark L Robbins
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Andrea L Paiva
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Kathleen Monahan
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Hayley Lindsey
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Cheyenne Reyes
- Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Andrea Rusnock
- Department of History, College of Arts and Sciences, University of Rhode Island, Kingston, RI, USA
| |
Collapse
|
4
|
Older Age is Associated With Lower Utilization of Living Donor Kidney Transplant. Kidney Int Rep 2022; 8:282-293. [PMID: 36815100 PMCID: PMC9939357 DOI: 10.1016/j.ekir.2022.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 10/09/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Older adults (65 years or older) constitute a substantial and increasing proportion of patients with kidney failure, potentially needing kidney replacement therapy. Living donor kidney transplant (LDKT) offers superior outcomes for suitable patients of all ages. However, exploring LDKT and finding a living donor could be challenging for older adults. Here, we assessed the association between age and utilization of LDKT and assessed effect modification of key variables such as ethnicity and language. Methods This is a retrospective cohort study of patients with kidney failure referred for kidney transplant (KT) assessment in Toronto between January 2006 and December 2013. The association between age and having a potential living donor identified was assessed using logistic regression and the association between age and the receipt of LDKT was assessed using Cox proportional hazards models. Results Of the 1617 participants, 50% were middle-aged (45-64 years old), and 17% were ≥65 years old. In our final multivariable adjusted models, compared to young adults, middle-aged and older adults had lower odds of having a potential living donor identified (odds ratio [OR], 0.47; confidence interval [CI], [0.35-0.63]; OR, 0.30; CI, [0.20-0.43]; P < 0.001, for middle-aged and older adults, respectively), and were less likely to receive LDKT (hazard ratio [HR], 0.79; CI, [0.63-0.99]; P = 0.04; HR, 0.47; CI, [0.30-0.72]; P = 0.001, for middle-aged and older adults, respectively.). Conclusion Age is an independent predictor of receiving LDKT. Considering that nearly 90% of patients with kidney failure in Canada are >45 years of age, these results point to important and potentially modifiable age-related barriers to LDKT.
Collapse
|
5
|
Identifying Modifiable System-Level Barriers to Living Donor Kidney Transplantation. Kidney Int Rep 2022; 7:2410-2420. [DOI: 10.1016/j.ekir.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/11/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
|
6
|
Redeker S, Massey EK, van Merweland RG, Weimar W, Ismail S, Busschbach J. Induced Demand in Kidney Replacement Therapy. Health Policy 2022; 126:1062-1068. [DOI: 10.1016/j.healthpol.2022.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022]
|
7
|
Morinelli TA, Taber DJ, Su Z, Rodrigue JR, Sutton Z, Chastain M, Tindal TT, Weeda E, Mauldin PD, Casey M, Bian J, Baliga P, DuBay DA. A Dialysis Center Educational Video Intervention Increases Patient Self-Efficacy and Kidney Transplant Evaluations. Prog Transplant 2021; 32:27-34. [PMID: 34874194 DOI: 10.1177/15269248211064882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: The optimal treatment for end-stage kidney disease is renal transplant. However, only 1 in 5 (21.5%) patients nationwide receiving dialysis are on a transplant waitlist. Factors associated with patients not initiating a transplant evaluation are complex and include patient specific factors such as transplant knowledge and self-efficacy. Research Question: Can a dialysis center-based educational video intervention increase dialysis patients' transplant knowledge, self-efficacy, and transplant evaluations initiated? Design: Dialysis patients who had not yet completed a transplant evaluation were provided a transplant educational video while receiving hemodialysis. Patients' transplant knowledge, self-efficacy to initiate an evaluation, and dialysis center rates of transplant referral and evaluation were assessed before and after this intervention. Results: Of 340 patients approached at 14 centers, 252 (74%) completed the intervention. The intervention increased transplant knowledge (Likert scale 1 to 5: 2.53 [0.10] vs 4.62 [0.05], P < .001) and transplant self-efficacy (2.55 [0.10] to 4.33 [0.07], P < .001. The incidence rate per 100 patient years of transplant evaluations increased 85% (IRR 1.85 [95% CI: 1.02, 3.35], P = .0422) following the intervention. The incidence rates of referrals also increased 56% (IRR 1.56 [95% CI: 1.03, 2.37], P = .0352), while there was a nonsignificant 47% increase in incidence rates of waitlist entries (IRR 1.47 [95% CI: 0.45, 4.74], P = .5210). Conclusion: This dialysis center-based video intervention provides promising preliminary evidence to conduct a large-scale randomized controlled trial to test its effectiveness in increasing self-efficacy of dialysis patients to initiate a transplant evaluation.
Collapse
Affiliation(s)
| | - David J Taber
- Medical University of South Carolina, Charleston, SC, USA.,Ralph H. Johnson Veterans' Hospital, Charleston, SC, USA
| | - Zemin Su
- Medical University of South Carolina, Charleston, SC, USA
| | - James R Rodrigue
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Zachary Sutton
- Medical University of South Carolina, Charleston, SC, USA
| | - Misty Chastain
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Erin Weeda
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Michael Casey
- Medical University of South Carolina, Charleston, SC, USA
| | - John Bian
- Medical University of South Carolina, Charleston, SC, USA
| | | | - Derek A DuBay
- Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
8
|
Fenn N, Reyes C, Monahan K, Robbins ML. How Ready Are Young Adults to Participate in Community Service? An Application of the Transtheoretical Model of Behavior Change. Am J Health Promot 2021; 36:64-72. [PMID: 34296641 DOI: 10.1177/08901171211034742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Engaging in community service, or unpaid work intended to help people in a community, is generally associated with greater overall well-being. However, the process of beginning and maintaining community service engagement has been sparsely examined. The current study applied the Transtheoretical Model (TTM) of behavior change to understanding community service readiness among young adults. DESIGN Cross-sectional design using an online survey. SETTING Participants were undergraduate students recruited at a mid-sized Northeastern US university in Spring 2018. SAMPLE Participants (N = 314) had a mean age of 20.36 years (SD = 3.69), were primarily White (78%), female (72%), and from moderately high socioeconomic backgrounds (as measured by parental level of education). MEASURES Socio-demographics including age, gender, race-ethnicity, and parental level of education; readiness, pros, cons, and self-efficacy for community service; civic engagement behavior; well-being. ANALYSIS Participants were classified into very low (n = 62), low (n = 59), moderate (n = 92), high (n = 46), and very high (n = 55) readiness for community service groupings. A MANOVA was conducted to assess relationships between groupings and community service TTM constructs, civic engagement, and well-being. RESULTS There were significant differences between readiness groupings on all main outcome variables, F(20, 1012) = 10.34, p < .001; Wilks' Λ = 0.54, η2 = .14. Post-hoc Games-Howell tests showed that those exhibiting higher levels of readiness reported fewer cons, greater pros, higher self-efficacy, more overall civic engagement, and greater well-being compared to lower readiness individuals. CONCLUSION Consistent with previous TTM applications, self-efficacy and the importance of pros increased across readiness groupings while the importance of cons decreased. Study findings may be used to inform readiness-tailored interventional work for increasing community service. This area of study would benefit from longitudinal research examining community service readiness beyond the college environment.
Collapse
Affiliation(s)
- Natalie Fenn
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Cheyenne Reyes
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Kathleen Monahan
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Mark L Robbins
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| |
Collapse
|
9
|
Destination Transplant: Protocol for a Parallel-group Randomized Trial of an Educational Intervention to Increase Kidney Transplant Among Black People on the Transplant Waiting List. Transplant Direct 2021; 7:e683. [PMID: 33748412 PMCID: PMC7969245 DOI: 10.1097/txd.0000000000001136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/30/2020] [Accepted: 01/19/2021] [Indexed: 11/27/2022] Open
Abstract
For most patients with kidney failure, living donor kidney transplant (LDKT) is their best treatment option. Compared with White people, Black people are more likely to have kidney failure but less likely to receive LDKTs. In this study, the investigators will test an educational intervention, Destination Transplant, designed to reduce this disparity, among Black people already listed for kidney transplant.
Collapse
|
10
|
Waterman AD, Peipert JD, Cui Y, Beaumont JL, Paiva A, Lipsey AF, Anderson CS, Robbins ML. Your Path to Transplant: A randomized controlled trial of a tailored expert system intervention to increase knowledge, attitudes, and pursuit of kidney transplant. Am J Transplant 2021; 21:1186-1196. [PMID: 33245618 PMCID: PMC7882639 DOI: 10.1111/ajt.16262] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 08/03/2020] [Accepted: 08/05/2020] [Indexed: 01/25/2023]
Abstract
Individually tailoring education over time may help more patients, especially racial/ethnic minorities, get waitlisted and pursue deceased and living donor kidney transplant (DDKT and LDKT, respectively). We enrolled 802 patients pursuing transplant evaluation at the University of California, Los Angeles Transplant Program into a randomized education trial. We compared the effectiveness of Your Path to Transplant (YPT), an individually tailored coaching and education program delivered at 4 time points, with standard of care (SOC) education on improving readiness to pursue DDKT and LDKT, transplant knowledge, taking 15 small transplant-related actions, and pursuing transplant (waitlisting or LDKT rates) over 8 months. Survey outcomes were collected prior to evaluation and at 4 and 8 months. Time to waitlisting or LDKT was assessed with at least 18 months of follow-up. At 8 months, compared to SOC, the YPT group demonstrated increased LDKT readiness (47% vs 33%, P = .003) and transplant knowledge (effect size [ES] = 0.41, P < .001). Transplant pursuit was higher in the YPT group (hazard ratio: 1.44, 95% confidence interval: 1.15-1.79, P = .002). A focused, coordinated education effort can improve transplant-seeking behaviors and waitlisting rates. ClinicalTrials.gov registration: NCT02181114.
Collapse
Affiliation(s)
- Amy D. Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California,Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | - John D. Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University,Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL
| | - Yujie Cui
- Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | | | - Andrea Paiva
- Department of Psychology, The University of Rhode Island, Kingston, RI
| | - Amanda F. Lipsey
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California,Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | - Crystal S. Anderson
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Mark L. Robbins
- Department of Psychology, The University of Rhode Island, Kingston, RI
| |
Collapse
|
11
|
Waterman AD, Wood EH, Ranasinghe ON, Faye Lipsey A, Anderson C, Balliet W, Holland-Carter L, Maurer S, Aurora Posadas Salas M. A Digital Library for Increasing Awareness About Living Donor Kidney Transplants: Formative Study. JMIR Form Res 2020; 4:e17441. [PMID: 32480362 PMCID: PMC7404010 DOI: 10.2196/17441] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/08/2020] [Accepted: 05/14/2020] [Indexed: 12/15/2022] Open
Abstract
Background It is not common for people to come across a living kidney donor, let alone consider whether they would ever donate a kidney themselves while they are alive. Narrative storytelling, the sharing of first-person narratives based on lived experience, may be an important way to improve education about living donor kidney transplants (LDKTs). Developing ways to easily standardize and disseminate diverse living donor stories using digital technology could inspire more people to consider becoming living donors and reduce the kidney shortage nationally. Objective This paper aimed to describe the development of the Living Donation Storytelling Project, a web-based digital library of living donation narratives from multiple audiences using video capture technology. Specifically, we aimed to describe the theoretical foundation and development of the library, a protocol to capture diverse storytellers, the characteristics and experiences of participating storytellers, and the frequency with which any ethical concerns about the content being shared emerged. Methods This study invited kidney transplant recipients who had received LDKTs, living donors, family members, and patients seeking LDKTs to record personal stories using video capture technology by answering a series of guided prompts on their computer or smartphone and answering questions about their filming experience. The digital software automatically spliced responses to open-ended prompts, creating a seamless story available for uploading to a web-based library and posting to social media. Each story was reviewed by a transplant professional for the disclosure of protected health information (PHI), pressuring others to donate, and medical inaccuracies. Disclosures were edited. Results This study recruited diverse storytellers through social media, support groups, churches, and transplant programs. Of the 137 storytellers who completed the postsurvey, 105/137 (76.6%) were white and 99/137 (72.2%) were female. They spent 62.5 min, on average, recording their story, with a final median story length of 10 min (00:46 seconds to 32:16 min). A total of 94.8% (130/137) of storytellers were motivated by a desire to educate the public; 78.1% (107/137) were motivated to help more people become living donors; and 75.9% (104/137) were motivated to dispel myths. The ease of using the technology and telling their story varied, with the fear of being on film, emotional difficulty talking about their experiences, and some technological barriers being reported. PHI, most commonly surnames and transplant center names, was present in 62.9% (85/135) of stories and was edited out. Conclusions With appropriate sensitivity to ensure diverse recruitment, ethical review of content, and support for storytellers, web-based storytelling platforms may be a cost-effective and convenient way to further engage patients and increase the curiosity of the public in learning more about the possibility of becoming living donors.
Collapse
Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Terasaki Research Institute, Los Angeles, CA, United States
| | - Emily H Wood
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Omesh N Ranasinghe
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Crystal Anderson
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Wendy Balliet
- Medical University of South Carolina, Charleston, SC, United States
| | | | - Stacey Maurer
- Medical University of South Carolina, Charleston, SC, United States
| | | |
Collapse
|
12
|
Use of Telehealth to Expand Living Kidney Donation and Living Kidney Donor Transplantation. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00276-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
13
|
Waterman AD, Peipert JD, McSorley AM, Goalby CJ, Beaumont JL, Peace L. Direct Delivery of Kidney Transplant Education to Black and Low-Income Patients Receiving Dialysis: A Randomized Controlled Trial. Am J Kidney Dis 2019; 74:640-649. [PMID: 31227225 PMCID: PMC6815244 DOI: 10.1053/j.ajkd.2019.03.430] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 03/29/2019] [Indexed: 12/22/2022]
Abstract
RATIONALE & OBJECTIVE Compared with others, black and low-income patients receiving dialysis are less likely to receive kidney transplantation (KT) education within dialysis centers. We examined the efficacy of 2 supplementary KT education approaches delivered directly to patients. STUDY DESIGN Prospective, 3-arm parallel-group, randomized, controlled trial. SETTINGS & PARTICIPANTS Adult, black, and white low-income patients receiving dialysis in Missouri. INTERVENTION Patients were randomly assigned to 1 of 3 educational conditions: (1) standard of care, usual KT education provided in dialysis centers (control); (2) Explore Transplant @ Home patient-guided, 4 modules of KT education sent directly to patients using print, video, and text messages; and (3) Explore Transplant @ Home educator-guided, the patient-guided intervention plus 4 telephonic discussions with an educator. OUTCOMES Primary: patient knowledge of living (LDKT) and deceased donor KT (DDKT). Secondary: informed decision making, change in attitudes in favor of LDKT and DDKT, and change in the number of new steps taken toward KT. RESULTS In intent-to-treat analyses, patients randomly assigned to educator- and patient-guided interventions had greater knowledge gains (1.4 point increase) than control patients (0.8 point increase; P=0.02 and P=0.01, respectively). Compared with control patients, more patients randomly assigned to educator- and patient-guided interventions were able to make informed decisions about starting KT evaluation (82% vs 91% and 95%; P=0.003), pursuing DDKT (70% vs 84% and 84%; P=0.003), and pursuing LDKT (73% vs 91% and 92%; P<0.001). LIMITATIONS Potential contamination because of patient-level randomization; no assessment of clinical end points. CONCLUSIONS Education presented directly to dialysis patients, with or without coaching by telephone, increased dialysis patients' KT knowledge and informed decision making without increasing educational burden on providers. FUNDING SOURCE This project was funded by the National Institutes of Health and Health Resources and Services Administration. TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT02268682.
Collapse
Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles; Terasaki Research Institute, Los Angeles, CA.
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University; Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL
| | - Anna-Michelle McSorley
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles
| | - Christina J Goalby
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles
| | | | - Leanne Peace
- Missouri Kidney Program, University of Missouri, Columbia, MO
| |
Collapse
|
14
|
Vedadi A, Bansal A, Yung P, Famure O, Mitchell M, Waterman AD, Singh SK, Novak M, Kim SJ, Mucsi I. Ethnic background is associated with no live kidney donor identified at the time of first transplant assessment-an opportunity missed? A single-center retrospective cohort study. Transpl Int 2019; 32:1030-1043. [PMID: 31250484 DOI: 10.1111/tri.13476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 04/29/2019] [Accepted: 06/24/2019] [Indexed: 12/31/2022]
Abstract
Patients from ethnocultural minorities have reduced access to live donor kidney transplant (LDKT). To explore early pretransplant ethnocultural disparities in LDKT readiness, and the impact of the interactions with the transplant program, we assessed if patients had a potential live donor (LD) identified at first pretransplant assessment, and if patients with no LD initially received LDKT subsequently. Single-center, retrospective cohort of adults referred for kidney transplant (KT) assessment. Multivariable logistic regression assessed the association between ethnicity and having a potential LD. Cox proportional hazard analysis assessed the association between no potential LD initially and subsequent LDKT. Of 1617 participants, 66% of Caucasians indicated having a potential LD, compared with 55% of South Asians, 44% of African Canadians, and 41% of East Asians (P < 0.001). In multivariable logistic regression analysis, the odds of having a potential LD identified was significantly lower for African, East and South Asian Canadians. No potential LD at initial KT assessment was associated with lower likelihood of LDKT subsequently (hazard ratio [HR], 0.14; [0.10-0.19]). Compared to Caucasians, African, East and South Asian and African Canadians are less likely to have a potential LD identified at first KT assessment, which predicts a lower likelihood of subsequent LDKT.
Collapse
Affiliation(s)
- Ali Vedadi
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Aarushi Bansal
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Priscilla Yung
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Olusegun Famure
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Margot Mitchell
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Sunita K Singh
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sang Joseph Kim
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Istvan Mucsi
- Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Cabacungan A, Diamantidis C, St. Clair Russell J, Strigo T, Pounds I, Alkon A, Riley J, Falkovic M, Pendergast J, Davenport C, Ellis M, Sudan D, Hill-Briggs F, Browne T, Ephraim P, Boulware L. Development of a Telehealth Intervention to Improve Access to Live Donor Kidney Transplantation. Transplant Proc 2019; 51:665-675. [DOI: 10.1016/j.transproceed.2018.12.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 12/05/2018] [Indexed: 01/07/2023]
|
16
|
Waterman AD, Anderson C, Alem A, Peipert JD, Beaumont JL, Henry SL, Dub B, Ambriz L, Bijjala N, Lipsey AF, Mittman B. A randomized controlled trial of Explore Transplant at Home to improve transplant knowledge and decision-making for CKD 3-5 patients at Kaiser Permanente Southern California. BMC Nephrol 2019; 20:78. [PMID: 30832619 PMCID: PMC6399838 DOI: 10.1186/s12882-019-1262-9] [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] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/20/2019] [Indexed: 01/31/2023] Open
Abstract
Background Five-year survival on dialysis is only 40%, compared to 74% with a deceased donor kidney transplant (DDKT) and 87% with a living donor kidney transplant (LDKT). An American Society of Transplantation (AST) Consensus Conference recommended that patients with chronic kidney disease (CKD) Stages 3–5 have the opportunity to learn about and decide which treatment option is right for them, particularly about LDKT. However, early education about LDKT and DDKT outside of transplant centers is inconsistent and often poor, with patients in CKD 3 and 4 and ethnic/racial minorities even less likely to receive it. A new randomized control trial (RCT), in partnership with Kaiser Permanente Southern California (KPSC), will assess knowledge gaps and the effectiveness of a supplementary video-guided, print and technology-based education intervention for English- and Spanish-speaking patients in CKD Stages 3, 4, and 5 to increase LDKT knowledge and decision-making. To date, no published LDKT educational interventions have studied such a large and diverse CKD population. Methods In this RCT, 1200 English and Spanish-speaking CKD Stage 3–5 patients will be randomly assigned to one of two education conditions: ET@Home or KPSC standard of care education. Randomization will be stratified by CKD stage and primary language spoken. Those in the ET@Home condition will receive brochures, postcards, DVDs, and text messages delivering educational content in modules over a six-month period. Baseline data collection will measure demographics, transplant derailers, and the amount of previous CKD and transplant education they have received. Changes in CKD and transplant knowledge, ability to make an informed decision about transplant, and self-efficacy to pursue LDKT will be captured with surveys administered at baseline and at six months. Discussion At the conclusion of the study, investigators will understand key knowledge gaps for patients along the CKD continuum and between patients who speak different languages and have assessed the effectiveness of both English- and Spanish-language supplementary education in increasing KPSC patients’ knowledge about the opportunities for and risks and benefits of LDKT. We hope this program will reduce disparities in access to transplant. Trial Registration ClinicalTrials.gov Identifier: NCT03389932; date registered: 12/26/2017.
Collapse
Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA. .,Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA.
| | - Crystal Anderson
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Angelika Alem
- Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - John D Peipert
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Jennifer L Beaumont
- Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Shayna L Henry
- Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - Bhanuja Dub
- Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
| | - Lizeth Ambriz
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Neha Bijjala
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.,Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Amanda Faye Lipsey
- Terasaki Research Institute, Terasaki Research Institute, 1018 Westwood Blvd, Los Angeles, CA, 90024, USA
| | - Brian Mittman
- Kaiser Permanente Southern California, 100 S Los Robles Ave, Pasadena, CA, 91101, USA
| |
Collapse
|
17
|
Sandal S, Charlebois K, Fiore JF, Wright DK, Fortin MC, Feldman LS, Alam A, Weber C. Health Professional-Identified Barriers to Living Donor Kidney Transplantation: A Qualitative Study. Can J Kidney Health Dis 2019; 6:2054358119828389. [PMID: 30792874 PMCID: PMC6376531 DOI: 10.1177/2054358119828389] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Living donor kidney transplantation (LDKT) has several advantages over deceased donor kidney transplantation. Yet rates of living donation are declining in Canada and there exists significant interprovincial variability. Efforts to improve living donation tend to focus on the patient and barriers identified at their level, such as not knowing how to ask for a kidney or lack of education. These efforts favor those who have the means and the support to find living donors. Thus, a Canadian Institutes of Health Research (CIHR)-organized workshop recommended that education efforts to understand and remove barriers should focus on health professionals (HPs). Despite this, little attention has been paid to what they identify as barriers to discussing LDKT with their patients. OBJECTIVE Our aim was to explore HP-identified barriers to discuss living donation with patients in 3 provinces of Canada with low (Quebec), moderate (Ontario), and high (British Columbia) rates of LDKT. DESIGN This study consists of an interpretive descriptive approach as it enables to move beyond description and inform clinical practice. SETTING Purposive criterion and quota sampling were used to recruit HPs from Quebec, Ontario, and British Columbia who are involved in the care of patients with kidney disease and/or with transplant coordination. PATIENTS Not applicable. MEASUREMENTS Semistructured interviews were conducted. The interview guide was developed based on a preliminary analytical framework and a review of the literature. METHODS Thematic analysis was used to analyze the data stemming from the interviews. The coding process comprised of a deductive and inductive approach, and the use of a qualitative analysis software (NVivo 11). Following this, themes were identified and developed. Interviews were conducted until thematic saturation was obtained. In total, we conducted 16 telephone interviews as thematic saturation was attained. RESULTS Six predominant themes emerged: (1) lack of communication between transplant and dialysis teams, (2) absence of referral guidelines, (3) role perception and lack of multidisciplinary involvement, (4) HP's lack of information and training, (5) negative attitudes of some HP toward LDKT, (6) patient-level barriers as defined by the HP. HPs did mention patients' attitudes and some characteristics as the main barriers to discussions about living donation; this was noted in all provinces. HPs from Ontario and British Columbia indicated multiple strategies being implemented to address some of these barriers. Those from Ontario mentioned strategies that center on the core principles of provincial-level standardization, while those from British Columbia center on engaging the entire multidisciplinary team and improved role perception. We noted a dearth of such efforts in Quebec; however, efforts around education and promotion, while tentative, have emerged. LIMITATIONS Social desirability and selection bias. Our analysis might not be applicable to other provinces. CONCLUSIONS HPs involved with the referral and coordination of transplantation play a major role in access to LDKT. We have identified challenges they face when discussing living donation with their patients that warrant further assessment and research to inform policy change.
Collapse
Affiliation(s)
- Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Julio F. Fiore
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - David Kenneth Wright
- St. Mary’s Research Center, Montreal, QC, Canada
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Chantal Fortin
- Division of Nephrology, Department of Medicine, Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
- Centre de recherche du Centre hospitalier de l’Université de Montréal, Montreal, QC, Canada
| | - Liane S. Feldman
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Ahsan Alam
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Catherine Weber
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| |
Collapse
|
18
|
Mucsi I, Novak M, Toews D, Waterman A. Explore Transplant Ontario: Adapting the Explore Transplant Education Program to Facilitate Informed Decision Making About Kidney Transplantation. Can J Kidney Health Dis 2018; 5:2054358118789369. [PMID: 30057772 PMCID: PMC6058418 DOI: 10.1177/2054358118789369] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Accepted: 04/05/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose: In this article, we describe a province-wide collaborative project in which we adapted the Explore Transplant (ET) education program for use in Ontario, Canada, to develop Explore Transplant Ontario (ETO). Kidney transplantation (KT), especially living donor kidney transplantation (LDKT), is the best treatment for many patients with end-stage kidney disease (ESKD), with the best patient survival and quality of life and also reduced health care costs. Yet KT and LDKT are underutilized both internationally and in Canada. Research has demonstrated that patients with ESKD who receive personalized transplant education are more likely to complete the transplant evaluation process and to receive LDKT compared with patients who do not receive this education. Sources of information: Research expertise of the lead authors and Medline search of studies assessing the impact of education interventions on access to KT and LDKT. Methods: The ET program, developed by Dr Amy Waterman, has been used in thousands of patients with ESKD in the United States to enhance KT and LDKT knowledge. To adapt this program for use in Ontario, we convened a working group, including patient representatives, nephrologists, transplant coordinators, dialysis nurses, and patient educators from all Ontario KT centers and selected dialysis units. In an iterative process concluding in a consensus workshop, the working group reviewed and edited the text of the original ET program and suggested changes to the videos. Key findings: The adapted program reflects the Ontario health care environment and responds to the specific needs of patients with chronic kidney disease (CKD) in the province. The videos feature Ontario transplant nephrologists, transplant coordinators, and patients, representative of the ethnic diversity in Ontario, sharing their transplant experience and expertise. Despite the changes, ETO is consistent with the quality and style of the original ET program. At the end of this article, we summarize subsequent steps to test and utilize ETO. Those projects, specifically the ETO pilot study and a multicomponent quality improvement initiative to increase utilization of KT and LDKT across Ontario, will be described in full in future papers. Limitations: This article describes a provincial initiative; therefore, our findings may not be fully generalizable without further considerations. The adapted education program has not yet been tested in large trial for effectiveness. Implications: As a program grounded in the theoretical model of behavior change, ETO places patients with ESKD at the center of a complex process of navigating renal replacement therapy modalities and acknowledges a broad range of patient values, priorities, and states of readiness to pursue KT.
Collapse
Affiliation(s)
- Istvan Mucsi
- Division of Nephrology, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network and University of Toronto, ON, Canada
| | - Marta Novak
- Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, ON, Canada
| | - Deanna Toews
- Division of Nephrology, Multi-Organ Transplant Program, Toronto General Hospital, University Health Network and University of Toronto, ON, Canada
| | - Amy Waterman
- Division of Nephrology, University of California, Los Angeles, CA, USA.,Terasaki Research Institute, Los Angeles, CA, USA
| |
Collapse
|
19
|
Waterman AD, Peipert JD. An Explore Transplant Group Randomized Controlled Education Trial to Increase Dialysis Patients' Decision-Making and Pursuit of Transplantation. Prog Transplant 2018; 28:174-183. [PMID: 29699451 DOI: 10.1177/1526924818765815] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Dialysis centers must provide transplant education to patients but often do not address the risks and benefits of living and deceased donor transplant. RESEARCH QUESTIONS In a group randomized controlled trial of 20 dialysis centers and 253 patients, we assessed whether the Explore Transplant education program increased patients' readiness to pursue transplant, transplant knowledge, informed transplant decision-making, discussions about transplant with potential living donors, pursuit and receipt of living or deceased donor transplant, and whether these effects varied by race. METHODS Patients at participating dialysis centers were randomized to receive either (1) a 4-module Explore Transplant education program, including videos, printed materials, and transplant educator discussions or (2) standard-of-care transplant education provided by dialysis centers. The trial had 3 phases: (1) pre- and postsurveying and dialysis center education (2007-2008), (2) follow-up to determine whether patients restarted or began transplant evaluation (2008-2010), and (3) assessment of participants' receipt of a renal transplant (2012-2015). RESULTS Compared to patients in standard-of-care dialysis centers, patients who received the intervention were more likely to increase in their stage of readiness for living donor transplantation (odds ratio: 2.50; 95% confidence interval: 1.10-5.66), had greater increases in their transplant knowledge ( P < .001), and were more likely to call to restart/begin transplant evaluation (38% vs 24%, P = .006). When analyses were stratified by race, black patients were more likely to take several steps toward transplant in comparison to whites. DISCUSSION The Explore Transplant helps dialysis patients make informed decisions and increases their pursuit of transplant, particularly among black patients.
Collapse
Affiliation(s)
- Amy D Waterman
- 1 Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,2 Terasaki Research Institute, Los Angeles, CA, USA
| | - John Devin Peipert
- 1 Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.,2 Terasaki Research Institute, Los Angeles, CA, USA
| |
Collapse
|
20
|
Flemming SSC, Redmond N, Williamson DHZ, Thompson NJ, Perryman JP, Patzer RE, Arriola KJ. Understanding the pros and cons of organ donation decision-making: Decisional balance and expressing donation intentions among African Americans. J Health Psychol 2018; 25:1612-1623. [DOI: 10.1177/1359105318766212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Increasing public commitment to organ donation is critical to improving donor kidney availability for end-stage renal disease patients desiring transplant. This study surveyed ( N = 1339) African Americans, measuring perceived pros relative to cons of organ donation, to evaluate an existing Transtheoretical Model decisional balance scale and associations between decisional balance and expressing donation intentions. Findings supported the existing scale structure. More positive decisional balance ratios were associated with 1.76 times the odds of expressing intentions (95% confidence interval = 1.52–2.04). Pros were more strongly linked to donation intentions than cons. Greater understanding of organ donation decision-making is valuable for informing interventions that encourage donation.
Collapse
Affiliation(s)
| | | | | | | | | | - Rachel E Patzer
- Emory University, USA
- Emory University School of Medicine, USA
| | | |
Collapse
|
21
|
Weng FL, Peipert JD, Holland BK, Brown DR, Waterman AD. A Clustered Randomized Trial of an Educational Intervention During Transplant Evaluation to Increase Knowledge of Living Donor Kidney Transplant. Prog Transplant 2017; 27:377-385. [PMID: 29187135 DOI: 10.1177/1526924817732021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Maximizing education about living donor kidney transplant (LDKT) during the in-person evaluation at the transplant center may increase the numbers of kidney patients pursuing LDKT. Research Questions and Design: To test the effectiveness of a 1-time LDKT educational intervention, we performed a cluster-randomized trial among 499 patients who presented for evaluation of kidney transplant. We compared usual care education (n = 250) versus intensive LDKT education (n = 249), which was implemented only on the evaluation day and consisted of viewing a 25-minute video of information and stories about LDKT and discussion of LDKT possibilities with an educator. Our primary outcome was knowledge of LDKT, 1 week after the transplant evaluation. RESULTS One week after evaluation, patients who received intensive education had higher knowledge than patients who received usual care (12.7 vs. 11.7; P = .0008), but there were no differences in postevaluation readiness for LDKT. Among patients who had not previously identified a potential living donor, receiving intensive education was associated with increased willingness to take steps toward LDKT. DISCUSSION In conclusion, expansion of LDKT education within the evaluation day may be helpful, but interventions that are implemented at multiple times and for greater duration may be necessary to ensure larger and long-term behavioral changes in pursuit of LDKT.
Collapse
Affiliation(s)
- Francis L Weng
- 1 Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA.,2 Rutgers School of Public Health, Piscataway, NJ, USA
| | - John D Peipert
- 3 Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Diane R Brown
- 2 Rutgers School of Public Health, Piscataway, NJ, USA
| | - Amy D Waterman
- 3 Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| |
Collapse
|
22
|
Pisanti R, Lombardo C, Luszczynska A, Poli L, Bennardi L, Giordanengo L, Berloco PB, Violani C. Appraisal of transplant-related stressors, coping strategies, and psychosocial adjustment following kidney transplantation. Stress Health 2017; 33:437-447. [PMID: 27862894 DOI: 10.1002/smi.2727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 09/06/2016] [Accepted: 09/30/2016] [Indexed: 12/28/2022]
Abstract
This study examined the relations between appraisal of transplant-related stressors, coping, and adjustment dimensions following kidney transplantation (KT). Two models were tested: (1) the main effects model proposing that stress appraisal and coping strategies are directly associated with adjustment dimensions; and (2) the moderating model of stress proposing that each coping strategy interacts with stress appraisal. Importantly, there is a lack of research examining the two models simultaneously among recipients of solid organ transplantation. A total of 174 KT recipients completed the questionnaires. Predictors of post-transplant adjustment included appraisal of transplant-related stressors and coping strategies (task-, emotion-, and avoidance-focused). Adjustment dimensions were psychological distress, worries about the transplant, feelings of guilt, fear of disclosure of transplant, adherence, and responsibility for the functioning of the new organ. The main and moderating effects were tested with regression analyses. Appraisal of transplant-related stressors and emotion-oriented coping were related to all adjustment dimensions, except of adherence and responsibility. Task-oriented coping was positively related to responsibility. Avoidance-oriented coping was negatively correlated with adherence. Only 1 out of 18 hypothesized interactive terms was significant, yielding a synergistic interaction between appraisal of transplant-related stressors and emotion-oriented coping on the sense of guilt. The findings have the potential to inform interventions promoting psychosocial adjustment among KT recipients.
Collapse
Affiliation(s)
- Renato Pisanti
- Faculty of Psychology, University Niccolò Cusano, Rome, Italy
| | | | - Aleksandra Luszczynska
- SWPS University of Social Sciences and Humanities, Warsaw, Poland.,Trauma, Health, & Hazards Center, University of Colorado, Colorado, USA
| | - Luca Poli
- Sapienza University of Rome, Organ Transplant Unit Paride Stefanini, Rome, Italy
| | | | | | | | | |
Collapse
|
23
|
Traino HM, West SM, Nonterah CW, Russell J, Yuen E. Communicating About Choices in Transplantation (COACH). Prog Transplant 2016; 27:31-38. [DOI: 10.1177/1526924816679844] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction: Previous research highlights the difficulties patients with end-stage renal disease awaiting kidney transplant experience while attempting to manage both the logistical and the content-related aspects of discussions about transplantation. This article presents pilot results of the behavioral communication intervention program, Communicating about Choices in Transplantation (COACH), designed to improve transplant candidates’ communication about transplantation. Research Questions: As compared to matched controls, increases in knowledge of deceased and living donor transplantation, communication self-efficacy, intentions to hold conversations about transplantation, and self-reported discussion were expected for pilot participants from pre- and postassessment; decreases in conversational difficulties were also posited. Design: Using a nonrandomized quasi-experimental design, we compared transplant knowledge and communication between patients completing a 2-hour COACH session (pilot sample) to a sample of matched controls (n = 10). Data were collected via semi-structured telephone interviews upon enrollment and 1 month after enrollment or attendance at a COACH program session. Results: The results revealed significant differences in knowledge from pre- to postassessment between the pilot and control samples ( P = .02). Although no other statistically significant between-group differences were found, paired-sample t tests revealed significant pre–post increases in transplant knowledge (7.6 [standard deviation, SD = 2.0] to 9.5 [SD =1.8]; P = .05) and communication self-efficacy (1255.8 [SD = 239.7] to 1513.8 [SD = 114.3]; P = .009) for pilot participants. Decreases in perceived conversational difficulties were also observed ( P = .53). Discussion: Results provide preliminary support for the program’s impact. Moreover, participant evaluations of the COACH were overwhelmingly positive. A more definitive program evaluation with a larger, more diverse sample is currently underway.
Collapse
Affiliation(s)
- Heather M. Traino
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Stacy M. West
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Camilla W. Nonterah
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Jennifer Russell
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, USA
| | - Eva Yuen
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| |
Collapse
|
24
|
Waterman AD, Robbins ML, Peipert JD. Educating Prospective Kidney Transplant Recipients and Living Donors about Living Donation: Practical and Theoretical Recommendations for Increasing Living Donation Rates. CURRENT TRANSPLANTATION REPORTS 2016; 3:1-9. [PMID: 27347475 PMCID: PMC4918088 DOI: 10.1007/s40472-016-0090-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A promising strategy for increasing living donor kidney transplant (LDKT) rates is improving education about living donation for both prospective kidney transplant recipients and living donors to help overcome the proven knowledge, psychological, and socioeconomic barriers to LDKT. A recent Consensus Conference on Best Practices in Live Kidney Donation recommended that comprehensive LDKT education be made available to patients at all stages of chronic kidney disease (CKD). However, in considering how to implement this recommendation across different healthcare learning environments, the current lack of available guidance regarding how to design, deliver, and measure the efficacy of LDKT education programs is notable. In the current article, we provide an overview of how one behavior change theory, the Transtheoretical Model of Behavior Change, can guide the delivery of LDKT education for patients at various stages of CKD and readiness for LDKT. We also discuss the importance of creating educational programs for both potential kidney transplant recipients and living donors, and identify key priorities for educational research to reduce racial disparities in LDKT and increase LDKT rates.
Collapse
Affiliation(s)
- Amy D. Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA 90024, USA
| | | | - John D. Peipert
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA 90024, USA
| |
Collapse
|
25
|
Waterman AD, McSorley AMM, Peipert JD, Goalby CJ, Peace LJ, Lutz PA, Thein JL. Explore Transplant at Home: a randomized control trial of an educational intervention to increase transplant knowledge for Black and White socioeconomically disadvantaged dialysis patients. BMC Nephrol 2015; 16:150. [PMID: 26316264 PMCID: PMC4552175 DOI: 10.1186/s12882-015-0143-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/07/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Compared to others, dialysis patients who are socioeconomically disadvantaged or Black are less likely to receive education about deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT) before they reach transplant centers, often due to limited availability of transplant education within dialysis centers. Since these patients are often less knowledgeable or ready to pursue transplant, educational content must be simplified, made culturally sensitive, and presented gradually across multiple sessions to increase learning and honor where they are in their decision-making about transplant. The Explore Transplant at Home (ETH) program was developed to help patients learn more about DDKT and LDKT at home, with and without telephone conversations with an educator. METHODS AND STUDY DESIGN In this randomized controlled trial (RCT), 540 low-income Black and White dialysis patients with household incomes at or below 250 % of the federal poverty line, some of whom receive financial assistance from the Missouri Kidney Program, will be randomly assigned to one of three education conditions: (1) standard-of-care transplant education provided by the dialysis center, (2) patient-guided ETH (ETH-PG), and (3) health educator-guided ETH (ETH-EG). Patients in the standard-of-care condition will only receive education provided in their dialysis centers. Those in the two ETH conditions will receive four video and print modules delivered over an 8 month period by mail, with the option of receiving supplementary text messages weekly. In addition, patients in the ETH-EG condition will participate in multiple telephonic educational sessions with a health educator. Changes in transplant knowledge, decisional balance, self-efficacy, and informed decision making will be captured with surveys administered before and after the ETH education. DISCUSSION At the conclusion of this RCT, we will have determined whether an education program administered to socioeconomically disadvantaged dialysis patients, over several months directly in their homes, can help more individuals learn about the options of DDKT and LDKT. We also will be able to examine the efficacy of different educational delivery approaches to further understand whether the addition of a telephone educator is necessary for increasing transplant knowledge. TRIAL REGISTRATION ClinicalTrials.gov, NCT02268682.
Collapse
Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Anna-Michelle M McSorley
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
| | - John D Peipert
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Christina J Goalby
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Leanne J Peace
- Missouri Kidney Program, University of Missouri, Columbia, AP Green Building, Suite 111, 201 Business Loop-70 W, Columbia, MO, 65211, USA.
| | - Patricia A Lutz
- Missouri Kidney Program, University of Missouri, Columbia, AP Green Building, Suite 111, 201 Business Loop-70 W, Columbia, MO, 65211, USA.
| | - Jessica L Thein
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| |
Collapse
|
26
|
Brick LA, Sorensen D, Robbins ML, Paiva AL, Peipert JD, Waterman AD. Invariance of measures to understand decision-making for pursuing living donor kidney transplant. J Health Psychol 2015; 21:2912-2922. [PMID: 26113527 DOI: 10.1177/1359105315589390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Living donor kidney transplant is the ideal treatment option for end-stage renal disease; however, the decision to pursue living donor kidney transplant is complex and challenging. Measurement invariance of living donor kidney transplant Decisional Balance and Self-Efficacy across gender (male/female), race (Black/White), and education level (no college/college or higher) were examined using a sequential approach. Full strict invariance was found for Decisional Balance and Self-Efficacy for gender and partial strict invariance was found for Decisional Balance and Self-Efficacy across race and education level. This information will inform tailored feedback based on these constructs in future intervention studies targeting behavior change among specific demographic subgroups.
Collapse
|
27
|
Rudow DL, Hays R, Baliga P, Cohen DJ, Cooper M, Danovitch GM, Dew MA, Gordon EJ, Mandelbrot DA, McGuire S, Milton J, Moore DR, Morgieivich M, Schold JD, Segev DL, Serur D, Steiner RW, Tan JC, Waterman AD, Zavala EY, Rodrigue JR. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant 2015; 15:914-22. [PMID: 25648884 PMCID: PMC4516059 DOI: 10.1111/ajt.13173] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/07/2014] [Accepted: 12/21/2014] [Indexed: 01/25/2023]
Abstract
Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation.
Collapse
Affiliation(s)
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - David J. Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | | | - Gabriel M. Danovitch
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Elisa J. Gordon
- Comprehensive Transplant Center and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Suzanne McGuire
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Jennifer Milton
- Transplant Center, University of Texas at San Antonio, San Antonio, TX
| | - Deonna R. Moore
- Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - Marie Morgieivich
- The Living Donor Institute, Barnabas Health Transplant Division, Livingston, NJ
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Serur
- Department of Medicine, Cornell University, New York, NY
| | - Robert W. Steiner
- Department of Medicine, University of California at San Diego, San Diego, CA
| | - Jane C. Tan
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Amy D. Waterman
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Edward Y. Zavala
- Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - James R. Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| |
Collapse
|
28
|
Waterman AD, Robbins ML, Paiva AL, Peipert JD, Kynard-Amerson CS, Goalby CJ, Davis LA, Thein JL, Schenk EA, Baldwin KA, Skelton SL, Amoyal NR, Brick LA. Your Path to Transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant. BMC Nephrol 2014; 15:166. [PMID: 25315644 PMCID: PMC4213461 DOI: 10.1186/1471-2369-15-166] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients' knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention. METHODS/DESIGN Nine hundred Black, Hispanic, and White ESRD patients presenting for transplant evaluation at University of California, Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) will be randomly assigned to one of two education conditions, YPT or Usual Care Control Education (UC). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored telephonic coaching sessions, feedback reports, video and print transplant education resources, and assistance with reducing any known socioeconomic barriers to LDKT. Patients receiving UC will only receive transplant education provided by UCLA-KPTP. Changes in transplant knowledge, readiness, pros and cons, and self-efficacy to pursue LDKT will be assessed prior to presenting at the transplant center (baseline), during transplant evaluation, and 4- and 8-months post-baseline, while completion of transplant evaluation and receipt of LDKTs will be assessed at 18-months post-baseline. The RCT will determine, compared to UC, whether Black, Hispanic, and White patients receiving YPT increase in their readiness to pursue LDKT and transplant knowledge, and become more likely to complete transplant medical evaluation and pursue LDKT. It will also examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with YPT to affect patients' transplant decision-making and behavior. Statistical analyses will be performed under an intent-to-treat approach. DISCUSSION At the conclusion of the study, we will have assessed the effectiveness of an innovative and cost-effective YPT intervention that could be utilized to tailor LDKT discussion and education based on the needs of individual patients of different races in many healthcare settings. TRIAL REGISTRATION ClinicalTrials.gov, number NCT02181114.
Collapse
Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine at the University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA 90024, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Waterman AD, Peipert JD, Hyland SS, McCabe MS, Schenk EA, Liu J. Modifiable patient characteristics and racial disparities in evaluation completion and living donor transplant. Clin J Am Soc Nephrol 2013; 8:995-1002. [PMID: 23520044 DOI: 10.2215/cjn.08880812] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES To reduce racial disparities in transplant, modifiable patient characteristics associated with completion of transplant evaluation and receipt of living donor kidney transplant must be identified. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS From 2004 to 2007, 695 black and white patients were surveyed about 15 less-modifiable and 10 more-modifiable characteristics at evaluation onset; whether they had completed evaluation within 1 year and received living donor kidney transplants by 2010 was determined. Logistic regression and competing risks time-to-event analysis were conducted to determine the variables that predicted evaluation completion and living donor kidney transplant receipt. RESULTS Not adjusting for covariates, blacks were less likely than whites to complete evaluation (26.2% versus 51.8%, P<0.001) and receive living donor kidney transplants (8.7% versus 21.9%, P<0.001). More-modifiable variables associated with completing evaluation included more willing to be on the waiting list (odds ratio=3.4, 95% confidence interval=2.1, 5.7), more willing to pursue living donor kidney transplant (odds ratio=2.7, 95% confidence interval=1.8, 4.0), having access to more transplant education resources (odds ratio=2.2, 95% confidence interval=1.5, 3.2), and having greater transplant knowledge (odds ratio=1.8, 95% confidence interval=1.2, 2.7). Patients who started evaluation more willing to pursue living donor kidney transplant (hazard ratio=4.3, 95% confidence interval=2.7, 6.8) and having greater transplant knowledge (hazard ratio=1.2, 95% confidence interval=1.1, 1.3) were more likely to receive living donor kidney transplants. CONCLUSIONS Because patients who began transplant evaluation with greater transplant knowledge and motivation were ultimately more successful at receiving transplants years later, behavioral and educational interventions may be very successful strategies to reduce or overcome racial disparities in transplant.
Collapse
Affiliation(s)
- Amy D Waterman
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
| | | | | | | | | | | |
Collapse
|