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Zhang C, Mathur AK. Breaking Barriers and Bridging Gaps: Advancing Diversity, Equity, and Inclusion in Kidney Transplant Care for Black and Hispanic Patients in the United States. Transpl Int 2023; 36:11455. [PMID: 37829616 PMCID: PMC10565005 DOI: 10.3389/ti.2023.11455] [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: 04/07/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023]
Abstract
Kidney transplantation offers better mortality and quality of life outcomes to patients with end-stage renal failure compared to dialysis. Specifically, living donor kidney transplantation is the best treatment for end-stage renal disease, since it offers the greatest survival benefit compared to deceased donor kidney transplant or dialysis. However, not all patients from all racial/ethnic backgrounds enjoy these benefits. While black and Hispanic patients bear the predominant disease burden within the United States, they represent less than half of all kidney transplants in the country. Other factors such as cultural barriers that proliferate myths about transplant, financial costs that impede altruistic donation, and even biological predispositions create a complex maze and can also perpetuate care inaccessibility. Therefore, blanket efforts to increase the overall donation pool may not extend access to vulnerable populations, who may require more targeted attention and interventions. This review uses US kidney transplantation data to substantiate accessibility differences amongst racial minorities as well as provides examples of successful institutional and national systemic level changes that have improved transplantation outcomes for all.
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Affiliation(s)
- Chi Zhang
- Mayo Clinic Arizona, Phoenix, AZ, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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Thongprayoon C, Tangpanithandee S, Jadlowiec CC, Mao SA, Mao MA, Vaitla P, Acharya PC, Leeaphorn N, Kaewput W, Pattharanitima P, Suppadungsuk S, Krisanapan P, Nissaisorakarn P, Cooper M, Craici IM, Cheungpasitporn W. Characteristics of Kidney Transplant Recipients with Prolonged Pre-Transplant Dialysis Duration as Identified by Machine Learning Consensus Clustering: Pathway to Personalized Care. J Pers Med 2023; 13:1273. [PMID: 37623523 PMCID: PMC10455164 DOI: 10.3390/jpm13081273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/26/2023] Open
Abstract
Longer pre-transplant dialysis duration is known to be associated with worse post-transplant outcomes. Our study aimed to cluster kidney transplant recipients with prolonged dialysis duration before transplant using an unsupervised machine learning approach to better assess heterogeneity within this cohort. We performed consensus cluster analysis based on recipient-, donor-, and transplant-related characteristics in 5092 kidney transplant recipients who had been on dialysis ≥ 10 years prior to transplant in the OPTN/UNOS database from 2010 to 2019. We characterized each assigned cluster and compared the posttransplant outcomes. Overall, the majority of patients with ≥10 years of dialysis duration were black (52%) or Hispanic (25%), with only a small number (17.6%) being moderately sensitized. Within this cohort, three clinically distinct clusters were identified. Cluster 1 patients were younger, non-diabetic and non-sensitized, had a lower body mass index (BMI) and received a kidney transplant from younger donors. Cluster 2 recipients were older, unsensitized and had a higher BMI; they received kidney transplant from older donors. Cluster 3 recipients were more likely to be female with a higher PRA. Compared to cluster 1, cluster 2 had lower 5-year death-censored graft (HR 1.40; 95% CI 1.16-1.71) and patient survival (HR 2.98; 95% CI 2.43-3.68). Clusters 1 and 3 had comparable death-censored graft and patient survival. Unsupervised machine learning was used to characterize kidney transplant recipients with prolonged pre-transplant dialysis into three clinically distinct clusters with variable but good post-transplant outcomes. Despite a dialysis duration ≥ 10 years, excellent outcomes were observed in most recipients, including those with moderate sensitization. A disproportionate number of minority recipients were observed within this cohort, suggesting multifactorial delays in accessing kidney transplantation.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (S.S.); (P.K.); (I.M.C.); (W.C.)
| | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (S.S.); (P.K.); (I.M.C.); (W.C.)
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Caroline C. Jadlowiec
- Division of Nephrology, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Shennen A. Mao
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ 85054, USA;
| | - Michael A. Mao
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Pradeep Vaitla
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Prakrati C. Acharya
- Division of Nephrology, Texas Tech Health Sciences Center El Paso, El Paso, TX 79905, USA;
| | - Napat Leeaphorn
- Renal Transplant Program, University of Missouri-Kansas City School of Medicine/Saint Luke’s Health System, Kansas City, MO 64108, USA;
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand;
| | - Pattharawin Pattharanitima
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Thammasat University, Pathum Thani 12120, Thailand;
| | - Supawadee Suppadungsuk
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (S.S.); (P.K.); (I.M.C.); (W.C.)
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (S.S.); (P.K.); (I.M.C.); (W.C.)
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine Thammasat University, Pathum Thani 12120, Thailand;
- Division of Nephrology, Department of Internal Medicine, Thammasat University Hospital, Pathum Thani 12120, Thailand
| | - Pitchaphon Nissaisorakarn
- Deparment of Medicine, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA;
| | - Matthew Cooper
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA;
| | - Iasmina M. Craici
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (S.S.); (P.K.); (I.M.C.); (W.C.)
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (S.T.); (S.S.); (P.K.); (I.M.C.); (W.C.)
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Thongprayoon C, Vaitla P, Jadlowiec CC, Mao SA, Mao MA, Acharya PC, Leeaphorn N, Kaewput W, Pattharanitima P, Tangpanithandee S, Krisanapan P, Nissaisorakarn P, Cooper M, Cheungpasitporn W. Differences between kidney retransplant recipients as identified by machine learning consensus clustering. Clin Transplant 2023; 37:e14943. [PMID: 36799718 DOI: 10.1111/ctr.14943] [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: 05/28/2022] [Revised: 08/13/2022] [Accepted: 02/11/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Our study aimed to characterize kidney retransplant recipients using an unsupervised machine-learning approach. METHODS We performed consensus cluster analysis based on the recipient-, donor-, and transplant-related characteristics in 17 443 kidney retransplant recipients in the OPTN/UNOS database from 2010 to 2019. We identified each cluster's key characteristics using the standardized mean difference of >.3. We compared the posttransplant outcomes, including death-censored graft failure and patient death among the assigned clusters RESULTS: Consensus cluster analysis identified three distinct clusters of kidney retransplant recipients. Cluster 1 recipients were predominantly white and were less sensitized. They were most likely to receive a living donor kidney transplant and more likely to be preemptive (30%) or need ≤1 year of dialysis (32%). In contrast, cluster 2 recipients were the most sensitized (median PRA 95%). They were more likely to have been on dialysis >1 year, and receive a nationally allocated, low HLA mismatch, standard KDPI deceased donor kidney. Recipients in cluster 3 were more likely to be minorities (37% Black; 15% Hispanic). They were moderately sensitized with a median PRA of 87% and were also most likely to have been on dialysis >1 year. They received locally allocated high HLA mismatch kidneys from standard KDPI deceased donors. Thymoglobulin was the most commonly used induction agent for all three clusters. Cluster 1 had the most favorable patient and graft survival, while cluster 3 had the worst patient and graft survival. CONCLUSION The use of an unsupervised machine learning approach characterized kidney retransplant recipients into three clinically distinct clusters with differing posttransplant outcomes. Recipients with moderate allosensitization, such as those represented in cluster 3, are perhaps more disadvantaged in the kidney retransplantation process. Potential opportunities for improvement specific to these re-transplant recipients include working to improve opportunities to improve access to living donor kidney transplantation, living donor paired exchange and identifying strategies for better HLA matching.
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Affiliation(s)
- Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Pradeep Vaitla
- Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | | | - Shennen A Mao
- Division of Transplant Surgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Prakrati C Acharya
- Division of Nephrology, Texas Tech Health Sciences Center El Paso, El Paso, Texas, USA
| | - Napat Leeaphorn
- Renal Transplant Program, University of Missouri-Kansas City School of Medicine/Saint Luke's Health System, Kansas City, Missouri, USA
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | | | - Supawit Tangpanithandee
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Pajaree Krisanapan
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Pitchaphon Nissaisorakarn
- Department of Medicine, Division of Nephrology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Cooper
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Arıburnu Ö, Gül Ş, Dinç L. Nurses' Perspectives and Experiences Regarding Organ Transplantation in Turkey: A Qualitative Study. JOURNAL OF RELIGION AND HEALTH 2022; 61:1936-1950. [PMID: 35072839 DOI: 10.1007/s10943-022-01500-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 06/14/2023]
Abstract
As professionals, nurses are often required to provide care for patients from different cultural and religious backgrounds during an organ transplantation process. It is therefore important to understand the views and experiences of nurses regarding the organ transplantation process. The aim of this study was to explore nurses' perspectives and experiences in providing care to donors and transplant recipients. In this descriptive qualitative study, semistructured in-depth interviews were conducted with 17 nurses in Turkey. The qualitative interviews were analyzed using thematic analysis. At the end of the study, four themes were represented: nurses' characteristics, nurses' roles and responsibilities, nurses' views on organ transplantation, and nurses' experiences with providing care. The results of the study revealed that nurses have positive and negative attitudes about organ transplantation, and they need education on this topic. In addition, considering the cultural factors and religious beliefs that prevent organ donation, cooperation between health professionals and religious authorities is necessary. Furthermore, support systems should be developed to reduce the problems that nurses face. The relevant authorities should collaborate to increase the number of donors by informing the public that the religious view is favorable to organ donation.
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Affiliation(s)
- Özlem Arıburnu
- Faculty of Nursing, Hacettepe University, Sıhhiye/Ankara, Turkey.
| | - Şenay Gül
- Faculty of Nursing, Hacettepe University, Sıhhiye/Ankara, Turkey
| | - Leyla Dinç
- Faculty of Nursing, Hacettepe University, Sıhhiye/Ankara, Turkey
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Wilson EM, Chen A, Johnson M, Perkins JA, Purnell TS. Elucidating measures of systemic racism to mitigate racial disparities in kidney transplantation. Curr Opin Organ Transplant 2021; 26:554-559. [PMID: 34456271 DOI: 10.1097/mot.0000000000000913] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Given recent national attention to the role of racism in perpetuating racial inequities in society and health, this review provides a timely and relevant summary of key measures of systemic racism in kidney transplantation. More specifically, the review identifies current and promising interventions, whereas highlighting the need for more sustainable and impactful interventions. RECENT FINDINGS Racial disparities persist in kidney transplantation. Black and Hispanic individuals are less likely to receive a kidney transplant than non-Hispanic Whites despite disproportionately higher rates of kidney failure. Studies demonstrate that socioeconomic factors do not fully explain existing racial disparities in transplantation. Systemic racism at all levels, individual, interpersonal, institutional, and structural, is at the core of racial disparities, and current interventions are insufficient in mitigating their effects. Thus, targeted and sustainable interventions must be implemented to mitigate systemic racism in kidney transplantation. SUMMARY Systemic racism in all its forms continues to influence disparities at all stages of kidney transplantation. This paper highlights recent findings that shed light on how racism contributes to racial disparities in kidney transplantation. Using these findings to identify targets and strategies for mitigation, relevant interventions and policies that show promise are detailed.
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Affiliation(s)
- Elena M Wilson
- Epidemiology Research Group in Organ Transplantation, Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Andy Chen
- Epidemiology Research Group in Organ Transplantation, Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Morgan Johnson
- Epidemiology Research Group in Organ Transplantation, Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Columbia University Mailman School of Public Health, New York City, New York
| | - Jamilah A Perkins
- Epidemiology Research Group in Organ Transplantation, Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tanjala S Purnell
- Epidemiology Research Group in Organ Transplantation, Division of Transplantation, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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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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Krupic F. The Impact of Religion and Provision of Information on Increasing Knowledge and Changing Attitudes to Organ Donation: An Intervention Study. JOURNAL OF RELIGION AND HEALTH 2020; 59:2082-2095. [PMID: 31838627 PMCID: PMC7359157 DOI: 10.1007/s10943-019-00961-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
One of the most significant developments in recent history has probably been organ donation and organ transplantation. They are frequently the only treatment available in certain cases. However, there is an ever-increasing discrepancy between the number of people needing transplantation and the organs available, because the decision to donate an organ is up to each individual. The study aims to assess the impact of the intervention on knowledge, attitudes and practices on organ donation among religious immigrants in Sweden. Data were collected through three group interviews using open-ended questions and qualitative content analysis. Thirty-six participants, 18 males and 18 females from six countries, participated in the focus group interviews. The analysis of the collected data resulted in two main categories: "Religion in theory and practice" and "More information-more knowledge about organ donation" including seven subcategories. Understanding of religion and religiosity, happiness by taking the class, the practice of religion in everyday life, the overcoming the prejudices in religion, having more information about organ donation and the donations process, as well as that the increased information changes people's minds, were some of things the informants emphasised as predictors of the decision of organ donation. A class dealing with religion, the religious aspects of organ donation and the way the Swedish healthcare system is organised increased people's knowledge and changed their attitudes so they became potential organ donors. More intervention studies are needed in every field of medicine to build confidence and give time to educate and discuss issues with potential organ donors in Sweden.
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Affiliation(s)
- Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Mölndal, Sweden.
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Göthenburg, Sweden.
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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.
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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
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Gan Kim Soon P, Lim SK, Rampal S, Su TT. A qualitative examination of barriers and solutions to renal transplantation in Malaysia: Key-informants' perspective. PLoS One 2019; 14:e0220411. [PMID: 31404075 PMCID: PMC6690507 DOI: 10.1371/journal.pone.0220411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/15/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION End-stage renal disease (ESRD) is increasing globally, and renal transplantation (RT) is the preferred renal replacement therapy to treat ESRD. Internationally, there are only a few countries with RT rates above 50 per million population (pmp), while most of the countries have RT rates between 30-40 pmp. The low- and middle-income countries (LMIC) makes up the majority for the RT rates below 20 pmp in which Malaysia belongs to despite its increasing ESRD rates. There is a need to explore the barriers to access RT with targeted solutions to improve the RT rates and service in LMIC. Thus, a qualitative study was undertaken in Malaysia to address this issue. METHOD A qualitative methodological approach was performed between March-May 2018. Semi-structured interviews were used to explore current RT policy and service availability. Key-informants were identified from a detailed stakeholder analysis of RT system in Malaysia. Interviews were digitally audio-recorded, transcribed verbatim, coded with ATLAS.ti software and underwent thematic analysis thoroughly. RESULTS Eight key-informants participated in the study. Barriers and related solutions were classified using the socio-ecological model (SEM). As reported, the barriers and solutions of RT in Malaysia are the results of a complex interplay of personal, cultural, and environmental factors. Key barriers are linked to public's attitude and perception towards RT and the unaccommodating practices in the healthcare fraternity for RT. Key-informants provided a systematic solution that shed light on how RT could be improved at each SEM level via effective communication, education and inter-agency collaboration. CONCLUSION The SEM provided a framework to foster a better understanding of current practice, barriers, and solutions to RT in Malaysia. This study is the first to explore the barriers and related solutions to RT comprehensively as a whole. Implications of these findings could prompt a policy change for a better RT service delivery model not just for Malaysia but also for other LMIC. Further stakeholder engagement and evaluation of the systems are required to provide insight into best practices that will help to improve the RT rates and service in Malaysia.
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Affiliation(s)
- Peter Gan Kim Soon
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Soo Kun Lim
- Nephrology Unit, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Sanjay Rampal
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tin Tin Su
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- South East Asia Community Observatory (SEACO), Jeffery Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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Krupic F, Westin O, Hagelberg M, Sköldenberg O, Samuelsson K. The Influence of Age, Gender and Religion on Willingness to be an Organ Donor: Experience of Religious Muslims Living in Sweden. JOURNAL OF RELIGION AND HEALTH 2019; 58:847-859. [PMID: 30006834 PMCID: PMC6522646 DOI: 10.1007/s10943-018-0670-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The transplantation of organs is one of the most successful medical advances in recent decades, and transplantation is the treatment of choice for severe organ failure worldwide. Despite this situation and the general acknowledgment of organ donation (OD) as a global priority, the demand for organs outstrips the supply in virtually every country in the world. The study aims to elucidate whether age, gender and religion influence decision-making about organ donation in religious Muslims living in Sweden Data were collected through three group interviews using open-ended questions and qualitative content analysis. Twenty-seven participants, 15 males and 12 females from four countries, participated in the focus group interviews. The analysis of the collected data resulted in three main categories: "Information and knowledge about organ donation," "The priorities when deciding about organ donation" and "The religious aspects of organ donation," including a number of subcategories. Good information about and knowledge of OD, priorities in OD, importance of the fact that religion must be studied and taught daily and religious education were only a few of the factors informants emphasized as predictors of the total and successful donation of organs. Age, gender or religion did not have an impact on organ donation. High levels of education through religious education and good information via various media, as well as a good knowledge of the Swedish language, are predictors of improved OD. In order to overcome religious ideology as a source of misinformation relating to OD and to promote increased OD in the future, specific intervention studies and the improved involvement of religious communities and education in schools and the healthcare system are vital and must be a starting point for improved OD.
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Affiliation(s)
- Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Mölndal, Sweden.
| | - Olof Westin
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Mölndal, Sweden
| | - Mårten Hagelberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Olof Sköldenberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborgsvägen 31, 431 80, Mölndal, Sweden
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Alhalel N, Francone NO, Salazar AM, Primeaux S, Ruiz R, Caicedo JC, Gordon EJ. Patients' perceptions of a culturally targeted Hispanic Kidney Transplant Program: A mixed methods study. Clin Transplant 2019; 33:e13577. [PMID: 31034642 DOI: 10.1111/ctr.13577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/11/2019] [Accepted: 04/22/2019] [Indexed: 11/29/2022]
Abstract
Disproportionately fewer waitlisted Hispanics receive living donor kidney transplants (LDKTs) compared to non-Hispanic whites. Northwestern Medicine's® culturally targeted Hispanic Kidney Transplant Program (HKTP) is associated with a significant increase in LDKTs among Hispanics. This multisite study assessed potential kidney recipients' and donors' and/or family members' perceptions of the HKTP's cultural components through semi-structured interviews and validated surveys. Qualitative thematic analysis and descriptive statistics were performed. Thirty-six individuals participated (62% participation rate) comprising 21 potential recipients and 15 potential donors/family (mean age: 51 years, 50% female, 72% preferred Spanish). Participants felt confident about the educational information because a transplant physician delivered the education and viewed the group format as effective. Participants felt that education sessions addressed myths about transplantation shared by Hispanics. Primary use of Spanish enhanced participants' understanding of transplantation. While few knew about living donation before attending the HKTP, most were "more in favor of" kidney transplantation (97%) and living donation (97%) afterward. Few reported learning about the HKTP from outreach staff and suggested leveraging community leaders to promote HKTP awareness. Our findings suggest the HKTP's cultural components were viewed favorably and positively influenced perceptions of kidney transplantation and living donation, which may help reduce transplant disparities in Hispanics. (Clinicaltrial.gov registration # NCT03276390, date of registration: 9-7-17, retrospectively registered).
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Affiliation(s)
- Nathan Alhalel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Alice M Salazar
- Abdominal Transplant Research, Baylor Scott & White Research Institute, Dallas, Texas.,Baylor Scott & White Research Institute, Dallas, Texas
| | | | - Richard Ruiz
- Baylor Simmons Transplant Institute, Dallas, Texas
| | - Juan Carlos Caicedo
- Comprehensive Transplant Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elisa J Gordon
- Comprehensive Transplant Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Center for Bioethics and Medical Humanities, Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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12
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Ali Husain S, Brennan C, Michelson A, Tsapepas D, Patzer RE, Schold JD, Mohan S. Patients prioritize waitlist over posttransplant outcomes when evaluating kidney transplant centers. Am J Transplant 2018; 18:2781-2790. [PMID: 29945305 PMCID: PMC6314030 DOI: 10.1111/ajt.14985] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 05/31/2018] [Accepted: 06/15/2018] [Indexed: 01/25/2023]
Abstract
Factors that patients value when choosing a transplant center have not been well studied. In order to guide the improvement of patient-facing materials, we conducted an anonymous electronic survey of patients that assessed the relative importance of patient experience, practical considerations, transplant center reputation, center experience, and waitlist when selecting a transplant center. A total of 409 respondents completed the survey, of whom 68% were kidney transplant recipients and 32% had chronic kidney disease or were on dialysis. Participants had mean age 56 ± 12 years and were predominantly female (61%), white (79%), and had an associate's degree or higher (68%). Participants most often prioritized waitlist when evaluating transplant centers (transplanted 26%, chronic kidney disease 40%), and waitlist was almost twice as likely as outcomes to be ranked most important (30% vs 17%). Education level and transplant status were significantly associated with factors used for center prioritization. Waitlisted respondents most commonly (48%) relied on physicians for information when selecting a center, while a minority cited transplant-specific organizations. In order to improve shared decision-making, materials outlining center-specific waitlist features should be prioritized. Novel patient-oriented metrics for measuring transplant center quality that align with patient priorities must be explored.
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Affiliation(s)
- Syed Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA,The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA
| | - Corey Brennan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Ariane Michelson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Demetra Tsapepas
- The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA,New York-Presbyterian Hospital, New York, NY, USA
| | - Rachel E. Patzer
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA,Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA,The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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13
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Gordon EJ, Lee J, Kang RH, Caicedo JC, Holl JL, Ladner DP, Shumate MD. A complex culturally targeted intervention to reduce Hispanic disparities in living kidney donor transplantation: an effectiveness-implementation hybrid study protocol. BMC Health Serv Res 2018; 18:368. [PMID: 29769080 PMCID: PMC5956564 DOI: 10.1186/s12913-018-3151-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 04/25/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The shortage of organs for kidney transplantation for patients with end-stage renal disease (ESRD) is magnified in Hispanics/Latin Americans in the United States. Living donor kidney transplantation (LDKT) is the treatment of choice for ESRD. However, compared to their representation on the transplant waitlist, fewer Hispanics receive a LDKT than non-Hispanic whites. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and language barriers. Few interventions have been designed to reduce LDKT disparities. This study aims to reduce Hispanic disparities in LDKT through a culturally targeted intervention. METHODS/DESIGN Using a prospective effectiveness-implementation hybrid design involving pre-post intervention evaluation with matched controls, we will implement a complex culturally targeted intervention at two transplant centers in Dallas, TX and Phoenix, AZ. The goal of the study is to evaluate the effect of Northwestern Medicine's® Hispanic Kidney Transplant Program's (HKTP) key culturally targeted components (outreach, communication, education) on Hispanic LDKT rates over five years. The main hypothesis is that exposure to the HKTP will reduce disparities by increasing the ratio of Hispanic to non-Hispanic white LDKTs and the number of Hispanic LDKTs. We will also examine other process and outcome measures including: dialysis patient outreach, education session attendance, marketing efforts, Hispanic patients added to the waitlist, Hispanic potential donors per potential recipient, and satisfaction with culturally competent care. We will use mixed methods based on the Promoting Action on Research Implementation in Health Services (revised PARIHS) and the Consolidated Framework for Implementation Research (CFIR) frameworks to formatively evaluate the fidelity and innovative adaptations to HKTP's components at both study sites, to identify moderating factors that most affect implementation fidelity, and to identify adaptations that positively and negatively affect outcomes for patients. DISCUSSION Our study will provide new knowledge about implementing culturally targeted interventions and their impact on reducing health disparities. Moreover, the study of a complex organizational-level intervention's implementation over five years is rare in implementation science; as such, this study is poised to contribute new knowledge to the factors influencing how organizational-level interventions are sustained over time. TRIAL REGISTRATION (ClinicalTrials.gov registration # NCT03276390 , date of registration: 9-7-17, retrospectively registered).
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Affiliation(s)
- Elisa J Gordon
- Department of Surgery-Division of Transplantation, Center for Healthcare Studies, Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th FL, Chicago, IL, 60611, USA.
| | - Jungwha Lee
- Preventive Medicine and Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1400, Chicago, IL, 60611, USA
| | - Raymond H Kang
- Center for Healthcare Studies, Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th FL, Chicago, IL, 60611, USA
| | - Juan Carlos Caicedo
- Department of Surgery-Division of Transplantation, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, 19th FL, Chicago, IL, 60611, USA
| | - Jane L Holl
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th FL, Chicago, IL, 60611, USA
| | - Daniela P Ladner
- Department of Surgery-Division of Transplantation, Northwestern University Feinberg School of Medicine, 676 N. St. Clair, 19th FL, Chicago, IL, 60611, USA
| | - Michelle D Shumate
- Department of Communication Studies, Northwestern University, 240 Campus Drive, Rm 2-118, Evanston, IL, 60208, USA
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Rodrigue JR, Feranil M, Lang J, Fleishman A. Readability, content analysis, and racial/ethnic diversity of online living kidney donation information. Clin Transplant 2017; 31. [PMID: 28640438 PMCID: PMC5581210 DOI: 10.1111/ctr.13039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2017] [Indexed: 11/28/2022]
Abstract
More than three-fourths of adults in the USA use the Internet to access health-related information. Adults exploring the possibility of living donation should have access to online content that is readable and comprehensive. We simulated a search of online information about living kidney donation and evaluated readability, topics covered, and racial/ethnic diversity of 21 websites meeting inclusion criteria (eg, hosted by a nonprofit or patient advocacy organization, English content, based in USA). Using standard readability metrics, 62% of sites were classified as "Difficult to read" and none achieved the recommended reading level of sixth grade. On average, websites covered 18.5 (62%) of 30 recommended information topics (range: 7 to 28) and only 2.1 (23%) of 9 racial/ethnic diversity items (range: 0 to 6). Overall, the most common nonprofit or patient advocacy organization websites do not meet the readability standards established by the National Institutes of Health and the American Medical Association, many lack fundamental information about living kidney donation, and most are not racially/ethnically diverse. We encourage the transplant community to consider playing a more active role in improving the overall quality of online information disseminated to the general public. Further, there is a need to more critically examine the accuracy of online living donation content in future investigations.
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Affiliation(s)
- James R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Departments of Surgery and Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mario Feranil
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jenna Lang
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron Fleishman
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
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15
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A Culturally Targeted Website for Hispanics/Latinos About Living Kidney Donation and Transplantation: A Randomized Controlled Trial of Increased Knowledge. Transplantation 2017; 100:1149-60. [PMID: 26444846 DOI: 10.1097/tp.0000000000000932] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hispanics/Latinos receive disproportionately fewer living donor kidney transplantations (LDKTs) than non-Hispanic whites. We conducted a multisite, randomized controlled trial to evaluate the efficacy of exposure to a bilingual, culturally targeted website, Infórmate, for increasing Hispanics' knowledge about LDKT. METHODS Hispanic patients initiating transplant evaluation and their family/friends at 2 transplant centers were randomized to view Infórmate before attending routine transplant education sessions; usual care controls only attended education sessions. All participants completed a pretest; website participants also completed a posttest immediately after viewing Infórmate. All participants completed a 3-week telephone follow-up test. Random effects linear regression of 3-week knowledge scores tested the significance of website exposure after adjusting for clustering within families and controlling for pretest scores and covariates. RESULTS Two hundred-eighty-two individuals participated (81% patient participation rate). Website exposure was associated with a mean 21.7% same day knowledge score increase between pretest and posttest (P < 0.001). At 3 weeks, website participants' knowledge scores remained 22.6% above the pretest; control scores increased to 11.8% (P = 0.0001). Regression results found that website participants were associated with a 10.0% greater knowledge score at 3-week follow-up (P < 0.0001). Most website participants (92.6%) plan to return to Infórmate in the future. CONCLUSIONS Our culturally targeted website increased participants' knowledge about LDKT above and beyond transplant education and should supplement transplant center education for Hispanics. When considered at the population level, Infórmate could have a great impact on knowledge gains in this underserved population disproportionately affected by kidney disease.
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Gander JC, Gordon EJ, Patzer RE. Decision aids to increase living donor kidney transplantation. CURRENT TRANSPLANTATION REPORTS 2017; 4:1-12. [PMID: 29034143 PMCID: PMC5638125 DOI: 10.1007/s40472-017-0133-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW For the more than 636,000 adults with end-stage renal disease (ESRD) in the U.S., kidney transplantation is the preferred treatment compared to dialysis. Living donor kidney transplantation (LDKT) comprised 31% of kidney transplantations in 2015, an 8% decrease since 2004. We aimed to summarize the current literature on decision aids that could be used to improve LDKT rates. RECENT FINDINGS Decision aids are evidence-based tools designed to help patients and their families make difficult treatment decisions. LDKT decision aids can help ESRD patients, patients' family and friends, and healthcare providers engage in treatment decisions and thereby overcome multifactorial LDKT barriers. SUMMARY We identified 12 LDKT decision aids designed to provide information about LDKT, and/or to help ESRD patients identify potential living donors, and/or to help healthcare providers make decisions about treatment for ESRD or living donation. Of these, 4 were shown to be effective in increasing LDKT, donor inquiries, LDKT knowledge, and willingness to discuss LDKT. Although each LDKT decision aid has limitations, adherence to decision aid development guidelines may improve decision aid utilization and access to LDKT.
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Affiliation(s)
- Jennifer C Gander
- Department of Surgery, Division of Transplantation, Emory University, Atlanta, GA
| | - Elisa J Gordon
- Department of Surgery, Division of Transplantation, and Center for Healthcare Studies, and Center for Bioethics and Medical Humanities, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rachel E Patzer
- Department of Surgery, Division of Transplantation, Emory University, Atlanta, GA
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Gordon EJ. Culturally Competent Strategies for Increasing Knowledge of Live Kidney Donation in the Hispanic Community. CURRENT TRANSPLANTATION REPORTS 2017. [DOI: 10.1007/s40472-017-0136-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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18
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Krupic F, Sayed-Noor AS, Fatahi N. The impact of knowledge and religion on organ donation as seen by immigrants in Sweden. Scand J Caring Sci 2016; 31:687-694. [DOI: 10.1111/scs.12379] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ferid Krupic
- Department of Orthopaedics; Institute of Clinical Sciences; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Arkan S. Sayed-Noor
- Department of Surgical and Perioperative Sciences; Umeå University; Umeå Sweden
| | - Nabi Fatahi
- University of Gothenburg; Institute of Health and Caring Sciences; Gothenburg Sweden
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19
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Gordon EJ, Feinglass J, Carney P, Vera K, Olivero M, Black A, O'Connor KG, Baumgart JM, Caicedo JC. A Website Intervention to Increase Knowledge About Living Kidney Donation and Transplantation Among Hispanic/Latino Dialysis Patients. Prog Transplant 2016; 26:82-91. [PMID: 27136254 DOI: 10.1177/1526924816632124] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hispanic dialysis patients often encounter barriers to learning about living kidney donation and transplantation. Effective culturally targeted interventions to increase knowledge are lacking. We developed a culturally targeted educational website to enhance informed treatment decision making for end-stage kidney disease. METHODS A pretest/posttest intervention study was conducted among adult Hispanic patients undergoing dialysis at 5 dialysis centers in Chicago, Illinois. Surveys included a 31-item, multiple-choice pretest/posttest of knowledge about kidney transplantation and living donation, attitudes about the website, Internet use, and demographics. The intervention entailed viewing 3 of 6 website sections for a total of 30 minutes. The pretest/posttest was administered immediately before and after the intervention. Participants completed a second posttest via telephone 3 weeks thereafter to assess knowledge retention, attitudes, and use of the website. RESULTS Sixty-three patients participated (96% participation rate). Website exposure was associated with a mean 17.1% same day knowledge score increase between pretest and posttest (P < .001). At 3 weeks, participants' knowledge scores remained 11.7% above pretest (P < .001). The greatest knowledge gain from pretest to 3-week follow-up occurred in the Treatment Options (P < .0001) and Cultural Beliefs and Myths (P < .0001) website sections. Most participants (95%) "agreed" or "strongly agreed" that they would recommend the website to other Hispanics. CONCLUSIONS Web-based education for patients undergoing dialysis can effectively increase Hispanics' knowledge about transplantation and living kidney donation. Study limitations include small sample size and single geographic region study. Dialysis facilities could enable website access as a method of satisfying policy requirements to provide education about kidney transplantation.
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Affiliation(s)
- Elisa J Gordon
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Joe Feinglass
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Paula Carney
- Department of Health Sciences, Chicago State University, Chicago, IL, USA
| | - Karina Vera
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Maria Olivero
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Anne Black
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Jessica MacLean Baumgart
- Robert H. Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Juan Carlos Caicedo
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA Hispanic Transplant Program, Northwestern Memorial Hospital, Chicago, IL, USA
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Hispanic/Latino Disparities in Living Donor Kidney Transplantation: Role of a Culturally Competent Transplant Program. Transplant Direct 2015; 1:e29. [PMID: 27500229 DOI: 10.1097/txd.0000000000000540] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED Hispanic Americans face disparities in access to kidney transplantation, particularly living donor kidney transplantation (LDKT). This study compared characteristics of LDKT recipients before and after implementing the Hispanic Kidney Transplant Program (HKTP) at Northwestern Medicines (NM) and other centers. METHODS The NM HKTP, initiated in December 2006, delivers culturally and linguistically competent and congruent care. Program-specific data were used to compare the mean ratios of Hispanic to non-Hispanic white LDKTs between pre-HKTP (2001-2006) and post-HKTP (2008-2013), and to compare the characteristics of NM's adult LDKT patients between pre-HKTP and post-HKTP. The same ratio was calculated for transplant centers in regions with a significant Hispanic population (≥25%) and performing in the top tertile of total LDKT volume in the pre-HKTP period. The number of Hispanic and non-Hispanic white patients added to the waiting list were compared between pre-HKTP (2001-2006) and post-HKTP (2008-2013) as a proxy for increased patient referrals and a pathway by which the HKTP may increase LDKTs. RESULTS The ratio of Hispanic to non-Hispanic white LDKTs significantly increased by 70% after the implementation of NM's HKTP (pre-HKTP mean = 0.20, post-HKTP mean = 0.34; P= 0.001). None of the other transplant centers experienced a similar increase in their ratio of Hispanic to non-Hispanic white LDKTs. The NM waiting list additions grew by 91% among Hispanics, but grew only 4% for non-Hispanic whites. CONCLUSIONS These data suggest that the development and implementation of a culturally congruent transplant program can positively affect Hispanic LDKT and thereby reduce Hispanics disparities in LDKT rates. Further studies are needed to prospectively evaluate the generalizability of implementing such culturally competent interventions at other transplant programs.
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Gordon EJ, Feinglass J, Carney P, Ramirez D, Olivero M, O'Connor K, MacLean J, Brucker J, Caicedo JC. An interactive, bilingual, culturally targeted website about living kidney donation and transplantation for hispanics: development and formative evaluation. JMIR Res Protoc 2015; 4:e42. [PMID: 25896143 PMCID: PMC4419196 DOI: 10.2196/resprot.3838] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 02/19/2015] [Accepted: 02/19/2015] [Indexed: 01/13/2023] Open
Abstract
Background As the kidney shortage continues to grow, patients on the waitlist are increasingly turning to live kidney donors for transplantation. Despite having a disproportionately higher prevalence of end-stage kidney disease (ESKD), fewer waitlisted Hispanic patients received living donor kidney transplants (LDKTs) than non-Hispanic whites in 2014. Although lack of knowledge has been identified as a barrier to living kidney donation (LKD) among Hispanics, little is known about information needs, and few bilingual educational resources provide transplant-related information addressing Hispanics’ specific concerns. Objective This paper describes the process of developing a bilingual website targeted to the Hispanic community. The website was designed to increase knowledge about LKD among Hispanic patients with ESKD, their families, and the public, and was inspired by educational sessions targeted to Hispanic transplant patients provided by Northwestern University’s Hispanic Kidney Transplant Program. Methods Northwestern faculty partnered with the National Kidney Foundation of Illinois for expertise in ESKD and Hispanic community partners across the Chicago area. We established a Community Advisory Board (CAB) of 10 Chicago-area Hispanic community leaders to provide insight into cultural concerns and community and patients’ needs. Website content development was informed by 9 focus groups with 76 adult Hispanic kidney transplant recipients, living kidney donors, dialysis patients, and the general Hispanic public. The website development effort was guided by community input on images, telenovela scripts, and messages. After initial development, formal usability testing was conducted with 18 adult Hispanic kidney transplant recipients, dialysis patients, and living kidney donors to identify ways to improve navigability, design, content, comprehension, and cultural sensitivity. Usability testing revealed consistently high ratings as “easy to navigate”, “informative”, and “culturally appropriate”. Bandura’s Social Cognitive Theory and Gagne’s Conditions of Learning Theory guided website design to facilitate adult learning. Results The website, “Infórmate: Living Kidney Donation for Hispanics/Latinos” (Infórmate Acerca de la Donación de Riñón en Vida), includes six sections: Treatment Options, Donation: Step-by-Step, Benefits and Risks, Financial Issues, Immigrant Issues, and Cultural Beliefs and Myths. Sections host 5-10 interactive messages that summarize important points and link to detailed explanations for users interested in learning more about specific issues. The website hosts interactive videos, multimedia testimonials, telenovelas, games, and quizzes. Photographs and videos of Hispanic living donors are shown to promote pride and ownership. Conclusions Our success in developing a website was driven by a development team with expertise in transplantation, social science, evaluation, instructional design, and Hispanic perspectives, and by a patient-centered approach toward content and design. Based on feedback from usability testing and our CAB, the website is sensitive to Hispanic cultural sensibilities. We have nearly completed a formal evaluation of the website’s impact on increasing Hispanics’ knowledge about LKD and will disseminate the website thereafter.
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Affiliation(s)
- Elisa J Gordon
- Center for Healthcare Studies and Comprehensive Transplant Center, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
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Siegel JT, O'Brien EK, Alvaro EM, Poulsen JA. Barriers to living donation among low-resource Hispanics. QUALITATIVE HEALTH RESEARCH 2014; 24:1360-1367. [PMID: 25147215 DOI: 10.1177/1049732314546869] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hispanics are disproportionately affected by renal failure. Although living donation has been heralded as a potential means for alleviating the need for transplantable kidneys, a nuanced understanding of the obstacles faced by Hispanics is necessary. In our study, we conducted focus groups with 28 first-generation Spanish-dominant Hispanic renal patients. Although some of the barriers that emerged were akin to those reported in previous research (e.g., a lack of knowledge about the process), others were unique. Rarely chronicled barriers include the disqualification of family members because of medical issues, potential donors being unable to miss work, disqualification of family members who are undocumented, concern that potential donors cannot support their family if they donate, and declining social support because of illness. The interaction among this constellation of barriers makes living donation particularly difficult among this population. Investigations focused on the unique barriers faced by these low-resource individuals are warranted.
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Affiliation(s)
- Jason T Siegel
- Claremont Graduate University, Claremont, California, USA
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Gordon EJ, Mullee JO, Ramirez DI, MacLean J, Olivero M, Feinglass J, Carney P, O'Connor K, Caicedo JC. Hispanic/Latino concerns about living kidney donation: a focus group study. Prog Transplant 2014; 24:152-62. [PMID: 24919732 DOI: 10.7182/pit2014946] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Given the shortage of kidneys for transplant, living kidney donation (LKD) is increasingly used to expand the organ donor pool. Although Hispanics/Latinos need disproportionately more kidney transplants, they receive a smaller proportion of living donor kidney transplants than other ethnic/racial groups. OBJECTIVE To assess Hispanics' awareness, perceptions, misconceptions, cultural beliefs, and values about and barriers to LKD. DESIGN Nine focus groups were conducted with 76 adult Hispanics in Chicago, Illinois, between January and March 2012. PARTICIPANTS Focus groups included kidney transplant recipients, living kidney donors, dialysis patients, and the general Hispanic public. RESULTS Several themes emerged as perceived barriers to LKD. Many participants identified knowledge deficits about LKD, expressing uncertainty about the differences between LKD and deceased donation, and whether kidney disease simultaneously afflicts both kidneys. Many believed that donors experience dramatically shorter life expectancies, are unable to have children, and are more susceptible to kidney disease after donating. Recipients and donors reported that family members were involved in discussions about the donor's decision to donate, with some family members discouraging donation. Financial barriers cited included fear of becoming unable to work, losing one's job, or being unable to pay household bills while recovering. Participants also identified logistic barriers for undocumented immigrants (eg, the inability to obtain government insurance for transplant candidates and uncertainty about their eligibility to donate). Donors desired information about optimizing self-care to promote their remaining kidney's health. Culturally competent interventions are needed to redress Hispanics' knowledge deficits and misconceptions and reduce LKD disparities among Hispanics.
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Affiliation(s)
| | | | | | | | - Maria Olivero
- National Kidney Foundation of Illinois, Chicago, Illinois
| | | | | | - Kate O'Connor
- National Kidney Foundation of Illinois, Chicago, Illinois
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Gordon EJ, Reddy E, Gil S, Feinglass J, Rodde J, Abecassis MM, Caicedo JC. Culturally competent transplant program improves Hispanics' knowledge and attitudes about live kidney donation and transplant. Prog Transplant 2014; 24:56-68. [PMID: 24598567 DOI: 10.7182/pit2014378] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Hispanics receive disproportionately fewer live donor kidney transplants than non-Hispanic whites. Increasing Hispanics' knowledge and changing attitudes about live kidney donation may reduce these disparities. OBJECTIVE To evaluate the effectiveness of culturally and linguistically competent educational sessions delivered through Northwestern University's Hispanic Transplant Program. DESIGN Baseline and postsession questionnaires were used to evaluate changes in patients' and family members' knowledge and attitudes toward live kidney donation and program satisfaction. Knowledge items related to live kidney donation were scaled, and changes in scores were evaluated via a paired t test. Multiple regression analysis of follow-up knowledge scores controlled for baseline scores was used to estimate the effects of patients' and families' sociodemographic characteristics. Changes in attitude items, including comfort with exploring live kidney donation, were analyzed with χ2 tests. RESULTS One-hundred thirteen patients and family members completed surveys before and after an education session. Respondents' knowledge about live kidney donation and transplant increased significantly (P<.001) between baseline and after the session. Patients' attitudes toward live kidney donation became more favorable (P< .02), as did family members' attitudes toward being a donor (P < .001) after participating in the program. All respondents reported high levels of satisfaction with the program and preferences for culturally congruent care. CONCLUSIONS The educational sessions provided by the Hispanic Transplant Program effectively addressed commonly shared Hispanic concerns about live kidney donation. Culturally congruent education increased Hispanic patients' and family members' knowledge and improved attitudes about live donor kidney transplants.
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Public awareness and attitudes to living organ donation: systematic review and integrative synthesis. Transplantation 2013; 96:429-37. [PMID: 23677051 DOI: 10.1097/tp.0b013e31829282ac] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The deceased-donor organ shortage has driven widespread adoption of living-donor transplantation. Yet, public views on living donation are not well understood. This study aims to synthesize studies on public awareness and attitudes toward living organ donation. METHODS Electronic databases and reference lists were searched to September 2012. Summary estimates from survey data were obtained by random effects meta-analysis. Qualitative descriptive synthesis of each study was performed. RESULTS Forty-seven studies involving 34,610 respondents were included. The proportion of respondents aware of living organ donation was 76.7% (4 studies, n=3248; 95% confidence interval, 46.2%-97.0%; I=99.7%). The majority were in favor of living directed donation (85.5% (11 studies, n=15,836; 95% confidence interval, 81.6%-89.6%; I=98%), with recipient and community benefit as the rationale provided. However, barriers included fear of surgical and health risks, lack of knowledge, respect for cultural norms, financial loss, distrust in hospitals, and avoiding recipient indebtedness. The public voiced concern about possible risks or an obligatory pressure exerted on the donor. Many supported reimbursement for out-of-pocket expenses, paid leave, wait-listing priority, health insurance, and donor acknowledgment. There was strong opposition to financial incentives, which they believed risked exploitation and inequity and diminished voluntary altruistic donation. CONCLUSIONS The public is generally supportive of living donation and articulated important equity and ethical considerations for protecting the health and safety of living donors. This supports increased public engagement and strengthening of a shared view among professionals and the public in living donation practice and policy.
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Purnell TS, Powe NR, Troll MU, Wang NY, Haywood C, LaVeist TA, Boulware LE. Measuring and explaining racial and ethnic differences in willingness to donate live kidneys in the United States. Clin Transplant 2013; 27:673-83. [PMID: 23902226 DOI: 10.1111/ctr.12196] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Reasons for US racial-ethnic minority ESRD patients' reported difficulties identifying live kidney donors are poorly understood. METHODS We conducted a national study to develop scales measuring willingness to donate live kidneys among US adults (scores ranged from 0 [not willing] to 10 [extremely willing]), and we tested whether racial-ethnic differences exist in willingness to donate. We also examined whether clinical, sociodemographic, and attitudinal factors mediated potential racial-ethnic differences in willingness. RESULTS Among 845 participants, the majority were extremely willing to donate to relatives (77%) while fewer than half were extremely willing to donate to non-relatives (18%). In multivariable linear regression analyses, willingness to donate varied by race-ethnicity and recipient relationship to the donor. African Americans were less willing to donate to relatives than whites (β: -0.48; 95% CI [Confidence Interval]: -0.94 to -0.17; p = 0.04), but these differences were eliminated after accounting for socioeconomic factors, medical trust, and concerns about burial after death. There were no differences in willingness to donate between Hispanics and whites. CONCLUSIONS African Americans' burial concerns, medical trust, and socioeconomic factors explained differences in their willingness to donate to relatives, suggesting efforts to address these barriers may enhance rates of live kidney donation in this group.
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Affiliation(s)
- Tanjala S Purnell
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Gordon EJ, Rodde J, Gil S, Caicedo JC. Quality of Internet education about living kidney donation for Hispanics. Prog Transplant 2012; 22:294-303. [PMID: 22951507 DOI: 10.7182/pit2012802] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Hispanics need disproportionately more kidney transplants, yet receive disproportionately fewer kidney transplants and living donor kidney transplants than non-Hispanic whites. Lack of knowledge and cultural beliefs about living kidney donation contribute to these disparities. The Internet is an optimal venue to educate underserved, low-literacy populations. DESIGN Websites were evaluated for information on living kidney donation targeted to Hispanics. Hispanic websites addressing living kidney donation were identified through the Google search engine, using the search terms Hispanic, Latino, Spanish, and living kidney donor/donation. Websites were evaluated for accessibility of information, readability, and content required by 9 Centers for Medicare and Medicaid Services regulations representing 12 topics, and cultural competency. RESULTS Twenty resources met inclusion criteria. Websites contained 2.3 pages on living kidney donation and required 2.4 links to access all information on living kidney donation. Websites were written at the 9th grade reading level. Sites described alternative treatments for recipients (n = 14), the evaluation process (n = 7), and the surgical procedure (n=6). Few addressed psychosocial risks (n=2). Some contained culturally sensitive colors and pictures (n = 8), but few addressed Hispanic cultural beliefs (n = 4). CONCLUSIONS A comprehensive website on living kidney donation that provides more robust content and is targeted to Hispanics is needed to increase Hispanics' understanding of treatment options.
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Affiliation(s)
- Elisa J Gordon
- Center for Healthcare Studies, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Siegel JT, Alvaro EM, Hohman ZP, Maurer D. "Can you spare an organ?": exploring Hispanic Americans' willingness to discuss living organ donation with loved ones. HEALTH COMMUNICATION 2011; 26:754-764. [PMID: 21722061 DOI: 10.1080/10410236.2011.566831] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Living organ donation offers a means of overcoming the shortage of viable organs available for transplant: a shortage particularly problematic among Hispanics. One barrier standing between those in need of a kidney and a successful transplant operation is an inability, and often lack of desire, to talk to loved ones about the need for a living donation. With an eye on future intervention approaches, and guided in part by the theory of planned behavior, this research effort sought to explore the factors associated with a willingness to engage in a conversation about a living donation with loved ones. Study 1, a phone survey of Hispanic Americans drawn from a Hispanic surname list, reveals that while upward of 90% of respondents would be willing to offer a kidney to a family member in need, and a similar percentage would be willing to accept a living donation if offered, only about half of respondents would feel comfortable initiating a conversation with family members if the respondent was in need of a living donation. Study 2, a survey of Hispanic American patients currently in need of a living kidney donation, revealed that perceived behavioral control accounted for 60% of the variance in future intentions to initiate a conversation among those who have yet to speak to a family member about becoming a living donor. Moreover, perceived behavioral control mediated the relationship between perceived asking appropriateness and future intentions to initiate a conversation. Lastly, recipient outcome expectations, asking appropriateness, and subjective norms were revealed to be predictive of perceived behavioral control. Implications for future living donor interventions focusing on increasing recipient-initiated conversations are discussed.
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Affiliation(s)
- Jason T Siegel
- Department of Psychology, Claremont Graduate University, CA 91711, USA.
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Alvaro EM, Siegel JT, Crano WD, Dominick A. A mass mediated intervention on Hispanic live kidney donation. JOURNAL OF HEALTH COMMUNICATION 2010; 15:374-387. [PMID: 20574876 DOI: 10.1080/10810731003753133] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This research examines the impact of a Spanish language mass media campaign on living organ donation attitudes and behavioral intentions among Spanish dominant Hispanics in Tucson, Arizona. Impact was assessed via a pretest/posttest control group quasiexperimental design with Tucson, Arizona, as the intervention community and Phoenix, Arizona, as the control. Preintervention focus groups provided qualitative data to guide intervention development, while telephone surveys in both communities provided quantitative data to assess campaign impact. Analyses reveal pretest/posttest differences in the intervention community such that posttest intentions regarding living organ donation behaviors increased from pretest. No such differences were observed in the control community. Subsequent analyses revealed differences between respondents in the intervention community exposed to the campaign vs. those in the same community not exposed to the campaign. Exposed respondents reported more positive living organ donation behavioral intentions than nonexposed respondents. Implications for research and practice are discussed.
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Affiliation(s)
- Eusebio M Alvaro
- School of Behavioral and Organizational Sciences, Claremont Graduate University, Claremont, California, USA
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