Developing and designing an internet-based support and education program for patients awaiting kidney transplantation with deceased donors through: a Delphi study

AIMS

The aim of this study was to develop and refine the content and design of an internet-based support and education program for patients awaiting kidney transplantation from deceased donors.

DESIGN

A Delphi process was used.

METHODS

A prototype internet-based intervention was drafted, based on previous research. The intervention included educational and psychological support to manage the uncertain waiting time and specific education enabling preparation for transplantation and adjustment to life after transplantation. In a two-round Delphi process, patients who had received a kidney transplant from a deceased donor within the last 2 years (n = 27), significant others (n = 6), health-care personnel with renal (n = 20) or transplant (n = 14) expertise, rated importance of content and design aspects of the prototype intervention on a 5-point scale using web questionnaires. A median of ≥ 3 was considered as consensus. Quantitative data was analyzed using descriptive statistics. Free text answers were encouraged and analyzed using deductive content analysis. The STROBE-checklist was used.

RESULTS

Consensus was reached for all suggested content and design items in round 1, with median ratings of 4 or 5. Qualitative analysis from round 1 suggested four new content and design items which were rated in round 2, on all which consensus was reached; information about life with young children as relatives, expansion of kidney transplantation specific information, program extension by one week and individualization by making information available based on individual needs.

CONCLUSION

There was consensus among heterogenous experts regarding suggested educational and psychological support content and design aspects, and additional content and design aspects were identified for an internet-based support and education program for patients awaiting kidney transplantation from deceased donors.

An integrative literature review of kidney transplantation knowledge tools

PURPOSE

This study aimed to identify knowledge measurement tools for kidney transplantation (KT) and confirm their assessment methods, domains, and validity to provide useful information.

DESIGN

An integrative review based on Whittemore and Knafl's (2005) framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines.

METHODS

An integrative search was conducted using four English databases (PubMed, Embase, CINAHL, and the Cochrane Library) and the top three Korean databases (RISS, DBpia, and KISS). Search terms and strategies included ("kidney transplant*" OR "renal transplant*" OR "kidney replace*" OR "renal replace*" OR "kidney graft" OR "renal graft") & (knowledge OR awareness) & (scale OR tool OR instrument OR questionnaire OR inventory). The time limit was set to February 2022. The extracted data included the content of the tools, participants, and psychometrics. Quality of life was assessed using a psychometric grading framework.

RESULTS

A total of 15 studies and 13 tools were reviewed. Of these, seven studies (46.7%) targeted KT patients, five (33.3%) targeted KT candidates, and three (20.0%) included both groups. The number of items in the tools ranged from five to 33 items. Furthermore, seven tools comprised true-false questions and eight multiple-choice questions. The domains of the KT knowledge measurement tool used in each study differed across study participants. Both reliability and validity were confirmed in six tools, and only two showed a grade of "adequate" or higher.

CONCLUSION

A validated tool is required to measure KT knowledge. These tools can be used to evaluate the effectiveness of educational interventions in promoting self-management after KT.

PROTOCOL REGISTRATION NUMBER

CRD42022334559.

The Patient Care Experience as Perceived by Hispanic Patients With Chronic Illness Undergoing Transplant: A Grounded Theory

Hispanics are one of the largest-growing minorities, yet little is understood of the patient experience from their perspective. Patient experience is the current federally mandated hospital quality indicator that is measured via the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Minority representation in the HCAHPS survey development however was not robust. This study used a constructivist grounded theory method to explore how English- and Spanish-speaking Hispanic patients seeking kidney and liver transplant care at a safety-net hospital perceive and interpret the care experience. A grounded theory process model emerged finding comfort, communication, connection, and care to be interdependent factors crucial for a positive hospital admission. Furthermore, "cultural context" was found to influence perception of each of these concepts. This research provides key insights into how Hispanics may perceive their needs when seeking care. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A50 .

Waiting for kidney transplantation from deceased donors: Experiences and support needs during the waiting time -A qualitative study

OBJECTIVES

The study aimed to explore and describe patients' experiences of the transplantation process and the support they had received during the waiting time.

METHOD

Semi-structured interviews were conducted with 14 patients currently waiting for kidney transplantation from deceased donors (n = 7) or recently having received kidney transplantation (n = 7). Interviews were transcribed, anonymized and analysed inductively using thematic analysis.

RESULTS

Two themes and seven sub-themes were identified. The first theme, "Swaying between hope and despair" describes patients' perceptions of waiting for transplantation as a struggle, their expectations for life after the upcoming transplantation and experienced disappointments. The second theme, "Making your way through the waiting time", describes support, strategies and behaviours used to manage the waiting time.

CONCLUSION

Patients described life while waiting for kidney transplantation as challenging, involving unexpected events, not understanding the transplantation process and having unrealistic expectations on life after transplantation. They also described support, strategies and behaviours used, some of which led to unwanted consequences.

PRACTICE IMPLICATIONS

Patients waiting for kidney transplantation from deceased donors need continuous and easily available education, practical and emotional support to manage the waiting time. Transplantation specific education is also needed to facilitate preparation for transplantation and adjustment to life after transplantation.

Dialysis, Distress, and Difficult Conversations: Living with a Kidney Transplant

Background: Providing holistic care to kidney patients is important; however, without full consideration of the perspectives of people living with a kidney transplant, the provision of truly ‘holistic healthcare’ cannot be possible. It is imperative to understand patient experiences by including kidney patients in key strategies and future renal service planning. Ignoring these important patient views means that there is a significant risk of inappropriate renal service provision and lack of adequate support, impacting overall health. The aim of this study was to develop an in-depth understanding of the lived experiences of kidney transplant recipients. Methods: A total of 23 participants were recruited between two regional nephrology units within the United Kingdom via clinical gatekeepers. In-depth interviews were undertaken. Interviews were digitally recorded, transcribed verbatim, and subjected to interpretative phenomenological analysis. Results: Two themes emerged: “managing ongoing fears of dialysis, distress, and COVID-19” and “dealing with difficult conversations”. Conclusions: Renal healthcare professionals need to understand more than the biological impact of receiving a kidney transplant. Understanding the holistic and multidomain experiences that these participants experience will help healthcare professionals to recognize the needs of this group and ensure more responsive psychosocial care.

Pretransplant Patient Education in Solid-organ Transplant: A Narrative Review

Education for pretransplant, solid-organ recipient candidates aims to improve knowledge and understanding about the transplant process, outcomes, and potential complications to support informed, shared decision-making to reduce fears and anxieties about transplant, inform expectations, and facilitate adjustment to posttransplant life. In this review, we summarize novel pretransplant initiatives and approaches to educate solid-organ transplant recipient candidates. First, we review approaches that may be common to all solid-organ transplants, then we summarize interventions specific to kidney, liver, lung, and heart transplant. We describe evidence that emphasizes the need for multidisciplinary approaches to transplant education. We also summarize initiatives that consider online (eHealth) and mobile (mHealth) solutions. Finally, we highlight education initiatives that support racialized or otherwise marginalized communities to improve equitable access to solid-organ transplant. A considerable amount of work has been done in solid-organ transplant since the early 2000s with promising results. However, many studies on education for pretransplant recipient candidates involve relatively small samples and nonrandomized designs and focus on short-term surrogate outcomes. Overall, many of these studies have a high risk of bias. Frequently, interventions assessed are not well characterized or they are combined with administrative and data-driven initiatives into multifaceted interventions, which makes it difficult to assess the impact of the education component on outcomes. In the future, well-designed studies rigorously assessing well-defined surrogate and clinical outcomes will be needed to evaluate the impact of many promising initiatives.

A Randomized Controlled Trial of a Pretransplant Educational Intervention in Kidney Patients

Supplemental Digital Content is available in the text.

Poor patient knowledge about transplantation is a significant problem following kidney transplant. A video-based educational intervention was developed to supplement standard education provided by transplant teams.

Living in limbo while one's identity is changing: Patients' existential experiences 6 months after a kidney transplantation with a living donor

AIM

To investigate patients' existential experiences in everyday life after a kidney transplantation with a living donor.

DESIGN

A qualitative study anchored in a hermeneutic-phenomenological approach inspired by Ricoeur's theory of narrative and interpretation.

METHOD

Eleven patient interviews were conducted approximately 6 months after a kidney transplantation with a living donor. The interviews were conducted between August 2017-May 2019. Analysis and interpretation are based on Ricoeur's theory of interpretation.

RESULTS

Four themes were identified: Experiencing bodily vulnerability while getting back to life; Feeling guilt while experiencing gratitude; Living in limbo while one's identity is changing; and Facing the future with hope while having reservations.

CONCLUSION

This study reveals that patients experience multifaceted existential challenges in their everyday lives during the transition of the kidney transplantation process. Post-surgery complications for donors lead to feelings of guilt in patients; plus, they must adapt to a new existence, including a new identity. The patients feel they are in limbo, as they experience their existence as uncertain and their identity as unknown.

IMPACT

The study highlights a need for developing a rehabilitation programme to address the individual and various existential challenges faced by patients who need to undergo a kidney transplantation.

Validation of the Korean version of the Kidney Transplant Understanding Tool

PURPOSE

Because there are no new and validated tools that assess knowledge of kidney transplant (KT), we aimed to construct the Korean version of the Kidney Transplant Understanding Tool (K-TUT) and to validate it.

METHODS

The Korean version of the K-TUT was established based on a translation and cultural adaptation process. A total of 69 items were reviewed by eight experts in KT for content validity, and a quantitative analysis was used to assess convergent and criterion validity (correlation coefficients), internal consistency (Kuder-Richardson 20, KR-20), test-retest reliability (intraclass correlation coefficient, ICC), item difficulty, and item discrimination for 29 KT candidates and 91 KT recipients.

RESULTS

The content validity of the Korean version of the K-TUT proved to be excellent as all items; the scale-level content validity index (S-CVI) in universal average was .86 and the S-CVI in average was .98. A positive association between the scores assessed by the Korean version of the K-TUT and knowledge level of KT (r = .74 for KT candidates and r = .57 for KT recipients, both p < .001) and treatment adherence (r = .31, p = .003) was shown. The overall ICC values are .91 for KT candidates and .88 for KT recipients. The KR-20 values were .89‒.94 for KT candidates and .76‒.78 for KT recipients. The mean difficulty and discrimination were .72 and .41 for KT candidates, and .76 and .33 for KT recipients.

CONCLUSION

The Korean version of the K-TUT is proved to be a valid and reliable tool to assess KT-related knowledge in both KT candidates and recipients.

A Qualitative Study to Explore the Needs of Lung Transplant Caregivers

INTRODUCTION

Providing support throughout the lung transplant process is an intensive task, which requires a dedicated caregiver. The needs of caregivers who must relocate with their loved one receiving the transplant are currently unknown. The objective of this study is to explore experiences and perceptions of lung transplant caregivers identified from a satellite clinic to inform the development of educational resources.

METHODS

A qualitative study with a phenomenology approach was undertaken with individuals who have taken on the role of a caregiver for lung transplant candidates or recipients and must travel to the specialized transplant center. Semistructured interviews were conducted with 12 caregivers. Interviews conducted by phone were audio-recorded and then transcribed verbatim. NVivo software was used to code the data and identify emerging themes.

RESULTS

Ideas were classified into the following 4 themes: (1) the stress of being a caregiver, (2) caregivers undertake a variety of roles, (3) caregivers require support, and (4) satisfaction with health care providers. Even though the caregivers lived an average of 7.1 (standard deviation 2) hours from the surgical transplant center, all expressed satisfaction with the level of care that they received. Caregivers identified several stressors during the transplant process and described various strategies for coping.

CONCLUSION

Caregivers shared their experiences on the transplant process. It was evident that being a caregiver was a stressful and supports were necessary for those undertaking this role. These insights will help inform the development of a new educational resource for patients and caregivers.

Immunosuppression following organ transplantation. Part 2: complications and their management

Advances in the care of patients who have had a solid organ transplant has led to a growing population of post-transplant patients, who are also living for longer. As a result of their longer life expectancy, transplant recipients often face a multitude of challenges, including optimising their immunosuppressive regimens and managing potential complications. Life-threatening infections, malignancies, and organ-specific toxicities are the complications post-transplant patients commonly encounter and these complications are often associated with increased morbidity and mortality, adverse graft functioning and survival, profound impairment in the patient's quality of life, and significant healthcare burden. This article, the second of two parts, gives an overview of the issues involved in the care of patients who are receiving immunosuppressants. The common complications encountered by post-transplant patients are discussed and their assessment, management, prevention and treatment explored.

Balancing everyday life-Patients' experiences before, during and four months after kidney transplantation

AIM

To explore patients' experiences before, during and four months after kidney transplantation as a coherent process.

DESIGN

A qualitative explorative study with a phenomenological-hermeneutic approach.

METHODS

Participant observations and semi-structured interviews were used complementary. In total, 18 kidney recipients were included. Data were analysed in accordance with Ricoeur's theory of interpretation, on three levels: naïve reading, structural analysis and critical interpretation and discussion.

RESULTS

Three themes emerged: waiting time and hope during everyday life, transformation during the kidney transplantation process and towards a new everyday life with positive prospects. Going through the kidney transplantation process was challenging for the patients. Everyday life was affected through the process, and the patients had to balance the associated challenges like hope, positive prospects and health-related issues.

Patients’ Expectations for Longevity of Kidney Transplant

Introduction:

Prior to transplantation, the transplant team is responsible for transplant education and posttransplant expectations. The majority of outcomes research focuses on 1- and 3-year graft survival, with a lack of literature focused upon whether patients have a realistic understanding of how many years deceased donor kidneys can be expected to function after transplant.

Objective:

To determine whether potential kidney transplant patients’ expectations for how long a deceased donor kidney will function after transplantation differs from transplant surgeons, using quantitative analysis.

Design:

A cross-sectional survey was used with potential adult kidney transplant recipients and transplant surgeons. Patient surveys included demographics, quality-of-life questions, and questions of expectations of kidney function for deceased donor kidneys from the Kidney Donor Profile Index. The survey categorized donor organ risk as 0% to 20%, 21% to 85%, and 86% to 100%, and results were compared to responses from US Transplant Surgeons. Surgeons were contacted via e-mail using an online survey program.

Results:

Responses included 154 transplant surgeons and 172 patients. Surgeon and patient responses were compared using Fisher exact test, showing a significant difference in each of the donor organ categories. We found that 47% of patient respondents did not correctly interpret the Kidney Donor Profile Index continuum.

Conclusion:

In every organ donor category, patients had a significantly different expectation for how long a transplanted kidney will last after transplant when compared to transplant surgeons. More study is required to determine why 47% of patients did not correctly interpret the Kidney Donor Profile continuum.

Development of a patient-centered video series to improve education before kidney transplantation

BACKGROUND

Inadequate patient knowledge about transplantation can result in low patient satisfaction and contribute to poor clinical outcomes. The purpose of this patient-oriented research project was to develop an educational intervention for patients awaiting kidney transplantation.

METHODS

An educational intervention was developed by patients and health care providers, experts in medication adherence, video education, motivational psychology, and cultural education. Project objectives were defined and content was guided by a series of studies conducted with stakeholders. A review process was undertaken with additional patients, external health care providers and ninth grade high school students and edits were applied accordingly.

RESULTS

A set of six educational videos, ranging in length from 3 to 24 min, was created to describe the transplant process. The videos are patient friendly in design, and incorporate animations to explain complex information to accommodate low health literacy, and patient testimonials align the content with principles of adult learning theory. Feedback from external patient reviews [n = 8], external care providers [n = 13] and students [n = 26], indicate that the mini-series is informative and useful.

CONCLUSION

Patient involvement significantly influenced the development of a video series about kidney transplantation.

PRACTICE IMPLICATIONS

Patient engagement is integral for developing high quality and relevant educational interventions.