Recommendations for Systematizing Transplant Education Within a Care Delivery System for Patients With Chronic Kidney Disease Stages 3 to 5

CONTEXT

Early tailored transplant education could help patients make informed transplant choices.

OBJECTIVE

We interviewed 40 patients with chronic kidney disease (CKD) stages 3 to 5, 13 support persons, and 10 providers at Kaiser Permanente Southern California to understand: (1) barriers to transplant education and (2) transplant educational preferences and recommendations based on CKD stage and primary language spoken.

DESIGN

A grounded theory analysis identified central themes related to transplant education barriers, preferences, and recommendations.

RESULTS

Barriers included confusion about diagnosis and when transplant may be necessary, concerns about transplant risks, families' lack of transplant knowledge, financial burdens, transportation and scheduling, and the emotional overload of chronic illness. Hispanic and Spanish-speaking participants reported difficulty in understanding transplant education and medical mistrust. Recommendations included providing general education, earlier introduction to transplant, wait-listing information, transplant education for support persons, living donation education for patients and potential donors, opportunities to meet living donors and kidney recipients, information on the benefits of transplant, recovery, and available financial resources, flexible class scheduling, online and print resources, and more provider follow-up. Spanish-speaking and Hispanic participants recommended using bilingual educators, print, video, and online resources in Spanish, and culturally responsive education. Patients with CKD stages 3 to 4 wanted information on slowing disease progression and avoiding transplant.

CONCLUSION

Increasing access to culturally responsive transplant education in multiple languages, pairing appropriate content to the disease stage, and increasing system-wide follow-up as the disease progresses might help patients make more informed choices about transplant.

A randomized controlled trial of Explore Transplant at Home to improve transplant knowledge and decision-making for CKD 3-5 patients at Kaiser Permanente Southern California

Background

Five-year survival on dialysis is only 40%, compared to 74% with a deceased donor kidney transplant (DDKT) and 87% with a living donor kidney transplant (LDKT). An American Society of Transplantation (AST) Consensus Conference recommended that patients with chronic kidney disease (CKD) Stages 3–5 have the opportunity to learn about and decide which treatment option is right for them, particularly about LDKT. However, early education about LDKT and DDKT outside of transplant centers is inconsistent and often poor, with patients in CKD 3 and 4 and ethnic/racial minorities even less likely to receive it. A new randomized control trial (RCT), in partnership with Kaiser Permanente Southern California (KPSC), will assess knowledge gaps and the effectiveness of a supplementary video-guided, print and technology-based education intervention for English- and Spanish-speaking patients in CKD Stages 3, 4, and 5 to increase LDKT knowledge and decision-making. To date, no published LDKT educational interventions have studied such a large and diverse CKD population.

Methods

In this RCT, 1200 English and Spanish-speaking CKD Stage 3–5 patients will be randomly assigned to one of two education conditions: ET@Home or KPSC standard of care education. Randomization will be stratified by CKD stage and primary language spoken. Those in the ET@Home condition will receive brochures, postcards, DVDs, and text messages delivering educational content in modules over a six-month period. Baseline data collection will measure demographics, transplant derailers, and the amount of previous CKD and transplant education they have received. Changes in CKD and transplant knowledge, ability to make an informed decision about transplant, and self-efficacy to pursue LDKT will be captured with surveys administered at baseline and at six months.

Discussion

At the conclusion of the study, investigators will understand key knowledge gaps for patients along the CKD continuum and between patients who speak different languages and have assessed the effectiveness of both English- and Spanish-language supplementary education in increasing KPSC patients’ knowledge about the opportunities for and risks and benefits of LDKT. We hope this program will reduce disparities in access to transplant.

Trial Registration

ClinicalTrials.gov Identifier: NCT03389932; date registered: 12/26/2017.

Teaching interpersonal communication skills in paediatrics with the help of mothers

Medical students were randomly assigned by two groups. The experimental or Family Health Project (FHP) group was given a short training course in conducting a first interview, which incorporated the content of the paediatric history as well as the process of the interview. Students in the FHP and control of Community Care (CC) groups conducted a videotaped interview with a mother of a child. The students viewed themselves on a replay and were given feedback information on their performance during the interview. An objective content checklist was used to assess the content of the interview. For the process of the interview all the videotapes were rated by the mothers, using the Flanders method of interaction analysis modified by Helfer. Significant differences were noted between the FHP and CC groups, which have implications for patient compliance and satisfaction. Medical students were enthusiastic about this form of learning.

An innovation in an undergraduate paediatric teaching programme

The reasons for removal of children into care and the effects of institutionalization are described. Medical students were attached to children's institutions and played various roles in befriending individual children, caring for groups of children, undertaking health education, and monitoring growth and development. The majority of students became committed to assisting the children and, simultaneously, the learning objectives were fulfilled. The programme has potential as a learning experience and a community service.

Attitudes of medical students to a family attachment scheme

A family attachment scheme is described, in which a few fourth-year students followed-up the babies they delivered during their obstetric training until the final year of study. Fifth-year students visited families of a normal newborn infant or a child who had presented with an illness or abnormality until the end of their final year. Some students felt that the project had been worth while, while others thought that it was pointless. Families visited by the students thought the scheme had been beneficial, mainly because the student was somebody they could talk to about their problems.