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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 DOI: 10.1053/j.ajkd.2019.03.430] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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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McSorley AMM, Peipert JD, Gonzalez C, Norris KC, Goalby CJ, Peace LJ, Waterman AD. Dialysis Providers’ Perceptions of Barriers to Transplant for Black and Low-Income Patients: A Mixed Methods Analysis Guided by the Socio-Ecological Model for Transplant. World Medical & Health Policy 2017. [DOI: 10.1002/wmh3.251] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Waterman AD, McSorley AMM, Peipert JD, Goalby CJ, Peace LJ, Lutz PA, Thein JL. Explore Transplant at Home: a randomized control trial of an educational intervention to increase transplant knowledge for Black and White socioeconomically disadvantaged dialysis patients. BMC Nephrol 2015; 16:150. [PMID: 26316264 PMCID: PMC4552175 DOI: 10.1186/s12882-015-0143-0] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 08/07/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Compared to others, dialysis patients who are socioeconomically disadvantaged or Black are less likely to receive education about deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT) before they reach transplant centers, often due to limited availability of transplant education within dialysis centers. Since these patients are often less knowledgeable or ready to pursue transplant, educational content must be simplified, made culturally sensitive, and presented gradually across multiple sessions to increase learning and honor where they are in their decision-making about transplant. The Explore Transplant at Home (ETH) program was developed to help patients learn more about DDKT and LDKT at home, with and without telephone conversations with an educator. METHODS AND STUDY DESIGN In this randomized controlled trial (RCT), 540 low-income Black and White dialysis patients with household incomes at or below 250 % of the federal poverty line, some of whom receive financial assistance from the Missouri Kidney Program, will be randomly assigned to one of three education conditions: (1) standard-of-care transplant education provided by the dialysis center, (2) patient-guided ETH (ETH-PG), and (3) health educator-guided ETH (ETH-EG). Patients in the standard-of-care condition will only receive education provided in their dialysis centers. Those in the two ETH conditions will receive four video and print modules delivered over an 8 month period by mail, with the option of receiving supplementary text messages weekly. In addition, patients in the ETH-EG condition will participate in multiple telephonic educational sessions with a health educator. Changes in transplant knowledge, decisional balance, self-efficacy, and informed decision making will be captured with surveys administered before and after the ETH education. DISCUSSION At the conclusion of this RCT, we will have determined whether an education program administered to socioeconomically disadvantaged dialysis patients, over several months directly in their homes, can help more individuals learn about the options of DDKT and LDKT. We also will be able to examine the efficacy of different educational delivery approaches to further understand whether the addition of a telephone educator is necessary for increasing transplant knowledge. TRIAL REGISTRATION ClinicalTrials.gov, NCT02268682.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Anna-Michelle M McSorley
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
| | - John D Peipert
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Christina J Goalby
- Division of Nephrology, David Geffen School of Medicine at University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA, 90024, USA.
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
| | - Leanne J Peace
- Missouri Kidney Program, University of Missouri, Columbia, AP Green Building, Suite 111, 201 Business Loop-70 W, Columbia, MO, 65211, USA.
| | - Patricia A Lutz
- Missouri Kidney Program, University of Missouri, Columbia, AP Green Building, Suite 111, 201 Business Loop-70 W, Columbia, MO, 65211, USA.
| | - Jessica L Thein
- Division of General Medical Sciences, Washington University School of Medicine, Campus Box 8005, 660 S. Euclid Ave., St. Louis, MO, 63110, USA.
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Waterman AD, Peipert JD, Goalby CJ, Dinkel KM, Xiao H, Lentine KL. Assessing Transplant Education Practices in Dialysis Centers: Comparing Educator Reported and Medicare Data. Clin J Am Soc Nephrol 2015; 10:1617-25. [PMID: 26292696 DOI: 10.2215/cjn.09851014] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 05/22/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The Centers for Medicare & Medicaid Services (CMS) requires that dialysis centers inform new patients of their transplant options and document compliance using the CMS-2728 Medical Evidence Form (Form-2728). This study compared reports of transplant education for new dialysis patients reported to CMS with descriptions from transplant educators (predominantly dialysis nurses and social workers) of their centers' quantity of and specific educational practices. The goal was to determine what specific transplant education occurred and whether provision of transplant education was associated with center-level variation in transplant wait-listing rates. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Form-2728 data were drawn for 1558 incident dialysis patients at 170 centers in the Heartland Kidney Network (Iowa, Kansas, Missouri, and Nebraska) in 2009-2011; educators at these centers completed a survey describing their transplant educational practices. Educators' own survey responses were compared with Form-2728 reports for patients at each corresponding center. The association of quantity of transplant education practices used with wait-listing rates across dialysis centers was examined using multivariable negative binomial regression. RESULTS According to Form-2728, 77% of patients (n=1203) were informed of their transplant options within 45 days. Educators, who reported low levels of transplant knowledge themselves (six of 12 questions answered correctly), most commonly reported giving oral recommendations to begin transplant evaluation (988 informed patients educated, 81% of centers) and referrals to external transplant education programs (959 informed patients educated, 81% of centers). Only 18% reported having detailed discussions about transplant with their patients. Compared with others, centers that used more than three educational activities (incident rate ratio, 1.36; 95% confidence interval, 1.07 to 1.73) had higher transplant wait-listing rates. CONCLUSIONS While most educators inform new patients that transplant is an option, dialysis centers with higher wait-listing rates use multiple transplant education strategies.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri;
| | - John D Peipert
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | - Christina J Goalby
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California; Division of General Medical Sciences, Washington University School of Medicine, St. Louis, Missouri
| | | | - Huiling Xiao
- Center for Outcomes Research and Abdominal Transplantation Center, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Krista L Lentine
- Center for Outcomes Research and Abdominal Transplantation Center, Saint Louis University School of Medicine, St. Louis, Missouri
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Waterman AD, Robbins ML, Paiva AL, Peipert JD, Kynard-Amerson CS, Goalby CJ, Davis LA, Thein JL, Schenk EA, Baldwin KA, Skelton SL, Amoyal NR, Brick LA. Your Path to Transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant. BMC Nephrol 2014; 15:166. [PMID: 25315644 PMCID: PMC4213461 DOI: 10.1186/1471-2369-15-166] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 09/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients' knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention. METHODS/DESIGN Nine hundred Black, Hispanic, and White ESRD patients presenting for transplant evaluation at University of California, Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) will be randomly assigned to one of two education conditions, YPT or Usual Care Control Education (UC). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored telephonic coaching sessions, feedback reports, video and print transplant education resources, and assistance with reducing any known socioeconomic barriers to LDKT. Patients receiving UC will only receive transplant education provided by UCLA-KPTP. Changes in transplant knowledge, readiness, pros and cons, and self-efficacy to pursue LDKT will be assessed prior to presenting at the transplant center (baseline), during transplant evaluation, and 4- and 8-months post-baseline, while completion of transplant evaluation and receipt of LDKTs will be assessed at 18-months post-baseline. The RCT will determine, compared to UC, whether Black, Hispanic, and White patients receiving YPT increase in their readiness to pursue LDKT and transplant knowledge, and become more likely to complete transplant medical evaluation and pursue LDKT. It will also examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with YPT to affect patients' transplant decision-making and behavior. Statistical analyses will be performed under an intent-to-treat approach. DISCUSSION At the conclusion of the study, we will have assessed the effectiveness of an innovative and cost-effective YPT intervention that could be utilized to tailor LDKT discussion and education based on the needs of individual patients of different races in many healthcare settings. TRIAL REGISTRATION ClinicalTrials.gov, number NCT02181114.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine at the University of California, Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA 90024, USA.
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