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Jones EL, Shakespeare K, McLaughlin L, Noyes J. Understanding people's decisions when choosing or declining a kidney transplant: a qualitative evidence synthesis. BMJ Open 2023; 13:e071348. [PMID: 37562929 PMCID: PMC10423837 DOI: 10.1136/bmjopen-2022-071348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVES To synthesise qualitative research exploring patients' perspectives, experiences and factors influencing their decision-making preferences when choosing or declining kidney transplantation. DESIGN A qualitative evidence synthesis. DATA SOURCES Electronic databases were searched from 2000 to June 2021: PubMed, MEDLINE, CINAHL, Embase, PsycINFO, Web of Science, ProQuest Core Databases for Dissertations and Theses, and Google Scholar. ELIGIBILITY CRITERIA Qualitative studies exploring and reporting decision-making preferences of people with kidney disease, which reported influencing factors when choosing or declining kidney transplantation, published in English from high-income and middle-income countries. DATA EXTRACTION AND SYNTHESIS Titles were screened against the inclusion criteria. Thematic synthesis was done with the use of the Critical Appraisal Skills Programme qualitative checklist to assess study quality, and assessment of confidence in the qualitative findings was done using the Grading of Recommendation, Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research. FINDINGS 37 studies from 11 countries reported the perspectives of 1366 patients with kidney disease. Six descriptive themes were developed: decisional preferences influenced patients' readiness to pursue kidney transplantation, gathering sufficient information to support decision-making, navigating the kidney transplant assessment pathway, desire for kidney transplantation, opposed to kidney transplantation and uncertainties while waiting for the kidney transplant. A new enhanced theoretical model was developed to aid understanding of the complexities of decision-making in people with kidney disease, by integrating the Theory of Planned Behaviour and the Adaptive Decision Maker Framework to incorporate the novel findings. CONCLUSION The synthesis provides a better understanding of the extremely complex decision-making processes of people with kidney disease, which are aligned to their kidney transplantation preferences. Further research is needed to better understand the reasons for declining kidney transplantation, and to underpin development of personalised information, interventions and support for patients to make informed decisions when presented with kidney replacement options. PROSPERO REGISTRATION NUMBER CRD42021272588.
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Affiliation(s)
- Emma Louise Jones
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Kate Shakespeare
- Betsi Cadwaladr University Health Board, Clinical Psychology Dept, Royal Alexandra Hospital, Rhyl, UK
| | - Leah McLaughlin
- School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Jane Noyes
- School of Medical and Health Sciences, Bangor University, Bangor, UK
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Kayler LK, Breckenridge B, Thomas C, Brinser-Day S, Sierra E, Cadzow RB, Feeley TH, Tumiel-Berhalter L. Using Community-Based Participatory Research to Create Animated Videos to Attenuate Disparities in Access to Kidney Transplant Information. Prog Transplant 2023; 33:5-14. [PMID: 36514821 PMCID: PMC10997428 DOI: 10.1177/15269248221145031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Introduction: Community-based participatory research and animated video offer promising approaches to attenuate disparities in access to kidney transplant information. Project Aims: We refined an evidence-based animated video curriculum (Kidney Transplant and Donation Information Made Easy) designed for diverse individuals, that is currently being trialed to advance kidney transplant access among referred patients at a single transplant center, to further accommodate information needs in earlier stages of the path to transplant (pre-referral) and to enhance fit for Black and Hispanic people. Design: We describe formation of an academic-community partnership and the application of qualitative research methods and partnership discussions to refine the Kidney Transplant and Donation Information Made Easy videos. A simple content analysis was undertaken of intervention refinement transcriptions, minutes, and meeting notes. Results: We formed a community steering committee and advisory board of local members predominantly of minoritized race or ethnicity. Full engagement with community members is evident in the program's adaptation process. Essential refinement elements were adaptation of 17 original videos and iterative development of 8 new videos with the community, conducting parallel cognitive interviews of an expanded sample of stakeholders, maintaining the theoretical grounding of Elaboration Theory, communication/multimedia learning best practices, and self-efficacy framework, and doing Spanish-language translation. Conclusions: Applying community-based participatory research principles and qualitative methods, we produced a culturally grounded adaptation of the Kidney Transplant and Donation Information Made Easy videos that provides information about kidney transplantation from primary care to transplantation. This approach is likely to strengthen our community partnership and eventual community acceptance of the intervention during the implementation phase. Challenges were achieving consensus and adding Spanish-language translation.
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Affiliation(s)
- Liise K. Kayler
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | | | - Cheryl Thomas
- Kidney Health Together Steering Committee, Buffalo, NY, USA
| | | | | | - Renee B. Cadzow
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
- Center for Doctoral Studies and Research, D’Youville University, Buffalo, NY, USA
- University at Buffalo’s Clinical and Translational Science Institute, Buffalo, NY, USA
| | - Thomas H. Feeley
- Department of Communication, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Laurene Tumiel-Berhalter
- University at Buffalo’s Clinical and Translational Science Institute, Buffalo, NY, USA
- Department of Family Medicine, University at Buffalo, State University of New York, , Buffalo, NY, USA
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Leu GR, Links AR, Park J, Beach MC, Boss EF. Parental Expression of Emotions and Surgeon Responses During Consultations for Obstructive Sleep-Disordered Breathing in Children. JAMA Otolaryngol Head Neck Surg 2021; 148:145-154. [PMID: 34882170 DOI: 10.1001/jamaoto.2021.3530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Little is known about emotional communication between parents and surgeons. Understanding the patterns and correlates of emotional communication may foster collaboration during surgical consultations. Objective To describe the emotional expressions by parents when bringing their child for evaluation of obstructive sleep-disordered breathing (SDB) as well as surgeon responses to these emotional expressions and to evaluate the association between parental demographic characteristics and surgeon response types. Design, Setting, and Participants This cross-sectional study analyzed the audio-recorded consultations between otolaryngologists and parents of children who underwent their initial otolaryngological examination for obstructive SDB at 1 of 3 outpatient clinical sites in Maryland from April 1, 2016, to May 31, 2017. Data analysis was performed from November 1 to December 31, 2019. Main Outcomes and Measures Emotional expressions by parents and surgeon responses were audio recorded, transcribed, and coded using the Verona Coding Definitions of Emotional Sequences. Results A total of 59 consultations, of which 40 (67.8%) contained at least 1 emotional expression, were included. Participants included 59 parents (53 women [89.8%]; mean [SD] age, 33.4 [6.4] years) and 7 surgeons (4 men [57.1%]; mean [SD] age, 42.8 [7.9] years). Parents made 123 distinct emotional expressions (mean [SD], 3.08 [2.29] expressions per visit), which were often expressed as subtle cues (n = 103 of 123 [83.7%]) vs explicit concerns (n = 20 [16.3%]). Most expressions (n = 98 [79.7%]) were related to medical issues experienced by the child (eg, symptoms and surgical risks). Most surgeon responses provided parents space for elaboration of emotional expressions (n = 86 [69.9%]) and were nonexplicit (n = 55 [44.7%]). Surgeons were less likely to explore the emotions of parents from racial and ethnic minority groups compared with White parents (OR, 0.47; 95% CI, 0.18-0.98). Conclusions and Relevance This cross-sectional study found that emotional communication occurs between surgeons and parents of pediatric patients with obstructive SDB. However, surgeon responses varied according to parental race and ethnicity, suggesting the existence of implicit biases in surgeon-patient communication and calling for further research to inform efforts to promote family-centered, culturally competent communication in surgery.
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Affiliation(s)
- Grace R Leu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anne R Links
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jenny Park
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Catherine Beach
- Department of Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ranahan M, Dolph B, VonVisger J, Cadzow R, Feeley T, Kayler LK. A Narrative Review of Qualitative Studies Describing Access to Kidney Transplantation. Prog Transplant 2021; 31:174-183. [PMID: 33759625 DOI: 10.1177/15269248211002804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This review used the Information-Motivation-Behavioral Skills (IMB) model of health behavior change to conceptualize the determinants of kidney transplant access behavior for adult patients with end-stage renal disease (ESRD). METHODS A narrative review of qualitative studies of patient access to kidney transplantation was undertaken. Only articles in English were accessed. The existing literature was critically analyzed using theoretical constructs of the IMB model and thematic synthesis was performed. RESULTS Results suggest patients having more information (greater transplant knowledge), more personal motivation (higher transplant outcomes expectations), more social motivation (more social and provider support), and more selfefficacy (confidence in navigating the transplant continuum) may be more likely to perform transplant access behaviors. CONCLUSION Our findings provide a framework for considering patients' levels of knowledge, motivation, and self-efficacy in future educational and behavioral interventions for ESRD patients.
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Affiliation(s)
- Molly Ranahan
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
| | - Beth Dolph
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | - Jon VonVisger
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
| | - Renee Cadzow
- Department of Health Administration & Public Health, D'Youville College, Buffalo, NY, USA
| | - Thomas Feeley
- Department of Communication, 12292University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Liise K Kayler
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
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Kayler LK, Dolph B, Ranahan M, Keller M, Cadzow R, Feeley TH. Kidney Transplant Evaluation and Listing: Development and Preliminary Evaluation of Multimedia Education for Patients. Ann Transplant 2021; 26:e929839. [PMID: 33649286 PMCID: PMC7936469 DOI: 10.12659/aot.929839] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Patient knowledge gaps about the evaluation and waitlisting process for kidney transplantation lead to delayed and incomplete testing, which compromise transplant access. We aimed to develop and evaluate a novel video education approach to empower patients to proceed with the transplant evaluation and listing process and to increase their knowledge and motivation. Material/Methods We developed 2 theory-informed educational animations about the kidney transplantation evaluation and listing process with input from experts in transplantation and communication, 20 candidates/recipients, 5 caregivers, 1 anthropologist, 3 community advocates, and 36 dialysis or transplant providers. We then conducted an online pre-post study with 28 kidney transplantation candidates to measure the acceptability and feasibility of the 2 videos to improve patients’ evaluation and listing knowledge, understanding, and concerns. Results Compared with before intervention, the mean knowledge score increased after intervention by 38% (5.7 to 7.9; P<0.001). Increases in knowledge effect size were large across age group, health literacy, education, technology access, and duration of pretransplant dialysis. The proportion of positive responses increased from before to after animation viewing for understanding the evaluation process (25% to 61%; P=0.002) and waitlist placement (32% to 86%; P<0.001). Concerns about list placement decreased (32% to 7%; P=0.039). After viewing the animations, >90% of responses indicated positive ratings on trusting the information, comfort level with learning, and engagement. Conclusions In partnership with stakeholders, we developed 2 educational animations about kidney transplant evaluation and listing that were positively received by patients and have the potential to improve patient knowledge and understanding and reduce patient concerns.
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Affiliation(s)
- Liise K Kayler
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
| | - Beth Dolph
- Department of Surgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Molly Ranahan
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
| | - Maria Keller
- Department of Community Health and Health Behavior, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Renee Cadzow
- Department of Health Administration and Public Health, D'Youville College, Buffalo, NY, USA
| | - Thomas H Feeley
- Department of Communication, University at Buffalo, State University of New York, Buffalo, NY, USA
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Educational Animations to Inform Transplant Candidates About Deceased Donor Kidney Options: An Efficacy Randomized Trial. Transplant Direct 2020; 6:e575. [PMID: 32766430 PMCID: PMC7339360 DOI: 10.1097/txd.0000000000001026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 11/01/2022] Open
Abstract
Background Transplant candidates struggle making decisions about accepting kidneys with variable kidney donor profile index (KDPI) and increased risk donor (IRD) status. Methods This single site, pilot randomized controlled trial evaluated the efficacy of 2 animations to improve KDPI/IRD knowledge, decisional self-efficacy, and willingness. Kidney candidates were randomly assigned to animation viewing plus standard nurse discussion (intervention) or standard nurse discussion alone (control). Linear regression was used to test the significance of animation exposure after controlling for covariates (α < 0.1). Results Mean age was 60 years, and 27% were African American. Both intervention (n = 42) and control (n = 38) groups received similar education at similar duration (12.8 versus 11.8 min, respectively), usually by the same dedicated nurse educator (85% versus 75%, respectively). On multivariate analysis, the intervention group (versus control) exhibited significantly increased knowledge (β = 0.23; 95% confidence interval, 0.66-1.77) and IRD willingness (β = 0.22; 95% confidence interval, 0.05-0.86). There were no between-group differences in KDPI >85% willingness or distribution of KDPI/IRD decisional self-efficacy. Over 90% of participants provided positive ratings on each of 11 acceptability items. Conclusions Supporting conventional IRD and KDPI education with educational animations can improve knowledge and IRD willingness compared with standard methods.
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