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Brand S, Daga S, Mistry K, Morsy M, Bagul A, Hamer R, Malik S. Sikh and Muslim perspectives on kidney transplantation: phase 1 of the DiGiT project - a qualitative descriptive study. BMJ Open 2023; 13:e059668. [PMID: 38040423 PMCID: PMC10693862 DOI: 10.1136/bmjopen-2021-059668] [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: 03/24/2022] [Accepted: 10/06/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVES Kidney transplantation offers patients better quality of life and survival compared with dialysis. The risk of end stage renal disease is higher among ethnic minorities and they experience longer wait times on transplant lists. This inequality stems from a high need for kidney transplantation combined with a low rate of deceased donation among ethnic minority groups. This study aimed to explore the perspectives around living donor kidney transplantation of members of the Sikh and Muslim communities with an aim to develop a digital intervention to overcome any barriers. DESIGN A qualitative descriptive study using in person focus groups. SETTING University Teaching Hospital and Transplant Centre. PARTICIPANTS Convenience sampling of participants from the transplant population. Three focus groups were held with 20 participants, all were of South Asian ethnicity belonging to the Sikh and Muslim communities. METHODS Interviews were digitally audio-recorded and transcribed verbatim; transcripts were analysed thematically. RESULTS Four themes were identified: (a) religious issues; (b) lack of knowledge within the community; (c) time; (d) cultural identification with transplantation. CONCLUSIONS Not only is the information given and when it is delivered important, but also the person giving the information is crucial to enhance consideration of live donor kidney transplantation. Information should be in a first language where possible and overtly align to religious considerations. A more integrated approach to transplantation counselling should be adopted which includes healthcare professionals and credible members of the target cultural group. TRIAL REGISTRATION NUMBER NCT04327167.
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Affiliation(s)
- Sarah Brand
- Department of Nephrology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Sunil Daga
- Department of Nephrology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kirit Mistry
- South Asian Health Action Charity, Leicester, UK
| | - Mohamed Morsy
- Department of Nephrology and Transplantation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Atul Bagul
- Department of Nephrology and Transplantation, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Rizwan Hamer
- Department of Renal Transplantation and Nephrology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Shafi Malik
- Department of Nephrology and Transplantation, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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Wesselman H, Ford CG, Leyva Y, Li X, Chang CCH, Dew MA, Kendall K, Croswell E, Pleis JR, Ng YH, Unruh ML, Shapiro R, Myaskovsky L. Social Determinants of Health and Race Disparities in Kidney Transplant. Clin J Am Soc Nephrol 2021; 16:262-274. [PMID: 33509963 PMCID: PMC7863655 DOI: 10.2215/cjn.04860420] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 11/16/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Black patients have a higher incidence of kidney failure but lower rate of deceased- and living-donor kidney transplantation compared with White patients, even after taking differences in comorbidities into account. We assessed whether social determinants of health (e.g., demographics, cultural, psychosocial, knowledge factors) could account for race differences in receiving deceased- and living-donor kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Via medical record review, we prospectively followed 1056 patients referred for kidney transplant (2010-2012), who completed an interview soon after kidney transplant evaluation, until their kidney transplant. We used multivariable competing risk models to estimate the cumulative incidence of receipt of any kidney transplant, deceased-donor transplant, or living-donor transplant, and the factors associated with each outcome. RESULTS Even after accounting for social determinants of health, Black patients had a lower likelihood of kidney transplant (subdistribution hazard ratio, 0.74; 95% confidence interval, 0.55 to 0.99) and living-donor transplant (subdistribution hazard ratio, 0.49; 95% confidence interval, 0.26 to 0.95), but not deceased-donor transplant (subdistribution hazard ratio, 0.92; 95% confidence interval, 0.67 to 1.26). Black race, older age, lower income, public insurance, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, less transplant knowledge, and fewer learning activities were each associated with a lower probability of any kidney transplant. Older age, more comorbidities, being transplanted before changes to the Kidney Allocation System, greater religiosity, less social support, and fewer learning activities were each associated with a lower probability of deceased-donor transplant. Black race, older age, lower income, public insurance, higher body mass index, dialysis before kidney transplant, not presenting with a potential living donor, religious objection to living-donor transplant, and less transplant knowledge were each associated with a lower probability of living-donor transplant. CONCLUSIONS Race and social determinants of health are associated with the likelihood of undergoing kidney transplant.
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Affiliation(s)
- Hannah Wesselman
- Department of Biological Sciences, University of Notre Dame, Notre Dame, Indiana
| | - Christopher Graham Ford
- Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Yuridia Leyva
- Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Xingyuan Li
- Eli Lilly and Company, Indianapolis, Indiana
| | - Chung-Chou H. Chang
- Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania,Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Kellee Kendall
- Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Emilee Croswell
- Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - John R. Pleis
- Division of Research and Methodology, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland
| | - Yue Harn Ng
- Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico
| | - Mark L. Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, New York
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico,Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico
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Locke JE, Mehta S, Sawinski D, Gustafson S, Shelton BA, Reed RD, MacLennan P, Bolch C, Durand C, Massie A, Mannon RB, Gaston R, Saag M, Overton T, Segev DL. Access to Kidney Transplantation among HIV-Infected Waitlist Candidates. Clin J Am Soc Nephrol 2017; 12:467-475. [PMID: 28232406 PMCID: PMC5338712 DOI: 10.2215/cjn.07460716] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/02/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney transplantation among HIV-infected patients with ESRD confers a significant survival benefit over remaining on dialysis. Given the high mortality burden associated with dialysis, understanding access to kidney transplantation after waitlisting among HIV+ candidates is warranted. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Data from the Scientific Registry of Transplant Recipients were linked to Intercontinental Marketing Statistics pharmacy fills (January 1, 2001 to October 1, 2012) so that we could identify and study 1636 HIV+ (defined as having filled one or more antiretroviral medications unique to HIV treatment) and 72,297 HIV- kidney transplantation candidates. RESULTS HIV+ waiting list candidates were more often young (<50 years old: 62.7% versus 37.6%; P<0.001), were more often men (75.2% versus 59.3%; P<0.001), were more often black (73.6% versus 27.9%; P<0.001), had longer time on dialysis (years: 2.5 versus 0.8; P<0.001), were more often coinfected with hepatitis C virus (9.0% versus 3.9%; P<0.001), and were less likely to remain active on the waiting list (37.7% versus 49.4%; P<0.001). Waitlist mortality among HIV+ candidates was similar compared with HIV- candidates (adjusted hazard ratio, 1.03; 95% confidence interval, 0.89 to 1.20; P=0.67). In contrast, likelihood of living donor kidney transplantation was 47% lower (adjusted hazard ratio, 0.53; 95% confidence interval, 0.44 to 0.64; P<0.001), and there was a trend toward lower likelihood of deceased donor kidney transplantation (adjusted hazard ratio, 0.87; 95% confidence interval, 0.74 to 1.01; P=0.07) compared with in HIV- candidates. CONCLUSIONS Our findings highlight the need for additional study to better understand disparities in access to kidney transplantation, particularly living donor kidney transplantation, among HIV+ kidney waitlist candidates.
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Affiliation(s)
| | - Shikha Mehta
- Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Deirdre Sawinski
- Department of Medicine, University of Pennsylvania Comprehensive Transplant Center, Philadelphia, Pennsylvania
| | - Sally Gustafson
- Department of Analytics, Scientific Registry of Transplant Recipients, Minneapolis, Minnesota; and Departments of
| | | | | | | | - Charlotte Bolch
- Department of Analytics, Scientific Registry of Transplant Recipients, Minneapolis, Minnesota; and Departments of
| | | | - Allan Massie
- Surgery, Johns Hopkins University Comprehensive Transplant Center, Baltimore, Maryland
| | - Roslyn B. Mannon
- Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Robert Gaston
- Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Michael Saag
- Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Turner Overton
- Medicine, University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama
| | - Dorry L. Segev
- Surgery, Johns Hopkins University Comprehensive Transplant Center, Baltimore, Maryland
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Marlow NM, Kazley AS, Chavin KD, Simpson KN, Balliet W, Baliga PK. A patient navigator and education program for increasing potential living donors: a comparative observational study. Clin Transplant 2016; 30:619-27. [PMID: 26928471 DOI: 10.1111/ctr.12728] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Person-centered clinical environments may promote living donation for patients with end-stage renal disease (ESRD). We implemented an observational study design to explore whether a patient navigator (PN) program with person-centered education in nephrology practice settings could increase potential living donors (PLDs) and, subsequently, increase living transplantation. DESIGN, SETTING, PARTICIPANTS, AND MEASURES Patients referred to (N = 4621) and/or transplanted at (N = 950) our transplant center during 2007-2012 were eligible for inclusion. Two analytical study populations were derived from propensity score matched patient groups. Outcomes comprised total PLDs per candidate and living vs. deceased transplantation for recipients. RESULTS Multivariable generalized estimating equations logistic regression showed that PN practice candidates were significantly more likely to have an initial inquiry PLD (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.01-1.44) and a preliminary screening PLD (OR = 1.27, 95% CI = 1.05-1.54), while there were no significant differences observed in evaluated PLD (OR = 0.94, 95% CI = 0.61-1.45). CONCLUSIONS Our results suggest that our person-centered PN program stimulated willingness to seek living transplantation and was associated with a trend toward increased LD.
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Affiliation(s)
- Nicole M Marlow
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA
| | - Abby S Kazley
- Department of Healthcare Leadership and Management, College of Health Professions, Charleston, SC, USA
| | - Kenneth D Chavin
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Kit N Simpson
- Department of Healthcare Leadership and Management, College of Health Professions, Charleston, SC, USA
| | - Wendy Balliet
- Division of Bio-behavioral Medicine, Psychiatry and Behavioral Science, Medical University of South Carolina, Charleston, SC, USA
| | - Prabhakar K Baliga
- Division of Transplant Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC, USA
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Traino HM, Nonterah CW, Cyrus JW, Gillespie A, Urbanski M, Adair-Kriz M. Disparities in the completion of steps to kidney transplantation: protocol for a systematic review. BMJ Open 2015; 5:e008677. [PMID: 26351187 PMCID: PMC4563220 DOI: 10.1136/bmjopen-2015-008677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/19/2015] [Accepted: 08/21/2015] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Disparities in access to transplantation have been well documented. The extant literature, however, focuses largely on disparities and related barriers for African-American patients and none has used the steps to transplantation as a guiding framework. This review will catalogue disparities in the steps to transplantation as well as the barriers and facilitators to completion of each step identified in the extant literature. The results of the review will be used to generate recommendations for future research to improve equity in access to kidney transplantation. METHODS AND ANALYSIS Standard procedures will be used in the conduct of the review. Searches will be performed using the following electronic databases: PubMed/Medline, PsycINFO, CINHAL, EMBASE, Cochrane library and Web of Science. Reports of original research will be eligible for inclusion if they are published from 2005 to present, written or available in English language, performed in the USA, enrol adult participants (18 years of age or more), and employ descriptive or observational designs. Two authors will independently screen retrieved articles for inclusion. MaxQDA will be used for data analysis and management. All included reports will be coded for article characteristics; disparities identified; barriers and motivators of completion of steps to transplantation; and proposed solutions to disparities and barriers. Each report will be coded independently by two authors and discrepancies resolved by discussion among the full team. A qualitative approach to data analysis is planned. Risk of bias will be assessed using standard procedures. ETHICS AND DISSEMINATION The findings will provide crucial information on the current status of disparities in access to transplantation. PRISMA guidelines will be followed in reporting the results of the review. It is anticipated that these results will inform research which seeks to increase parity in access to transplantation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014015027.
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Affiliation(s)
- Heather M Traino
- Department of Social & Behavioral Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Camilla W Nonterah
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - John W Cyrus
- Tomkins-McCaw Library Virginia Commonwealth University, Richmond, Virginia, USA
| | - Avrum Gillespie
- Department of Medicine Section of Nephrology Hypertension and Kidney Transplantation, Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - Megan Urbanski
- Department of Social & Behavioral Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Michael Adair-Kriz
- Department of Public Health, Temple University, Philadelphia, Pennsylvania, USA
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6
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Sieverdes JC, Nemeth LS, Magwood GS, Baliga PK, Chavin KD, Ruggiero KJ, Treiber FA. African American kidney transplant patients' perspectives on challenges in the living donation process. Prog Transplant 2015; 25:164-75. [PMID: 26107278 PMCID: PMC4929989 DOI: 10.7182/pit2015852] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT The increasing shortage of deceased donor kidneys suitable for African Americans highlights the critical need to increase living donations among African Americans. Little research has addressed African American transplant recipients' perspectives on challenges and barriers related to the living donation process. OBJECTIVE To understand the perspectives of African American recipients of deceased and living donor kidney transplants on challenges, barriers, and educational needs related to pursuing such transplants. PARTICIPANTS AND DESIGN A mixed-method design involved 27 African American kidney recipients (13 male) in 4 focus groups (2 per recipient type: 16 African American deceased donor and 11 living donor recipients) and questionnaires. Focus group transcripts were evaluated with NVivo 10.0 (QSR, International) by using inductive and deductive qualitative methods along with crystallization to develop themes of underlying barriers to the living donor kidney transplant process and were compared with the questionnaires. RESULTS Four main themes were identified from groups: concerns, knowledge and learning, expectations of support, and communication. Many concerns for the donor were identified (eg, process too difficult, financial burden, effect on relationships). A general lack of knowledge about the donor process and lack of behavioral skills on how to approach others was noted. The latter was especially evident among deceased donor recipients. Findings from the questionnaires on myths and perceptions supported the lack of knowledge in a variety of domains, including donors' surgical outcomes risks, costs of surgery, and impact on future health. Participants thought that an educational program led by an African American recipient of a living donor kidney transplant, including practice in approaching others, would increase the likelihood of transplant-eligible patients pursuing living donor kidney transplant.
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Affiliation(s)
- John C Sieverdes
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Lynne S Nemeth
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Gayenell S Magwood
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Prabhakar K Baliga
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Kenneth D Chavin
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Ken J Ruggiero
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Frank A Treiber
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
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7
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Marlow NM, Simpson KN, Kazley AS, Balliet WE, Chavin KD, Baliga PK. Variations in coping stages for individuals with chronic kidney disease: Results from an exploratory study with patient navigators. J Health Psychol 2014; 21:1299-310. [PMID: 25293971 DOI: 10.1177/1359105314551776] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Using a cross-sectional design, we examined coping stages (Kübler-Ross) among patients with end-stage renal disease at nephrology practices incorporating professional social workers as patient navigators, providing person-centered education and support (N = 420). We evaluated associations with behavioral counseling constructs (assess-advise-agree-assist-arrange). Coping stages comprised denial = 35.24 percent, acceptance = 24.05 percent, depression = 21.43 percent, bargaining = 12.86 percent, and anger = 6.43 percent. Compared to denial, other coping stages showed increased odds ratios for transplant referral agreement, transplant referral evaluations, understanding treatments, understanding donation procedures, plans to recruit donors, active donor recruitment, and potential living donor(s). Assessment of coping stages, and strategies to influence these, may be key factors in guiding patients to living donor kidney transplantation.
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Srinivas TR. Kidney transplant access in the Southeastern United States: the need for a top-down transformation. Am J Transplant 2014; 14:1506-11. [PMID: 24891111 DOI: 10.1111/ajt.12747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/03/2014] [Accepted: 03/03/2014] [Indexed: 01/25/2023]
Abstract
End-stage renal disease (ESRD) and poverty are highly prevalent conditions in the Southeastern United States. The American Southeast also has some of the lowest attainments of health status among its constituents. Transplantation rates are particularly low in the Southeast compared with other regions of the United States. These low kidney transplantation rates in the Southeast likely reflect poor access to medical care. This disproportionate lack of access to medical care among ESRD patients in the Southeast reflects the convergence and interaction of socioeconomic and biologic forces at the patient level interacting with the financial and organizational structure of the health-care system. Improving kidney transplant access in the Southeast will take disruptive political, financial and health system changes whose scope transcends transplant centers and dialysis units.
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Affiliation(s)
- T R Srinivas
- Transplant Nephrology Section, Division of Nephrology, Medical University of South Carolina, Charleston, SC
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9
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Traino HM. Communication self-efficacy, perceived conversational difficulty, and renal patients' discussions about transplantation. PATIENT EDUCATION AND COUNSELING 2014; 94:180-186. [PMID: 24280037 DOI: 10.1016/j.pec.2013.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 10/12/2013] [Accepted: 10/26/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Many patients with chronic and end-stage renal disease (ESRD) have reported difficulties initiating and managing discussions about kidney transplantation, particularly live donor transplantation (LDT). Limited communication has demonstrable impact on patients' access to transplantation, the duration of dialysis treatments, and the length of time awaiting a transplantable kidney. This formative study sought to identify the specific communicative and conversational elements impeding ESRD patients' discussions about transplantation to inform the design of an educational program facilitating transplant-related discussions. METHODS From March to July 2012, semi-structured telephone interviews (n=63) were conducted with ESRD patients waitlisted for kidney transplantation at one mid-Atlantic transplant center. RESULTS Although 85.7% (n=54) of patients reported holding discussions about transplantation, qualitative analyses of open-ended responses revealed that the majority (66.7%) had limited conversations. Patients reported difficulties managing a variety of logistical and content-related aspects of LDT discussions. Moderate levels of communication self-efficacy were also found (mean=19.2 out of 28); self-efficacy was highest among respondents having held discussions and was significantly related to perceived magnitude of difficulty handling conversational aspects. CONCLUSION Results support comprehensive communication skills training for ESRD patients awaiting kidney transplantation. PRACTICE IMPLICATIONS Potential topics to be included in such training are discussed.
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Affiliation(s)
- Heather M Traino
- Department of Social and Behavioral Health, Virginia Commonwealth University, Richmond, USA.
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10
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Daw J. Of kin and kidneys: do kinship networks contribute to racial disparities in living donor kidney transplantation? Soc Sci Med 2013; 104:42-7. [PMID: 24581060 DOI: 10.1016/j.socscimed.2013.11.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 10/24/2013] [Accepted: 11/21/2013] [Indexed: 11/17/2022]
Abstract
In the United States, racial disparities in kidney transplantation are large and especially stark for living donor transplants. Medical researchers frequently attribute this to the availability of medically compatible living kidney donors, who are usually kin. This paper evaluates this hypothesis by testing whether African American transplant candidates likely have lesser access to suitable living donors in their kinship networks than white candidates. This paper evaluates this hypothesis using a simulation design. Contrary to prior research on this topic, this simulation analysis concludes that black-white disparities in living donor kidney transplantation are unlikely to be the result of group differences in the availability of suitable donors. Although individual white kin are individually more likely to be suitable donors, African Americans' larger average kinship networks compensate for this difference.
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Affiliation(s)
- Jonathan Daw
- Department of Sociology, University of Alabama, Birmingham, United States; Institute of Behavioral Science and Institute for Behavioral Genetics, University of Colorado - Boulder, 483 UCB, Boulder, CO 80309-0483, United States.
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11
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Moore DR, Feurer ID, Zaydfudim V, Hoy H, Zavala EY, Shaffer D, Schaefer H, Moore DE. Evaluation of living kidney donors: variables that affect donation. Prog Transplant 2013. [PMID: 23187057 DOI: 10.7182/pit2012570] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Approximately 10000 deceased donor organs are available yearly for 85 000 US patients awaiting kidney transplant. Living kidney donation is essential to close this gap and offers better survival rates. However, nationally, 80% of potential donors evaluated fail to donate. Nurse coordinators who perform predonation screening and education need additional insight into the large number of potential donors who fail to complete the donation process. Reasons for nondonation in donor candidates undergoing medical evaluation, and variables affecting nondonation at Vanderbilt University Medical Center between 2004 and 2009 are examined. Multivariable logistic regression models are used to test the effects of age and race on donation status and reasons for nondonation. Summary data are frequencies, percentages, and means (SD). The sample included 706 candidates (63% female, 80% white; mean age, 40 [SD, 12] years). Almost half (46%) received clearance to donate. Undiagnosed hypertension (14%), abnormal glucose tolerance (10%), and protein-urea (9%) were the most prevalent medical reasons for nondonation. About 13% of candidates changed their minds during evaluation. Analyses demonstrated an increased likelihood of older candidates (P < .001) and a decreased likelihood of white candidates (P = .007) being excluded from donation. Within the nondonation group, increased age was associated with undiagnosed hypertension and abnormal glucose tolerance (both race-adjusted, P = .01). Younger candidates (race-adjusted, P = .003) and African Americans (age-adjusted, P = .04) were more likely to decide against donation. The most prevalent medical reasons for nondonation could be identified through enhanced prescreening, and improved preevaluation education could decrease nondonation rates.
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Affiliation(s)
- Deonna R Moore
- Vanderbilt University Medical Center, Nashville, TN, USA
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