Preliminary feasibility of animated video education designed to empower patients' referral to kidney transplantation

Informing transplant candidate and donor education in living kidney donation: mapping educational needs through a rapid review

OBJECTIVES

Living donor kidney transplantation (LDKT) is a complex medical procedure requiring extensive education for both donors and transplant candidates. With technological advances in healthcare, video educational resources are becoming more widely used. This study aimed to synthesize the existing qualitative evidence on LDKT educational experiences, preferences, and needs from the perspectives of kidney transplant candidates and recipients, donors, and HCPs, to establish the essential LDKT education considerations for candidates and potential donors interested in kidney transplantation.

METHODS

A rapid review of qualitative studies on LDKT educational needs was conducted. A literature search was undertaken across MEDLINE, Embase, and CINAHL databases from 2013 to 2023. Cochrane Rapid Reviews Methods Group guidance was utilized.

RESULTS

Of 1,802 references, 27 qualitative studies were eligible for inclusion. Qualitative data was analyzed from 803 transplant candidates/recipients, 512 living donors, 104 healthcare providers, and 102 family/friends. Three main themes were identified, including Extensive LDKT Education Throughout Treatment; Shared Learning, Social Support, and Family Dynamics in LDKT; and Diversity and Inclusivity for Minorities.

CONCLUSIONS

Improvements and innovations are needed regarding LDKT education for kidney transplant candidates, donors, and support networks.

Impact of simulated animated video education on patients' disease uncertainty, anxiety, and sleep quality in digestive endoscopy examination

BACKGROUND

Gastrointestinal endoscopy examinations were commonly associated with patient uncertainty, anxiety, and sleep disturbances. Simulated animated video education has emerged as a potential intervention to address these psychosocial aspects in the healthcare setting. This study explores the impact of simulated animated video education on patients' disease uncertainty, anxiety, and sleep quality in the context of digestive endoscopy examinations.

METHODS

A total 166 patients who underwent digestive endoscopy examinations were conducted and divided into the conventional education group (n = 77) and the simulated animated video education group (n = 89). Disease uncertainty was assessed using the Mishel's Uncertainty in Illness Scale (MUIS), anxiety was evaluated using the Hamilton Anxiety Rating Scale (HAMA), and sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI).

RESULTS

Both conventional and simulated animated video education interventions led to a reduction in disease uncertainty, anxiety levels, and improvement in sleep quality post-education and at the one-month follow-up. However, the simulated animated video education group exhibited greater reductions in disease uncertainty (post-education: 86.69 ± 2.65 vs. 85.65 ± 3.46, P = 0.031; follow-up: 82.57 ± 4.57 vs. 81.21 ± 3.69, P = 0.038), anxiety (post-education: 19.88 ± 3.78 vs.18.75 ± 3.42, P = 0.046; follow-up: 18.59 ± 3.4 vs. 17.54 ± 3.25, P = 0.046), and improvement in sleep quality (post-education: 5.57 ± 1.25 vs. 5.15 ± 1.1, P = 0.023; follow-up: 5.22 ± 1.13 vs. 4.89 ± 0.86, P = 0.038) compared to the conventional education group.

CONCLUSION

The study findings suggest that simulated animated video education was associated with reduced disease uncertainty, alleviated anxiety, and improved sleep quality among patients undergoing gastrointestinal endoscopy.

Using Animation to Address Disparities in Kidney Transplantation

This essay reviews an arts-based project based in Buffalo, New York, seeking to educate patients with kidney failure and their social network about the transplantation process. Through a multi-phase arts-based research project, informed by a community-based steering committee and key stakeholders, 33 educational animated videos were developed and tested for efficacy in samples of diverse patients at a regional transplant center. Animation was chosen for its potential to better explain health concepts more sensibly to patients and support knowledge dissemination to their social network, who may donate a kidney or support a recipient or donor. The videos are 2D, short in duration, and designed for easy viewing on small devices using characters, scenes, narration, and movement. Aesthetic choices reinforce learning: characters have confident posture, memorable features (e.g. hair style, clothing color) with minimal detail, and model diverse races, ethnicities, gender, and body types. Scenes feature light backgrounds, illuminate main images, and are as large as possible for small screens. Narration is slow, calm, and uses strategic pauses to introduce concepts. Movement is selective to reinforce the message (signaling). The animation was guided by self-efficacy theory and the cognitive theory of multimedia learning. Findings to date indicate promising results with respect to patient knowledge and the feasibility of using animation to address disparities in kidney transplantation. Figures illustrate the evolution of the project and provide examples of the art used to capture a given aspect of the transplantation process.

Lower access to kidney transplantation for women in France is not explained by comorbidities and social deprivation

BACKGROUND

Access to kidney transplantation (KT) remains challenging for patients with end-stage kidney disease. This study assessed women's access to KT in France by considering comorbidities and neighbourhood social deprivation.

METHODS

All incident patients 18-85 years old starting dialysis in France between 1 January 2017 and 31 December 2019 were included. Three outcomes were assessed: access to the KT waiting list after dialysis start, KT access after waitlisting and KT access after dialysis start. Cox and Fine-Gray models were used. Gender-European Deprivation Index and gender-age interactions were tested and analyses were performed among strata if required.

RESULTS

A total of 29 395 patients were included (35% of women). After adjusting for social deprivation and comorbidities, women were less likely to be waitlisted at 1 year {adjusted hazard ratio [adjHR] 0.91 [95% confidence interval (CI) 0.87-0.96]} and 3 years [adjHR 0.87 (95% CI 0.84-0.91)] after dialysis initiation. This disparity concerned mainly women ≥60 years of age [adjHR 0.76 (95% CI 0.71-0.82) at 1 year and 0.75 (0.71-0.81) at 3 years]. Access to KT after 2 years of waitlisting was similar between genders. Access to KT was similar between genders at 3 years after dialysis start but decreased for women after 4 years [adjHR 0.93 (95% CI 0.88-0.99)] and longer [adjHR 0.90 (95% CI 0.85-0.96)] follow-up.

CONCLUSIONS

In France, women are less likely to be waitlisted and undergo KT. This is driven by the ≥60-year-old group and is not explained by comorbidities or social deprivation level.

Preliminary Evaluation of 2 Patient-Centered Educational Animations About Kidney Transplant Complications

BACKGROUND Fear of kidney transplant complications and incomplete information can lower transplant acceptance and preparedness. Our group developed 2 patient-centered educational animated videos on common kidney transplant complications to complement a previously developed video-based curriculum intended to promote kidney transplant access. MATERIAL AND METHODS We preliminarily evaluated the 2 animated educational videos at a single center using mixed methods. We conducted a before-and-after single group study with 22 patients after kidney transplantation to measure the videos' acceptability and feasibility to improve patient knowledge, understanding, and concerns of kidney transplant complications. Concurrently, we individually interviewed 12 patients before kidney transplantation about their perceptions of the 2 videos and analyzed the data thematically. RESULTS Knowledge of kidney transplant complications increased 10% (7.82 to 8.59, P=0.002) from before to after video viewing. Large effect size increases for knowledge were found for different strata of age, race, and health literacy. The mean total score for perceived understanding of kidney transplant complications increased after video exposure by 7% (mean 2.48 to 2.66, P=0.184). There was no change in kidney transplant concern scores from before to after video viewing (mean 1.70 to 1.70, P=1.00). After video viewing, all patients reported positive ratings on comfort watching, understanding, and engaging. Three themes of patient perceptions emerged: (1) messages received as intended, (2) felt informed, and (3) scared but not deterred. CONCLUSIONS Two animated educational videos about kidney transplant complications were well received and promise to positively impact individuals' knowledge and understanding, without raising excessive concerns.