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Grossi AA, Puoti F, Masiero L, Troni A, Cianchi T, Maggiore U, Cardillo M. Inequities in Organ Donation and Transplantation Among Immigrant Populations in Italy: A Narrative Review of Evidence, Gaps in Research and Potential Areas for Intervention. Transpl Int 2023; 36:11216. [PMID: 37636900 PMCID: PMC10450150 DOI: 10.3389/ti.2023.11216] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/19/2023] [Indexed: 08/29/2023]
Abstract
Immigrants from outside Europe have increased over the past two decades, especially in Southern European countries including Italy. This influx coincided with an increased number of immigrants with end-stage organ diseases. In this narrative review, we reviewed evidence of the gaps between native-born and immigrant populations in the Organ Donation and Transplantation (ODT) process in Italy. Consistent with prior studies, despite the availability of a publicly funded health system with universal healthcare coverage, non-European-born individuals living in Italy are less likely to receive living donor kidney transplantation and more likely to have inferior long-term kidney graft function compared with EU-born and Eastern European-born individuals. While these patients are increasingly represented among transplant recipients (especially kidney and liver transplants), refusal rates for organ donation are higher in some ethnic groups compared with native-born and other foreign-born referents, with the potential downstream effects of prolonged waiting times and inferior transplant outcomes. In the process, we identified gaps in relevant research and biases in existing studies. Given the Italian National Transplant Center's (CNT) commitment to fighting inequities in ODT, we illustrated actions taken by CNT to tackle inequities in ODT among immigrant communities in Italy.
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Affiliation(s)
- Alessandra Agnese Grossi
- Center for Clinical Ethics, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
- Department of Human Sciences, Innovation and Territory, University of Insubria, Como, Italy
| | - Francesca Puoti
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Masiero
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Alessia Troni
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Tiziana Cianchi
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
| | - Umberto Maggiore
- Nephrology Unit, Dipartimento di Medicina e Chirurgia, Università di Parma, Parma, Italy
| | - Massimo Cardillo
- Italian National Transplant Center (CNT), Istituto Superiore di Sanità, Rome, Italy
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3
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Gordon EJ, Lee J, Kang R, Caicedo JC. Impact of having potential living donors on ethnic/racial disparities in access to kidney transplantation. Am J Transplant 2022; 22:2433-2442. [PMID: 35524363 PMCID: PMC9547969 DOI: 10.1111/ajt.17090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/10/2022] [Accepted: 05/03/2022] [Indexed: 01/25/2023]
Abstract
Racial/ethnic disparities persist in patients' access to living donor kidney transplantation (LDKT). This study assessed the impact of having available potential living donors (PLDs) on candidates' receipt of a kidney transplant (KT) and LDKT at two KT programs. Using data from our clinical trial of waitlisted candidates (January 1, 2014-December 31, 2019), we evaluated Hispanic and Non-Hispanic White (NHW) KT candidates' number of PLDs. Multivariable logistic regression assessed the impact of PLDs on transplantation (KT vs. no KT; for KT recipients, LDKT vs. deceased donor KT). A total of 847 candidates were included, identifying as Hispanic (45.8%) or NHW (54.2%). For Site A, both Hispanic (adjusted OR = 2.26 [95% CI 1.13-4.53]) and NHW (OR = 2.42 [1.10-5.33]) candidates with PLDs completing the questionnaire were more likely to receive a KT. For Site B, candidates with PLDs were not significantly more likely to receive KT. Among KT recipients at both sites, Hispanic (Site A: OR = 21.22 [2.44-184.88]; Site B: OR = 25.54 [7.52-101.54]), and NHW (Site A: OR = 37.70 [6.59-215.67]; Site B: OR = 15.18 [5.64-40.85]) recipients with PLD(s) were significantly more likely to receive a LDKT. Our findings suggest that PLDs increased candidates' likelihood of KT receipt, particularly LDKT. Transplant programs should help candidates identify PLDs early in transplant evaluation.
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Affiliation(s)
- Elisa J. Gordon
- Department of Surgery‐ Division of TransplantationCenter for Health Services and Outcomes ResearchCenter for Bioethics and Medical HumanitiesNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Jungwha Lee
- Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Raymond Kang
- Center for Community HealthNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
| | - Juan Carlos Caicedo
- Department of Surgery‐ Division of TransplantationNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Gordon EJ, Uriarte JJ, Anderson N, Romo E, Caicedo JC, Shumate M. Implementation and modification of an organizational-level intervention: a prospective analysis. Implement Sci Commun 2022; 3:59. [PMID: 35659156 PMCID: PMC9164326 DOI: 10.1186/s43058-022-00296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/05/2022] [Indexed: 11/12/2022] Open
Abstract
Background Modifications to interventions can jeopardize intervention outcomes. Pre-existing perceived barriers and facilitators to the intervention arising in the implementation preparation phase may help explain why modifications to the intervention may occur during the implementation phase. This two-site comparative case study describes modifications made to a complex organizational-level intervention and examines how known implementation science factors may have enabled such changes to occur. Methods Northwestern Medicine’sTM Hispanic Kidney Transplant Program (HKTP) is a culturally competent transplant center-based intervention designed to reduce disparities in living donor kidney transplantation among Hispanics. In-depth qualitative interviews and discussions were longitudinally conducted with transplant stakeholders (i.e., physicians, administrators, clinicians) at two kidney transplant programs with large Hispanic populations during implementation preparation and implementation phases. The Consolidated Framework for Implementation Research (CFIR) guided interview design and qualitative analysis, and Stirman’s Framework for Reporting Adaptations and Modifications-Expanded (FRAME) guided modification classification. Results Across sites, 57 stakeholders participated in an interview, group discussion, and/or learning collaborative discussion. Site-B made more modifications than Site-A (n = 29 versus n = 18). Sites differed in the proportions of delaying/skipping (Site-A 50% versus Site-B 28%) and adding (Site-A 11% versus Site-B 28%) but had comparable substituting (Site-A 17% versus Site-B 17%) and tweaking (Site-A 17% versus Site-B 14%) modification types. Across sites, the transplant team consistently initiated the most modifications (Site-A 66%; Site-B 62%). While individuals initiated slightly more modifications at Site-B (21% versus Site-A 17%), institutions instigated proportionately slightly more modifications at Site-A (17% versus Site-B 10%). CFIR inner setting factors (i.e., structural characteristics, culture, available resources, implementation climate) that prominently emerged during the implementation preparation phase explained similarities and differences in sites’ modification numbers, types, and agents in the implementation phase. Conclusion Organizations implementing a culturally competent care intervention made modifications. CFIR inner setting factors emerging in the implementation preparation phase largely explained similarities and differences in study sites’ modifications. Identifying factors contributing to modifications may help institutions become better prepared to implement an intervention by addressing known factors in advance, which may foster greater fidelity leading to desired outcomes. Trial registration ClinicalTrials.govNCT03276390. We registered the study retrospectively on 9-7-17. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00296-0.
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Affiliation(s)
- Elisa J Gordon
- Department of Surgery - Division of Transplantation, Center for Health Services and Outcomes Research, Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, 633 N. St. Clair, 20th Floor, Chicago, IL, 60611, USA.
| | - Jefferson J Uriarte
- Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Naomi Anderson
- School of Education and Policy, Northwestern University, Evanston, IL, USA
| | - Elida Romo
- Department of Neurology - Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - Juan Carlos Caicedo
- Department of Surgery - Division of Transplantation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michelle Shumate
- Department of Communication Studies, Northwestern University, Evanston, IL, USA
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Hamid M, Rogers E, Chawla G, Gill J, Macanovic S, Mucsi I. Pretransplant Patient Education in Solid-organ Transplant: A Narrative Review. Transplantation 2022; 106:722-733. [PMID: 34260472 DOI: 10.1097/tp.0000000000003893] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Education for pretransplant, solid-organ recipient candidates aims to improve knowledge and understanding about the transplant process, outcomes, and potential complications to support informed, shared decision-making to reduce fears and anxieties about transplant, inform expectations, and facilitate adjustment to posttransplant life. In this review, we summarize novel pretransplant initiatives and approaches to educate solid-organ transplant recipient candidates. First, we review approaches that may be common to all solid-organ transplants, then we summarize interventions specific to kidney, liver, lung, and heart transplant. We describe evidence that emphasizes the need for multidisciplinary approaches to transplant education. We also summarize initiatives that consider online (eHealth) and mobile (mHealth) solutions. Finally, we highlight education initiatives that support racialized or otherwise marginalized communities to improve equitable access to solid-organ transplant. A considerable amount of work has been done in solid-organ transplant since the early 2000s with promising results. However, many studies on education for pretransplant recipient candidates involve relatively small samples and nonrandomized designs and focus on short-term surrogate outcomes. Overall, many of these studies have a high risk of bias. Frequently, interventions assessed are not well characterized or they are combined with administrative and data-driven initiatives into multifaceted interventions, which makes it difficult to assess the impact of the education component on outcomes. In the future, well-designed studies rigorously assessing well-defined surrogate and clinical outcomes will be needed to evaluate the impact of many promising initiatives.
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Affiliation(s)
- Marzan Hamid
- Multi-Organ Transplant Program and Division of Nephrology, University Health Network, University of Toronto, Toronto, ON, Canada
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Designing a Liver Transplant Patient and Family Decision Support Tool for Organ Offer Decisions. Transplant Direct 2021; 7:e695. [PMID: 33937520 PMCID: PMC8081471 DOI: 10.1097/txd.0000000000001140] [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] [Received: 12/08/2020] [Revised: 01/21/2021] [Accepted: 01/31/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND For liver transplant candidates on the waiting list, deciding to accept a donor organ with known or potential risk factors can be stressful and can lead to declined offers. Current education for patients and family often takes place during transplant evaluations and can be overwhelming and result in low retention and poor understanding of donor quality. METHODS In the first phase, we sought to understand provider experiences when counseling patients about donor risks and donor offers. We conducted interviews and focus groups with liver transplant providers at 1 local center and at a national clinician conference. Twenty providers participated: 15 hepatologists and 5 surgeons. The provider feedback was used to create an initial outline of content that is consistent with decision support frameworks. In a second phase, graphic design collaborators created mockups of a patient-friendly tool. We reviewed mockups with 4 transplant coordinators and 9 liver transplant candidates for feedback on clarity and utility to prepare for an organ offer. Patient responses allowed a comparison of perceived readiness to receive an offer call before and after viewing mockups. RESULTS We identified themes relating to the offer process, repetition and timing of education, and standardization and tailoring of content. The results indicated a gap in available education after the evaluation session, and information specific to offer decisions is needed. Patient feedback emphasized the need to review the offer process before a real offer. CONCLUSIONS Patients and providers responded favorably to a patient tool addressing existing gaps in education while waiting for a donor offer. Additional patient, family, and provider feedback will guide the development of an interactive tool to prepare patients and families for an offer decision.
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Waterman AD, Lipsey AF, Ranasinghe ON, Wood EH, Anderson C, Bozzolo C, Henry SL, Dub B, Mittman B. Recommendations for Systematizing Transplant Education Within a Care Delivery System for Patients With Chronic Kidney Disease Stages 3 to 5. Prog Transplant 2020; 30:76-87. [PMID: 32238045 DOI: 10.1177/1526924820913520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
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.
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Affiliation(s)
- Amy D Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA.,Terasaki Research Institute, Los Angeles, CA, USA
| | | | - Omesh N Ranasinghe
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Emily H Wood
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | - Crystal Anderson
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, CA, USA
| | | | - Shayna L Henry
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Bhanuja Dub
- Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Brian Mittman
- Kaiser Permanente Southern California, Pasadena, CA, USA
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Deem MJ, Stokes F. Culture and Consent in Clinical Care: A Critical Review of Nursing and Nursing Ethics Literature. ANNUAL REVIEW OF NURSING RESEARCH 2019; 37:223-259. [PMID: 30692159 DOI: 10.1891/0739-6686.37.1.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Alhalel N, Francone NO, Salazar AM, Primeaux S, Ruiz R, Caicedo JC, Gordon EJ. Patients' perceptions of a culturally targeted Hispanic Kidney Transplant Program: A mixed methods study. Clin Transplant 2019; 33:e13577. [PMID: 31034642 DOI: 10.1111/ctr.13577] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/11/2019] [Accepted: 04/22/2019] [Indexed: 11/29/2022]
Abstract
Disproportionately fewer waitlisted Hispanics receive living donor kidney transplants (LDKTs) compared to non-Hispanic whites. Northwestern Medicine's® culturally targeted Hispanic Kidney Transplant Program (HKTP) is associated with a significant increase in LDKTs among Hispanics. This multisite study assessed potential kidney recipients' and donors' and/or family members' perceptions of the HKTP's cultural components through semi-structured interviews and validated surveys. Qualitative thematic analysis and descriptive statistics were performed. Thirty-six individuals participated (62% participation rate) comprising 21 potential recipients and 15 potential donors/family (mean age: 51 years, 50% female, 72% preferred Spanish). Participants felt confident about the educational information because a transplant physician delivered the education and viewed the group format as effective. Participants felt that education sessions addressed myths about transplantation shared by Hispanics. Primary use of Spanish enhanced participants' understanding of transplantation. While few knew about living donation before attending the HKTP, most were "more in favor of" kidney transplantation (97%) and living donation (97%) afterward. Few reported learning about the HKTP from outreach staff and suggested leveraging community leaders to promote HKTP awareness. Our findings suggest the HKTP's cultural components were viewed favorably and positively influenced perceptions of kidney transplantation and living donation, which may help reduce transplant disparities in Hispanics. (Clinicaltrial.gov registration # NCT03276390, date of registration: 9-7-17, retrospectively registered).
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Affiliation(s)
- Nathan Alhalel
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Alice M Salazar
- Abdominal Transplant Research, Baylor Scott & White Research Institute, Dallas, Texas.,Baylor Scott & White Research Institute, Dallas, Texas
| | | | - Richard Ruiz
- Baylor Simmons Transplant Institute, Dallas, Texas
| | - Juan Carlos Caicedo
- Comprehensive Transplant Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Elisa J Gordon
- Comprehensive Transplant Center, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Center for Healthcare Studies, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.,Center for Bioethics and Medical Humanities, Department of Medical Education, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Odegard M, Serrano OK, Peterson K, Mongin SJ, Berglund D, Vock DM, Chinnakotla S, Dunn TB, Finger EB, Kandaswamy R, Pruett TL, Matas AJ. Delivery of transplant care among Hmong kidney transplant recipients: Outcomes from a single institution. Clin Transplant 2019; 33:e13539. [DOI: 10.1111/ctr.13539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/26/2019] [Accepted: 03/11/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Marjorie Odegard
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Oscar K. Serrano
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Kent Peterson
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Steven J. Mongin
- Biostatistical Design and Analysis Center Clinical and Translational Science Institute Minneapolis Minnesota
| | - Danielle Berglund
- Informatics Services for Research and Reporting, Fairview Minneapolis Minnesota
| | - David M. Vock
- Division of Biostatistics, School of Public Health University of Minnesota Minneapolis Minnesota
| | | | - Ty B. Dunn
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Erik B. Finger
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Raja Kandaswamy
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Timothy L. Pruett
- Division of Transplantation Department of Surgery Minneapolis Minnesota
| | - Arthur J. Matas
- Division of Transplantation Department of Surgery Minneapolis Minnesota
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Patzer RE, McPherson L, Basu M, Mohan S, Wolf M, Chiles M, Russell A, Gander JC, Friedewald JJ, Ladner D, Larsen CP, Pearson T, Pastan S. Effect of the iChoose Kidney decision aid in improving knowledge about treatment options among transplant candidates: A randomized controlled trial. Am J Transplant 2018; 18:1954-1965. [PMID: 29446209 PMCID: PMC6510396 DOI: 10.1111/ajt.14693] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/05/2018] [Accepted: 02/04/2018] [Indexed: 01/25/2023]
Abstract
We previously developed a mobile- and web-based decision aid (iChoose Kidney) that displays individualized risk estimates of survival and mortality, for the treatment modalities of dialysis versus kidney transplantation. We examined the effect of iChoose Kidney on change in transplant knowledge and access to transplant in a randomized controlled trial among patients presenting for evaluation in three transplant centers. A total of 470 patients were randomized to standard transplantation education (control) or standard education plus iChoose Kidney (intervention). Change in transplant knowledge (primary outcome) among intervention versus control patients was assessed using nine items in pre- and postevaluation surveys. Access to transplant (secondary outcome) was defined as a composite of waitlisting, living donor inquiries, or transplantation. Among 443 patients (n = 226 intervention; n = 216 control), the mean knowledge scores were 5.1 ± 2.1 pre- and 5.8 ± 1.9 postevaluation. Change in knowledge was greater among intervention (1.1 ± 2.0) versus control (0.4 ± 1.8) patients (P < .0001). Access to transplantation was similar among intervention (n = 168; 74.3%) versus control patients (n = 153; 70.5%; P = .37). The iChoose Kidney decision aid improved patient knowledge at evaluation, but did not impact transplant access. Future studies should examine whether combining iChoose Kidney with other interventions can increase transplantation. (Clinicaltrials.gov NCT02235571).
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Affiliation(s)
- Rachel E. Patzer
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Laura McPherson
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohua Basu
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Michael Wolf
- Northwestern University Comprehensive Transplant Center, Chicago, IL, USA
| | - Mariana Chiles
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Allison Russell
- Northwestern University Comprehensive Transplant Center, Chicago, IL, USA
| | - Jennifer C. Gander
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - John J. Friedewald
- Northwestern University Comprehensive Transplant Center, Chicago, IL, USA
| | - Daniela Ladner
- Northwestern University Comprehensive Transplant Center, Chicago, IL, USA
| | - Christian P. Larsen
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Thomas Pearson
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephen Pastan
- Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Wu DA, Robb ML, Watson CJE, Forsythe JLR, Tomson CRV, Cairns J, Roderick P, Johnson RJ, Ravanan R, Fogarty D, Bradley C, Gibbons A, Metcalfe W, Draper H, Bradley AJ, Oniscu GC. Barriers to living donor kidney transplantation in the United Kingdom: a national observational study. Nephrol Dial Transplant 2018; 32:890-900. [PMID: 28379431 PMCID: PMC5427518 DOI: 10.1093/ndt/gfx036] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/09/2017] [Indexed: 02/06/2023] Open
Abstract
Background. Living donor kidney transplantation (LDKT) provides more timely access to transplantation and better clinical outcomes than deceased donor kidney transplantation (DDKT). This study investigated disparities in the utilization of LDKT in the UK. Methods. A total of 2055 adults undergoing kidney transplantation between November 2011 and March 2013 were prospectively recruited from all 23 UK transplant centres as part of the Access to Transplantation and Transplant Outcome Measures (ATTOM) study. Recipient variables independently associated with receipt of LDKT versus DDKT were identified. Results. Of the 2055 patients, 807 (39.3%) received LDKT and 1248 (60.7%) received DDKT. Multivariable modelling demonstrated a significant reduction in the likelihood of LDKT for older age {odds ratio [OR] 0.11 [95% confidence interval (CI) 0.08–0.17], P < 0.0001 for 65–75 years versus 18–34 years}; Asian ethnicity [OR 0.55 (95% CI 0.39–0.77), P = 0.0006 versus White]; Black ethnicity [OR 0.64 (95% CI 0.42–0.99), P = 0.047 versus White]; divorced, separated or widowed [OR 0.63 (95% CI 0.46–0.88), P = 0.030 versus married]; no qualifications [OR 0.55 (95% CI 0.42–0.74), P < 0.0001 versus higher education qualifications]; no car ownership [OR 0.51 (95% CI 0.37–0.72), P = 0.0001] and no home ownership [OR 0.65 (95% CI 0.85–0.79), P = 0.002]. The odds of LDKT varied significantly between countries in the UK. Conclusions. Among patients undergoing kidney transplantation in the UK, there are significant age, ethnic, socio-economic and geographic disparities in the utilization of LDKT. Further work is needed to explore the potential for targeted interventions to improve equity in living donor transplantation.
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Affiliation(s)
- Diana A Wu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Christopher J E Watson
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - John L R Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.,NHS Blood and Transplant, Bristol, UK
| | | | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Rommel Ravanan
- Department of Renal Medicine, Southmead Hospital, Bristol, UK
| | - Damian Fogarty
- Regional Nephrology and Transplant Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK
| | - Andrea Gibbons
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK
| | - Wendy Metcalfe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Heather Draper
- Health Sciences, University of Warwick, Conventry, UK (author has moved institutions since acceptance of the article)
| | - Andrew J Bradley
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
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Purnell TS, Luo X, Cooper LA, Massie AB, Kucirka LM, Henderson ML, Gordon EJ, Crews DC, Boulware LE, Segev DL. Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014. JAMA 2018; 319:49-61. [PMID: 29297077 PMCID: PMC5833543 DOI: 10.1001/jama.2017.19152] [Citation(s) in RCA: 193] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Over the past 2 decades, there has been increased attention and effort to reduce disparities in live donor kidney transplantation (LDKT) for black, Hispanic, and Asian patients with end-stage kidney disease. The goal of this study was to investigate whether these efforts have been successful. OBJECTIVE To estimate changes over time in racial/ethnic disparities in LDKT in the United States, accounting for differences in death and deceased donor kidney transplantation. DESIGN, SETTING, AND PARTICIPANTS A secondary analysis of a prospectively maintained cohort study conducted in the United States of 453 162 adult first-time kidney transplantation candidates included in the Scientific Registry of Transplant Recipients between January 1, 1995, and December 31, 2014, with follow-up through December 31, 2016. EXPOSURES Race/ethnicity. MAIN OUTCOMES AND MEASURES The primary study outcome was time to LDKT. Multivariable Cox proportional hazards and competing risk models were constructed to assess changes in racial/ethnic disparities in LDKT among adults on the deceased donor kidney transplantation waiting list and interaction terms were used to test the statistical significance of temporal changes in racial/ethnic differences in receipt of LDKT. The adjusted subhazard ratios are estimates derived from the multivariable competing risk models. Data were categorized into 5-year increments (1995-1999, 2000-2004, 2005-2009, 2010-2014) to allow for an adequate sample size in each analytical cell. RESULTS Among 453 162 adult kidney transplantation candidates (mean [SD] age, 50.9 [13.1] years; 39% were women; 48% were white; 30%, black; 16%, Hispanic; and 6%, Asian), 59 516 (13.1%) received LDKT. Overall, there were 39 509 LDKTs among white patients, 8926 among black patients, 8357 among Hispanic patients, and 2724 among Asian patients. In 1995, the cumulative incidence of LDKT at 2 years after appearing on the waiting list was 7.0% among white patients, 3.4% among black patients, 6.8% among Hispanic patients, and 5.1% among Asian patients. In 2014, the cumulative incidence of LDKT was 11.4% among white patients, 2.9% among black patients, 5.9% among Hispanic patients, and 5.6% among Asian patients. From 1995-1999 to 2010-2014, racial/ethnic disparities in the receipt of LDKT increased (P < .001 for all statistical interaction terms in adjusted models comparing white patients vs black, Hispanic, and Asian patients). In 1995-1999, compared with receipt of LDKT among white patients, the adjusted subhazard ratio was 0.45 (95% CI, 0.42-0.48) among black patients, 0.83 (95% CI, 0.77-0.88) among Hispanic patients, and 0.56 (95% CI, 0.50-0.63) among Asian patients. In 2010-2014, compared with receipt of LDKT among white patients, the adjusted subhazard ratio was 0.27 (95% CI, 0.26-0.28) among black patients, 0.52 (95% CI, 0.50-0.54) among Hispanic patients, and 0.42 (95% CI, 0.39-0.45) among Asian patients. CONCLUSIONS AND RELEVANCE Among adult first-time kidney transplantation candidates in the United States who were added to the deceased donor kidney transplantation waiting list between 1995 and 2014, disparities in the receipt of live donor kidney transplantation increased from 1995-1999 to 2010-2014. These findings suggest that national strategies for addressing disparities in receipt of live donor kidney transplantation should be revisited.
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Affiliation(s)
- Tanjala S. Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Xun Luo
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa A. Cooper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Allan B. Massie
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lauren M. Kucirka
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Macey L. Henderson
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elisa J. Gordon
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Deidra C. Crews
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - L. Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Dorry L. Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Weng FL, Peipert JD, Holland BK, Brown DR, Waterman AD. A Clustered Randomized Trial of an Educational Intervention During Transplant Evaluation to Increase Knowledge of Living Donor Kidney Transplant. Prog Transplant 2017; 27:377-385. [PMID: 29187135 DOI: 10.1177/1526924817732021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Maximizing education about living donor kidney transplant (LDKT) during the in-person evaluation at the transplant center may increase the numbers of kidney patients pursuing LDKT. Research Questions and Design: To test the effectiveness of a 1-time LDKT educational intervention, we performed a cluster-randomized trial among 499 patients who presented for evaluation of kidney transplant. We compared usual care education (n = 250) versus intensive LDKT education (n = 249), which was implemented only on the evaluation day and consisted of viewing a 25-minute video of information and stories about LDKT and discussion of LDKT possibilities with an educator. Our primary outcome was knowledge of LDKT, 1 week after the transplant evaluation. RESULTS One week after evaluation, patients who received intensive education had higher knowledge than patients who received usual care (12.7 vs. 11.7; P = .0008), but there were no differences in postevaluation readiness for LDKT. Among patients who had not previously identified a potential living donor, receiving intensive education was associated with increased willingness to take steps toward LDKT. DISCUSSION In conclusion, expansion of LDKT education within the evaluation day may be helpful, but interventions that are implemented at multiple times and for greater duration may be necessary to ensure larger and long-term behavioral changes in pursuit of LDKT.
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Affiliation(s)
- Francis L Weng
- 1 Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, Livingston, NJ, USA.,2 Rutgers School of Public Health, Piscataway, NJ, USA
| | - John D Peipert
- 3 Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | | | - Diane R Brown
- 2 Rutgers School of Public Health, Piscataway, NJ, USA
| | - Amy D Waterman
- 3 Division of Nephrology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Effect of a Mobile Web App on Kidney Transplant Candidates' Knowledge About Increased Risk Donor Kidneys: A Randomized Controlled Trial. Transplantation 2017; 101:1167-1176. [PMID: 27463536 DOI: 10.1097/tp.0000000000001273] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Kidney transplant candidates (KTCs) must provide informed consent to accept kidneys from increased risk donors (IRD), but poorly understand them. We conducted a multisite, randomized controlled trial to evaluate the efficacy of a mobile Web application, Inform Me, for increasing knowledge about IRDs. METHODS Kidney transplant candidates undergoing transplant evaluation at 2 transplant centers were randomized to use Inform Me after routine transplant education (intervention) or routine transplant education alone (control). Computer adaptive learning method reinforced learning by embedding educational material, and initial (test 1) and additional test questions (test 2) into each chapter. Knowledge (primary outcome) was assessed in person after education (tests 1 and 2), and 1 week later by telephone (test 3). Controls did not receive test 2. Willingness to accept an IRD kidney (secondary outcome) was assessed after tests 1 and 3. Linear regression test 1 knowledge scores were used to test the significance of Inform Me exposure after controlling for covariates. Multiple imputation was used for intention-to-treat analysis. RESULTS Two hundred eighty-eight KTCs participated. Intervention participants had higher test 1 knowledge scores (mean difference, 6.61; 95% confidence interval [95% CI], 5.37-7.86) than control participants, representing a 44% higher score than control participants' scores. Intervention participants' knowledge scores increased with educational reinforcement (test 2) compared with control arm test 1 scores (mean difference, 9.50; 95% CI, 8.27-10.73). After 1 week, intervention participants' knowledge remained greater than controls' knowledge (mean difference, 3.63; 95% CI, 2.49-4.78) (test 3). Willingness to accept an IRD kidney did not differ between study arms at tests 1 and 3. CONCLUSIONS Inform Me use was associated with greater KTC knowledge about IRD kidneys above routine transplant education alone.
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A Culturally Targeted Website for Hispanics/Latinos About Living Kidney Donation and Transplantation: A Randomized Controlled Trial of Increased Knowledge. Transplantation 2017; 100:1149-60. [PMID: 26444846 DOI: 10.1097/tp.0000000000000932] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hispanics/Latinos receive disproportionately fewer living donor kidney transplantations (LDKTs) than non-Hispanic whites. We conducted a multisite, randomized controlled trial to evaluate the efficacy of exposure to a bilingual, culturally targeted website, Infórmate, for increasing Hispanics' knowledge about LDKT. METHODS Hispanic patients initiating transplant evaluation and their family/friends at 2 transplant centers were randomized to view Infórmate before attending routine transplant education sessions; usual care controls only attended education sessions. All participants completed a pretest; website participants also completed a posttest immediately after viewing Infórmate. All participants completed a 3-week telephone follow-up test. Random effects linear regression of 3-week knowledge scores tested the significance of website exposure after adjusting for clustering within families and controlling for pretest scores and covariates. RESULTS Two hundred-eighty-two individuals participated (81% patient participation rate). Website exposure was associated with a mean 21.7% same day knowledge score increase between pretest and posttest (P < 0.001). At 3 weeks, website participants' knowledge scores remained 22.6% above the pretest; control scores increased to 11.8% (P = 0.0001). Regression results found that website participants were associated with a 10.0% greater knowledge score at 3-week follow-up (P < 0.0001). Most website participants (92.6%) plan to return to Infórmate in the future. CONCLUSIONS Our culturally targeted website increased participants' knowledge about LDKT above and beyond transplant education and should supplement transplant center education for Hispanics. When considered at the population level, Infórmate could have a great impact on knowledge gains in this underserved population disproportionately affected by kidney disease.
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Gordon EJ. Culturally Competent Strategies for Increasing Knowledge of Live Kidney Donation in the Hispanic Community. CURRENT TRANSPLANTATION REPORTS 2017. [DOI: 10.1007/s40472-017-0136-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gordon EJ, Shand J, Black A. Google analytics of a pilot mass and social media campaign targeting Hispanics about living kidney donation. Internet Interv 2016; 6:40-49. [PMID: 30135813 PMCID: PMC6096307 DOI: 10.1016/j.invent.2016.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 09/08/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The number of patients waiting for a kidney transplant surpasses available organs. Living donor kidney transplantation (LDKT) can expand the organ pool. However, Hispanics have lower rates of LDKT than non-Hispanic whites, largely due to a lack of awareness and knowledge about LDKT as a treatment option. To reduce this disparity about LDKT, Northwestern University faculty in partnership with the National Kidney Foundation of Illinois, developed a website culturally targeted to Hispanics about LDKT, called Infórmate. OBJECTIVE This paper describes a pilot mass media campaign about LDKT which leveraged Infórmate to provide additional education about LDKT targeting the Hispanic public in Chicago, IL. We report the impact of the campaign on visits to Infórmate. METHODS The mass media campaign was conducted in Chicago, IL from July 16, 2015 to January 17, 2016 in two waves. The campaign used traditional media, online media, and community-based venues. The campaign's bilingual (Spanish and English) messaging addressed key topics about kidney disease and LDKT, and included a call to action to visit Infórmate to learn more. Google Analytics was used to evaluate the effectiveness of the campaign's call to action by measuring the number of visits to Infórmate, visit duration, bounce rate, number of pages visited, pages most often visited, user demographics, and media channel. RESULTS Infórmate received an average of 1466 sessions per month during the entire campaign period, with a 16.7% return rate. Sessions and visitors increased during the entire campaign period compared to the pre- and post- campaign periods. Visits lasted an average of 1:26 min, with a bounce rate of 73.9% per session. Users visited an average of 1.93 pages, and the pages with the most views were Immigrant Issues and Financial Issues. Most sessions during this period occurred in the USA (69.57%) out of 100 countries, and in the city of Chicago (13.37%). Sessions were mostly conducted by men (54.1%) and people ages 18-34 (61%). Visitors accessed Infórmate primarily through their desktop computer (53.1%), and by typing the website address directly into their browser (32.78%). CONCLUSIONS Our findings suggest that our pilot mass media campaign's call to action was effective in increasing the Hispanic public's traffic to Infórmate. Google Analytics data can help to strategize future campaign messages and outlets. Future research should assess whether a theoretically-driven mass media campaign increases the Hispanic public's knowledge about LDKT, and increases rates of LDKT.
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Affiliation(s)
- Elisa J. Gordon
- Center for Healthcare Studies, Comprehensive Transplant Center, Center for Bioethics and Medical Humanities, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Corresponding author at: Center for Healthcare Studies, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, 633 N. St. Clair, 20th Floor, Chicago, IL 60611-3152, United States.
| | - Jennifer Shand
- National Kidney Foundation of Illinois, Chicago, IL 60654, USA
| | - Anne Black
- National Kidney Foundation of Illinois, Chicago, IL 60654, USA
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Rodrigue JR, Paek MJ, Schold JD, Pavlakis M, Mandelbrot DA. Predictors and Moderators of Educational Interventions to Increase the Likelihood of Potential Living Donors for Black Patients Awaiting Kidney Transplantation. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0286-0. [PMID: 27631380 PMCID: PMC5342956 DOI: 10.1007/s40615-016-0286-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 10/21/2022]
Abstract
Our aim was to identify predictors and moderators of the effects of a house calls (HC) educational intervention, relative to a group-based (GB) intervention and to individual counseling (IC), in a randomized controlled trial to increase the likelihood of having living donor (LD) evaluations initiated and live donor kidney transplantation (LDKT). Black adults wait listed for kidney transplantation (N = 152) were randomized into one of the three educational conditions. We examined demographic, clinical, psychosocial, and socio-contextual baseline characteristics as predictors and moderators of having a potential LD initiate evaluation. HC assignment (OR = 2.024.7311.05, P = 0.001), younger age (OR = 0.910.940.98, P = 0.001), more willingness to discuss donation with others (OR = 1.081.371.75, P = 0.01), and larger social network (OR = 1.011.091.18, P = 0.04) were significant multivariable predictors of having ≥1 LD initiate evaluation. Age (P = 0.03) and social network size (P = 0.02) moderated the effect of HC relative to IC and GB, but not GB relative to IC, on LD evaluation initiation. Our findings suggest that HC is most effective for patients <60 years old and those with average or large social network size.
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Affiliation(s)
- James R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, 110 Francis Street, 7th Floor, Boston, MA, 02215, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Matthew J Paek
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, 110 Francis Street, 7th Floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Martha Pavlakis
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, 110 Francis Street, 7th Floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
| | - Didier A Mandelbrot
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, 110 Francis Street, 7th Floor, Boston, MA, 02215, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
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20
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Jesse MT, Rubinstein E, Eshelman A, Wee C, Tankasala M, Li J, Abouljoud M. Lifestyle and Self-Management by Those Who Live It: Patients Engaging Patients in a Chronic Disease Model. Perm J 2016; 20:15-207. [PMID: 27455056 DOI: 10.7812/tpp/15-207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients pursuing organ transplantation have complex medical needs, undergo comprehensive evaluation for possible listing, and require extensive education. However, transplant patients and their supports frequently report the need for more lifestyle and self-management strategies for living with organ transplantation. OBJECTIVES First, to explore feasibility of a successful, patient-run transplant lifestyle educational group (Transplant Living Community), designed to complement medical care and integrated into the clinical setting; and second, to report the major themes of patients' and supports' qualitative and quantitative feedback regarding the group. METHODS Informal programmatic review and patient satisfaction surveys. RESULTS A total of 1862 patient satisfaction surveys were disseminated and 823 were returned (response rate, 44.2%). Patients and their supports reported positive feedback regarding the group, including appreciation that the volunteer was a transplant recipient and gratitude for the lifestyle information. Five areas were associated with the success of Transplant Living Community: 1) a "champion" dedicated to the program and its successful integration into a multidisciplinary team; 2) a health care environment receptive to integration of a patient-led group with ongoing community development; 3) a high level of visibility to physicians and staff, patients, and supports; 4) a clearly presented and manageable lifestyle plan ("Play Your ACES"(a) [Attitude, Compliance, Exercise, and Support]), and 5) a strong volunteer structure with thoughtful training with the ultimate objective of volunteers taking ownership of the program. CONCLUSION It is feasible to integrate a sustainable patient-led lifestyle and self-management educational group into a busy tertiary care clinic for patients with complex chronic illnesses.
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Affiliation(s)
- Michelle T Jesse
- Bioscientist for the Transplant Institute and Senior Staff Psychologist in the Behavioral Health Department at the Henry Ford Health System in Detroit, MI.
| | - Elizabeth Rubinstein
- Patient Advocate for the Transplant Institute at the Henry Ford Health System in Detroit, MI.
| | - Anne Eshelman
- Senior Staff Psychologist for the Transplant Institute at the Henry Ford Health System in Detroit, MI.
| | - Corinne Wee
- Research Assistant for the Transplant Institute at the Henry Ford Health System in Detroit, MI.
| | - Mrunalini Tankasala
- Research Assistant for the Transplant Institute at the Henry Ford Health System in Detroit, MI.
| | - Jia Li
- Assistant Scientist in Public Health Sciences at the Henry Ford Health System in Detroit, MI.
| | - Marwan Abouljoud
- Director of the Transplant Institute and Hepatobiliary Surgery for the Henry Ford Health System in Detroit, MI.
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Hispanic/Latino Disparities in Living Donor Kidney Transplantation: Role of a Culturally Competent Transplant Program. Transplant Direct 2015; 1:e29. [PMID: 27500229 DOI: 10.1097/txd.0000000000000540] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022] Open
Abstract
UNLABELLED Hispanic Americans face disparities in access to kidney transplantation, particularly living donor kidney transplantation (LDKT). This study compared characteristics of LDKT recipients before and after implementing the Hispanic Kidney Transplant Program (HKTP) at Northwestern Medicines (NM) and other centers. METHODS The NM HKTP, initiated in December 2006, delivers culturally and linguistically competent and congruent care. Program-specific data were used to compare the mean ratios of Hispanic to non-Hispanic white LDKTs between pre-HKTP (2001-2006) and post-HKTP (2008-2013), and to compare the characteristics of NM's adult LDKT patients between pre-HKTP and post-HKTP. The same ratio was calculated for transplant centers in regions with a significant Hispanic population (≥25%) and performing in the top tertile of total LDKT volume in the pre-HKTP period. The number of Hispanic and non-Hispanic white patients added to the waiting list were compared between pre-HKTP (2001-2006) and post-HKTP (2008-2013) as a proxy for increased patient referrals and a pathway by which the HKTP may increase LDKTs. RESULTS The ratio of Hispanic to non-Hispanic white LDKTs significantly increased by 70% after the implementation of NM's HKTP (pre-HKTP mean = 0.20, post-HKTP mean = 0.34; P= 0.001). None of the other transplant centers experienced a similar increase in their ratio of Hispanic to non-Hispanic white LDKTs. The NM waiting list additions grew by 91% among Hispanics, but grew only 4% for non-Hispanic whites. CONCLUSIONS These data suggest that the development and implementation of a culturally congruent transplant program can positively affect Hispanic LDKT and thereby reduce Hispanics disparities in LDKT rates. Further studies are needed to prospectively evaluate the generalizability of implementing such culturally competent interventions at other transplant programs.
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Abstract
Since the first living-donor kidney transplantation in 1954, more than half a million living kidney donations have occurred and research has advanced knowledge about long-term donor outcomes. Donors in developed countries have a similar life expectancy and quality of life as healthy non-donors. Living kidney donation is associated with an increased risk of end-stage renal disease, although this outcome is uncommon (<0·5% increase in incidence at 15 years). Kidney donation seems to elevate the risks of gestational hypertension and pre-eclampsia. Many donors incur financial expenses due to factors such as lost wages, need for sick days, and travel expenses. Yet, most donors have no regrets about donation. Living kidney donation is practised ethically when informed consent incorporates information about risks, uncertainty about outcomes is acknowledged when it exists, and a donor's risks are proportional to benefits for the donor and recipient. Future research should determine whether outcomes are similar for donors from developing countries and donors with pre-existing conditions such as obesity.
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Affiliation(s)
- Peter P Reese
- Renal Electrolyte and Hypertension Division, Department of Medicine, and Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Neil Boudville
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA, Australia
| | - Amit X Garg
- Division of Nephrology, Department of Medicine, Western University, London, ON, Canada
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Rudow DL, Hays R, Baliga P, Cohen DJ, Cooper M, Danovitch GM, Dew MA, Gordon EJ, Mandelbrot DA, McGuire S, Milton J, Moore DR, Morgieivich M, Schold JD, Segev DL, Serur D, Steiner RW, Tan JC, Waterman AD, Zavala EY, Rodrigue JR. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant 2015; 15:914-22. [PMID: 25648884 PMCID: PMC4516059 DOI: 10.1111/ajt.13173] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/07/2014] [Accepted: 12/21/2014] [Indexed: 01/25/2023]
Abstract
Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation.
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Affiliation(s)
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - David J. Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | | | - Gabriel M. Danovitch
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Elisa J. Gordon
- Comprehensive Transplant Center and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Suzanne McGuire
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Jennifer Milton
- Transplant Center, University of Texas at San Antonio, San Antonio, TX
| | - Deonna R. Moore
- Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - Marie Morgieivich
- The Living Donor Institute, Barnabas Health Transplant Division, Livingston, NJ
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Serur
- Department of Medicine, Cornell University, New York, NY
| | - Robert W. Steiner
- Department of Medicine, University of California at San Diego, San Diego, CA
| | - Jane C. Tan
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Amy D. Waterman
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Edward Y. Zavala
- Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - James R. Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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24
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The Expectations and Attitudes of Patients With Chronic Kidney Disease Toward Living Kidney Donor Transplantation. Transplantation 2015; 99:540-54. [DOI: 10.1097/tp.0000000000000433] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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25
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Skelton SL, Waterman AD, Davis LA, Peipert JD, Fish AF. Applying best practices to designing patient education for patients with end-stage renal disease pursuing kidney transplant. Prog Transplant 2015; 25:77-84. [PMID: 25758805 PMCID: PMC4489708 DOI: 10.7182/pit2015415] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite the known benefits of kidney transplant, less than 30% of the 615 000 patients living with end-stage renal disease (ESRD) in the United States have received a transplant. More than 100 000 people are presently on the transplant waiting list. Although the shortage of kidneys for transplant remains a critical factor in explaining lower transplant rates, another important and modifiable factor is patients' lack of comprehensive education about transplant. The purpose of this article is to provide an overview of known best practices from the broader literature that can be used as an evidence base to design improved education for ESRD patients pursuing a kidney transplant. Best practices in chronic disease education generally reveal that education that is individually tailored, understandable for patients with low health literacy, and culturally competent is most beneficial. Effective education helps patients navigate the complex health care process successfully. Recommendations for how to incorporate these best practices into transplant education design are described. Providing more ESRD patients with transplant education that encompasses these best practices may improve their ability to make informed health care decisions and increase the numbers of patients interested in pursuing transplant.
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Affiliation(s)
| | - Amy D Waterman
- David Geffen School of Medicine at UCLA Los Angeles, California
| | | | - John D Peipert
- David Geffen School of Medicine at UCLA Los Angeles, California
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Ladner DP, Dew MA, Forney S, Gillespie BW, Brown RS, Merion RM, Freise CE, Hayashi PH, Hong JC, Ashworth A, Berg CL, Burton JR, Shaked A, Butt Z. Long-term quality of life after liver donation in the adult to adult living donor liver transplantation cohort study (A2ALL). J Hepatol 2015; 62:346-53. [PMID: 25195558 PMCID: PMC4300258 DOI: 10.1016/j.jhep.2014.08.043] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/21/2014] [Accepted: 08/29/2014] [Indexed: 12/24/2022]
Abstract
BACKGROUND & AIMS There are few long-term studies of the health-related quality of life (HRQOL) in living liver donors. This study aimed to characterize donor HRQOL in the Adult to Adult Living Donor Liver Transplantation Study (A2ALL) up to 11 years post-donation. METHODS Between 2004 and 2013, HRQOL was assessed at evaluation, at 3 months, and yearly post-donation in prevalent liver donors using the short-form survey (SF-36), which provides a physical (PCS) and a mental component summary (MCS). RESULTS Of the 458 donors enrolled in A2ALL, 374 (82%) had SF-36 data. Mean age at evaluation was 38 (range 18-63), 47% were male, 93% white, and 43% had a bachelor's degree or higher. MCS and PCS means were above the US population at all time points. However, at every time point there were some donors who reported poor scores (>1/2 standard deviation below the age and sex adjusted mean) (PCS: 5.3-26.8%, MCS 10.0-25.0%). Predictors of poor PCS and MCS scores included recipient's death within the two years prior to the survey and education less than a bachelor's degree; poor PCS scores were also predicted by time since donation, Hispanic ethnicity, and at the 3-month post-donation time point. CONCLUSIONS In summary, most living donors maintain above average HRQOL up to 11 years prospectively, supporting the notion that living donation does not negatively affect HRQOL. However, targeted support for donors at risk for poor HRQOL may improve overall HRQOL outcomes for living liver donors.
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Affiliation(s)
- Daniela P. Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago, IL, United States
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology and Biostatistics, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, United States
| | - Sarah Forney
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States
| | - Brenda W. Gillespie
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, United States
| | - Robert S. Brown
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Robert M. Merion
- Arbor Research Collaborative for Health, Ann Arbor, MI, United States, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Chris E. Freise
- Department of Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Paul H. Hayashi
- Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Johnny C. Hong
- Department of Surgery, Medical College of Wisconsin, WI, United States
| | - April Ashworth
- Virginia Commonwealth University, Richmond, VA, United States
| | - Carl L. Berg
- Duke University Health System, Durham, North Carolina, United States
| | - James R. Burton
- Department of Medicine, University of Colorado, Aurora, CO, United States
| | - Abraham Shaked
- Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
| | - Zeeshan Butt
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Northwestern University, Chicago, IL, United States, Department of Medical Social Sciences, Northwestern University Feinberg School of ssMedicine, Chicago, IL, United States, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Hays RE. Informed Consent of Living Kidney Donors: Pitfalls and Best Practice. CURRENT TRANSPLANTATION REPORTS 2015. [DOI: 10.1007/s40472-014-0044-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gordon EJ, Ison MG. Decision aids for organ transplant candidates. Liver Transpl 2014; 20:753-5. [PMID: 24806135 PMCID: PMC4834713 DOI: 10.1002/lt.23908] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 05/02/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Elisa J Gordon
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL; Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Gordon EJ, Reddy E, Gil S, Feinglass J, Rodde J, Abecassis MM, Caicedo JC. Culturally competent transplant program improves Hispanics' knowledge and attitudes about live kidney donation and transplant. Prog Transplant 2014; 24:56-68. [PMID: 24598567 DOI: 10.7182/pit2014378] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Hispanics receive disproportionately fewer live donor kidney transplants than non-Hispanic whites. Increasing Hispanics' knowledge and changing attitudes about live kidney donation may reduce these disparities. OBJECTIVE To evaluate the effectiveness of culturally and linguistically competent educational sessions delivered through Northwestern University's Hispanic Transplant Program. DESIGN Baseline and postsession questionnaires were used to evaluate changes in patients' and family members' knowledge and attitudes toward live kidney donation and program satisfaction. Knowledge items related to live kidney donation were scaled, and changes in scores were evaluated via a paired t test. Multiple regression analysis of follow-up knowledge scores controlled for baseline scores was used to estimate the effects of patients' and families' sociodemographic characteristics. Changes in attitude items, including comfort with exploring live kidney donation, were analyzed with χ2 tests. RESULTS One-hundred thirteen patients and family members completed surveys before and after an education session. Respondents' knowledge about live kidney donation and transplant increased significantly (P<.001) between baseline and after the session. Patients' attitudes toward live kidney donation became more favorable (P< .02), as did family members' attitudes toward being a donor (P < .001) after participating in the program. All respondents reported high levels of satisfaction with the program and preferences for culturally congruent care. CONCLUSIONS The educational sessions provided by the Hispanic Transplant Program effectively addressed commonly shared Hispanic concerns about live kidney donation. Culturally congruent education increased Hispanic patients' and family members' knowledge and improved attitudes about live donor kidney transplants.
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Davis LA, Ryszkiewicz E, Schenk E, Peipert J, LaSee C, Miller C, Richardson G, Ridolfi G, Trulock EP, Patterson GA, Waterman A. Lung Transplant or Bust: Patients' Recommendations for Ideal Lung Transplant Education. Prog Transplant 2014; 24:132-41. [DOI: 10.7182/pit2014432] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Context Effective lung transplant education helps ensure informed decision making by patients and better transplant outcomes. Objective To understand the educational needs and experiences of lung transplant patients. Design Mixed-method study employing focus groups and patient surveys. Setting Barnes-Jewish Hospital in St Louis, Missouri. Patients 50 adult lung transplant patients: 23 pretransplant and 27 posttransplant. Main Outcome Measures Patients' interest in receiving specific transplant information, the stage in the transplant process during which they wanted to receive the education, and the preferred format for presenting the information. Results Patients most wanted information about how to sustain their transplant (72%), when to contact their coordinator immediately (56%), transplant benefits (56%), immunosuppressants (54%), and possible out-of-pocket expenses (52%). Patients also wanted comprehensive information early in the transplant process and a review of a subset of topics immediately before transplant (time between getting the call that a potential donor has been found and getting the transplant). Patients reported that they would use Internet resources (74%) and converse with transplant professionals (68%) and recipients (62%) most often. Discussion Lung transplant patients are focused on learning how to get a transplant and ensuring its success afterwards. A comprehensive overview of the evaluation, surgery, and recovery process at evaluation onset with a review of content about medications, pain management, and transplant recovery repeated immediately before surgery is ideal.
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Affiliation(s)
- LaShara A. Davis
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
| | - Eric Ryszkiewicz
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
| | - Emily Schenk
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
| | - John Peipert
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
| | - Claire LaSee
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
| | - Carol Miller
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
| | - Greg Richardson
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
| | - Gene Ridolfi
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
| | - Elbert P. Trulock
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
| | - G. Alexander Patterson
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
| | - Amy Waterman
- Saint Barnabas Medical Center, Livingston, New Jersey (LAD), Palo Alto Medical Foundation, Sutter Health, Sunnyvale, California (ER), Washington University School of Medicine, St. Louis, Missouri (ES, CL), David Geffen School of Medicine, University of California, Los Angeles (JP, AW), Barnes-Jewish Hospital, St. Louis, Missouri (CM, GR, GR, EPT, GAP)
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Weng FL, Brown DR, Peipert JD, Holland B, Waterman AD. Protocol of a cluster randomized trial of an educational intervention to increase knowledge of living donor kidney transplant among potential transplant candidates. BMC Nephrol 2013; 14:256. [PMID: 24245948 PMCID: PMC3840671 DOI: 10.1186/1471-2369-14-256] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 11/11/2013] [Indexed: 11/10/2022] Open
Abstract
Background The best treatment option for end-stage renal disease is usually a transplant, preferably a live donor kidney transplant (LDKT). The most effective ways to educate kidney transplant candidates about the risks, benefits, and process of LDKT remain unknown. Methods/design We report the protocol of the Enhancing Living Donor Kidney Transplant Education (ELITE) Study, a cluster randomized trial of an educational intervention to be implemented during initial transplant evaluation at a large, suburban U.S. transplant center. Five hundred potential transplant candidates are cluster randomized (by date of visit) to receive either: (1) standard-of-care (“usual”) transplant education, or (2) intensive education that is based upon the Explore Transplant series of educational materials. Intensive transplant education includes viewing an educational video about LDKT, receiving print education, and meeting with a transplant educator. The primary outcome consists of knowledge of the benefits, risks, and process of LDKT, assessed one week after the transplant evaluation. As a secondary outcome, knowledge and understanding of LDKT are assessed 3 months after the evaluation. Additional secondary outcomes, assessed one week and 3 months after the evaluation, include readiness, self-efficacy, and decisional balance regarding transplant and LDKT, with differences assessed by race. Although the unit of randomization is the date of the transplant evaluation visit, the unit of analysis will be the individual potential transplant candidate. Discussion The ELITE Study will help to determine how education in a transplant center can best be designed to help Black and non-Black patients learn about the option of LDKT. Trial registration Clinicaltrials.gov number NCT01261910
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Affiliation(s)
- Francis L Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, 94 Old Short Hills Road, East Wing, Suite 305, Livingston, NJ 07039, USA.
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Purnell TS, Xu P, Leca N, Hall YN. Racial differences in determinants of live donor kidney transplantation in the United States. Am J Transplant 2013; 13:1557-65. [PMID: 23669021 PMCID: PMC4282921 DOI: 10.1111/ajt.12258] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 03/08/2013] [Accepted: 03/15/2013] [Indexed: 01/25/2023]
Abstract
Few studies have compared determinants of live donor kidney transplantation (LDKT) across all major US racial-ethnic groups. We compared determinants of racial-ethnic differences in LDKT among 208 736 patients who initiated treatment for end-stage kidney disease during 2005-2008. We performed proportional hazards and bootstrap analyses to estimate differences in LDKT attributable to sociodemographic and clinical factors. Mean LDKT rates were lowest among blacks (1.19 per 100 person-years [95% CI: 1.12-1.26]), American Indians/Alaska Natives-AI/ANs (1.40 [1.06-1.84]) and Pacific Islanders (1.10 [0.78-1.84]), intermediate among Hispanics (2.53 [2.39-2.67]) and Asians (3.89 [3.51-4.32]), and highest among whites (6.46 [6.31-6.61]). Compared with whites, the largest proportion of the disparity among blacks (20%) and AI/ANs (29%) was attributed to measures of predialysis care, while the largest proportion among Hispanics (14%) was attributed to health insurance coverage. Contextual poverty accounted for 16%, 4%, 18%, and 6% of the disparity among blacks, Hispanics, AI/ANs and Pacific Islanders but none of the disparity among Asians. In the United States, significant disparities in rates of LDKT persist, but determinants of these disparities vary by race-ethnicity. Efforts to expand preESKD insurance coverage, to improve access to high-quality predialysis care and to overcome socioeconomic barriers are important targets for addressing disparities in LDKT.
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Affiliation(s)
- T. S. Purnell
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD,Corresponding author: Tanjala S. Purnell,
| | - P. Xu
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington
| | - N. Leca
- Kidney–Pancreas Transplant Section, Division of Nephrology, University of Washington, Seattle, WA
| | - Y. N. Hall
- Kidney Research Institute, Department of Medicine, University of Washington, Seattle, Washington
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Gordon EJ, Butt Z, Jensen SE, Lok-Ming Lehr A, Franklin J, Becker Y, Sherman L, Chon WJ, Beauvais N, Hanneman J, Penrod D, Ison MG, Abecassis MM. Opportunities for shared decision making in kidney transplantation. Am J Transplant 2013; 13:1149-58. [PMID: 23489435 DOI: 10.1111/ajt.12195] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 01/18/2013] [Accepted: 01/18/2013] [Indexed: 01/25/2023]
Abstract
Health researchers and policy-makers increasingly urge both patient and clinician engagement in shared decision making (SDM) to promote patient-centered care. Although SDM has been examined in numerous clinical settings, it has received little attention in solid organ transplantation. This paper describes the application of SDM to the kidney transplantation context. Several distinctive features of kidney transplantation present challenges to SDM including fragmented patient-provider relationships, the time-sensitive and unpredictable nature of deceased organ offers, decision-making processes by transplant providers serving as both organ guardians (given the organ scarcity) versus advocates for specific patients seeking transplantation, variable clinical practices and policies among transplant centers, and patients' potentially compromised cognitive status and literacy levels. We describe potential barriers to and opportunities for SDM, and posit that SDM is feasible, warranting encouragement in kidney transplantation. We propose strategies to promote and overcome obstacles to SDM in kidney transplantation. We contend that engagement in SDM can be facilitated by re-organization of clinical care, communication and education of providers and patients.
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Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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Secunda K, Gordon EJ, Sohn MW, Shinkunas LA, Kaldjian LC, Voigt MD, Levitsky J. National survey of provider opinions on controversial characteristics of liver transplant candidates. Liver Transpl 2013. [PMID: 23197388 DOI: 10.1002/lt.23581] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Candidate selection for liver transplantation presents challenging ethical issues that require balancing the principles of justice and utility. The goal of this study was to assess the opinions of U.S. transplant providers regarding the ways in which controversial medical and psychosocial characteristics influence patient eligibility for liver transplantation. An online, anonymous survey about adult patient characteristics was sent to providers (hepatologists, surgeons, psychiatrists, and social workers) at all 102 active adult liver transplant centers in the United States. A majority of the providers (251/444 or 56.5%) completed the survey. The providers were queried about 8 characteristics, and the 3 that were ranked most controversial were incarceration, marijuana use, and psychiatric diagnoses. Most providers identified a patient age ≥ 80 years (62.7%), a body mass index ≥ 45 kg/m2 (56.6%), and current incarceration with a lifetime sentence (54.7%) as absolute contraindications to liver transplantation. In a multivariate analysis, the identification of absolute contraindications varied significantly with the provider type, the center volume, and the geographical region. Less than half of the providers reported that their centers had written policies regarding most of the characteristics examined. In conclusion, providers differ significantly in their opinions on controversial patient characteristics and transplant contraindications. Along with a paucity of literature data on outcomes, these provider differences may play a role in the fact that many centers do not have formal policies for selecting patients with these characteristics. Evidence-based data on the outcomes of such patients are needed to guide the formation of written policies to better standardize eligibility criteria.
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Affiliation(s)
- Katharine Secunda
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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36
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Wilson R, Brown DR, Boothe MAS, Weng FL. Improving the delivery of patient education about kidney transplant in a transplant center. Prog Transplant 2013. [PMID: 23187059 DOI: 10.7182/pit2012716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Kidney transplant is usually the best treatment option for patients with end-stage renal disease; however, transplant rates remain low in the United States. More research is needed about patients' educational needs to ensure that patients are making informed decisions about their treatment options. OBJECTIVE To examine patients' perceptions of the delivery and format of a kidney transplant education program in a clinical setting, specifically to (1) identify useful aspects of the transplant education process, (2) discuss aspects of the program delivery that need improvement, and (3) provide recommendations to enhance the education delivery and format surrounding kidney transplant. DESIGN A descriptive study using focus group meetings with patients at different stages of the transplantation process (in evaluation, listed, and transplant recipients). Data were analyzed by using thematic content analysis. RESULTS Use of printed materials and handouts, group education format, and patient advocate component as well as bringing a companion were all effective aspects of the education program. Concerns about the education program stemmed from its complexity, technicality, and length. Participants recommended that patients be sent a formal invitation letter, with a detailed agenda and a video on kidney transplant, and that patients be encouraged to bring a companion to the education program. Responses specific to the stage of the transplant process are presented. CONCLUSION Concentrated attention to the delivery and content of the transplant education programs may significantly assist with patients' outcomes throughout the transplant process.
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Affiliation(s)
- Rula Wilson
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Ladner DP, Alonso EM, Butt Z, Caicedo JC, Cella D, Daud A, Friedewald JJ, Gordon EJ, Hazen GB, Ho BT, Hoke KR, Holl JL, Ison MG, Kang R, Mehrotra S, Preczewski LB, Ross OA, Sharaf PH, Skaro AI, Wang E, Wolf MS, Woods DM, Abecassis MM. NUTORC-a transdisciplinary health services and outcomes research team in transplantation. Transl Behav Med 2012; 2:446-458. [PMID: 23667403 PMCID: PMC3647618 DOI: 10.1007/s13142-012-0176-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The field of solid organ transplantation has historically concentrated research efforts on basic science and translational studies. However, there has been increasing interest in health services and outcomes research. The aim was to build an effective and sustainable, inter- and transdisciplinary health services and outcomes research team (NUTORC), that leveraged institutional strengths in social science, engineering, and management disciplines, coupled with an international recognized transplant program. In 2008, leading methodological experts across the university were identified and intramural funding was obtained for the NUTORC initiative. Inter- and transdisciplinary collaborative teams were created across departments and schools within the university. Within 3 years, NUTORC became fiscally sustainable, yielding more than tenfold return of the initial investment. Academic productivity included funding for 39 grants, publication of 60 manuscripts, and 166 national presentations. Sustainable educational opportunities for students were created. Inter- and transdisciplinary health services and outcomes research in transplant can be innovative and sustainable.
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Affiliation(s)
- Daniela P. Ladner
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Estella M. Alonso
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Zeeshan Butt
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Juan Carlos Caicedo
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - David Cella
- />Department of Medical Social Sciences, Northwestern University, Chicago, IL USA
| | - Amna Daud
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - John J. Friedewald
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Nephrology, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Elisa J. Gordon
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Gordon B. Hazen
- />Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Chicago, IL USA
| | - Bing T. Ho
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Nephrology, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Kathleen R. Hoke
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Jane L. Holl
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Michael G. Ison
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Raymond Kang
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Sanjay Mehrotra
- />Department of Industrial Engineering and Management Sciences, McCormick School of Engineering, Northwestern University, Chicago, IL USA
| | - Luke B. Preczewski
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
| | - Olivia A. Ross
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Pamela H. Sharaf
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Anton I. Skaro
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
- />Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL USA
| | - Edward Wang
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
| | - Michael S. Wolf
- />Division of General Internal Medicine, Department of Medicine, Northwestern University, Chicago, IL USA
| | - Donna M. Woods
- />Center for Healthcare Studies, Northwestern University, Chicago, IL USA
| | - Michael M. Abecassis
- />Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- />Division of Transplantation, Department of Surgery, Northwestern University, Chicago, IL USA
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Gordon EJ, Rodde J, Gil S, Caicedo JC. Quality of Internet education about living kidney donation for Hispanics. Prog Transplant 2012; 22:294-303. [PMID: 22951507 DOI: 10.7182/pit2012802] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Hispanics need disproportionately more kidney transplants, yet receive disproportionately fewer kidney transplants and living donor kidney transplants than non-Hispanic whites. Lack of knowledge and cultural beliefs about living kidney donation contribute to these disparities. The Internet is an optimal venue to educate underserved, low-literacy populations. DESIGN Websites were evaluated for information on living kidney donation targeted to Hispanics. Hispanic websites addressing living kidney donation were identified through the Google search engine, using the search terms Hispanic, Latino, Spanish, and living kidney donor/donation. Websites were evaluated for accessibility of information, readability, and content required by 9 Centers for Medicare and Medicaid Services regulations representing 12 topics, and cultural competency. RESULTS Twenty resources met inclusion criteria. Websites contained 2.3 pages on living kidney donation and required 2.4 links to access all information on living kidney donation. Websites were written at the 9th grade reading level. Sites described alternative treatments for recipients (n = 14), the evaluation process (n = 7), and the surgical procedure (n=6). Few addressed psychosocial risks (n=2). Some contained culturally sensitive colors and pictures (n = 8), but few addressed Hispanic cultural beliefs (n = 4). CONCLUSIONS A comprehensive website on living kidney donation that provides more robust content and is targeted to Hispanics is needed to increase Hispanics' understanding of treatment options.
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Affiliation(s)
- Elisa J Gordon
- Center for Healthcare Studies, Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA.
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Gordon EJ. Informed consent for living donation: a review of key empirical studies, ethical challenges and future research. Am J Transplant 2012; 12:2273-80. [PMID: 22594620 DOI: 10.1111/j.1600-6143.2012.04102.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Given the organ scarcity, live organ donation is increasingly considered a viable alternative for kidney and liver transplantation. Yet living donation challenges the ethical principle of nonmaleficence by subjecting healthy individuals to medical, psychosocial and unknown risks. Therefore, transplant providers, policy-makers and donors are committed to ensuring that prospective donors provide adequate informed consent to undergo the procedure. Informed consent for living donation is ethically required as a means of demonstrating respect for donor's autonomy and protecting their safety. However, all elements of informed consent are fraught with difficulties due to the unique nature of the donation process and outcome. This paper reviews empirical research on informed consent for live kidney donors (LKD) and live liver donors (LLD) for both adult and pediatric recipients. As this review shows, studies that empirically assessed the quality of informed consent elements reveal considerable variability and deficiencies across the informed consent process, suggesting the need for improvement. This review highlights challenges to each element of consent for both LKDs and LLDs, and situates trends within broader policy contexts, ethical debates and avenues for future innovative research.
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Affiliation(s)
- E J Gordon
- Institute for Healthcare Studies, Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Garcia GG, Harden P, Chapman J, For the World Kidney Day Steering Committee 2012. The Global role of kidney transplantation. J Nephropathol 2012; 1:69-76. [PMID: 24475391 PMCID: PMC3886138 DOI: 10.5812/nephropathol.7448] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Accepted: 03/30/2012] [Indexed: 01/15/2023] Open
Abstract
World Kidney Day on March 8th 2012 provides a chance to reflect on the success of kidney transplantation as a therapy for end stage kidney disease that surpasses dialysis treatments both for the quality and quantity of life that it provides and for its cost effectiveness. Anything that is both cheaper and better, but is not actually the dominant therapy, must have other drawbacks that prevent replacement of all dialysis treatment by transplantation. The barriers to universal transplantation as the therapy for end stage kidney disease include the economic limitations which, in some countries place transplantation, appropriately, at a lower priority than public health fundamentals such as clean water, sanitation and vaccination. Even in high income countries the technical challenges of surgery and the consequences of immunosuppression restrict the number of suitable recipients, but the major finite restrictions on kidney transplantation rates are the shortage of donated organs and the limited medical, surgical and nursing workforces with the required expertise. These problems have solutions which involve the full range of societal, professional, governmental and political environments. World Kidney Day is a call to deliver transplantation therapy to the one million people a year who have a right to benefit.
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Affiliation(s)
- Guillermo Garcia Garcia
- Nephrology Service, Hospital Civil de Guadalajara, University of Guadalajara Health Sciences Center Hospital 278, Guadalajara, Jal. 44280, Mexico
| | - Paul Harden
- Oxford Kidney Unit and Oxford Transplant Centre, Churchill Hospital, Oxford, United Kingdom
| | - Jeremy Chapman
- Centre for Transplant and Renal Research, West mead Millennium Institute, Sydney University, West mead Hospital, Sydney, NSW, 2145, Australia
| | - For the World Kidney Day Steering Committee 2012
- World Kidney Day (WKD) is a joint initiative of the International Society of Nephrology and the International Federations of
Kidney Foundations
- **WKD Steering Committee members: Abraham G, Beerkens P, Chapman JR, Couser W,Erk T, Feehally J, Garcia GG, Li PKT, Riella M, Segantini L, Shay P
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Assessment of variation in live donor kidney transplantation across transplant centers in the United States. Transplantation 2011; 91:1357-63. [PMID: 21562451 DOI: 10.1097/tp.0b013e31821bf138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transplant centers vary in the proportion of kidney transplants performed using live donors. Clinical innovations that facilitate live donation may drive this variation. METHODS We assembled a cohort of renal transplant candidates at 194 US centers using registry data from 1999 to 2005. We measured magnitude of live donor kidney transplantation (LDKTx) through development of a standardized live donor transplantation ratio (SLDTR) at each center that accounted for center population differences. We examined associations between center characteristics and the likelihood that individual transplant candidates underwent LDKTx. To identify practices through which centers increase LDKTx, we also examined center characteristics associated with consistently being in the upper three quartiles of SLDTR. RESULTS The cohort comprised 148,168 patients, among whom 34,593 (23.3%) underwent LDKTx. In multivariable logistic regression, candidates had an increased likelihood of undergoing LDKTx at centers with greater use of "unrelated donors" (defined as nonspouses and nonfirst-degree family members of the recipient; odds ratio [OR] 1.31 for highest vs. lowest use; P=0.02) and at centers with programs to overcome donor-recipient incompatibility (OR 1.33; P=0.01). Centers consistently in the upper three SLDTR quartiles were also more likely to use "unrelated" donors (OR 8.30 per tertile of higher use; P<0.01), to have incompatibility programs (OR 4.79, P<0.01), and to use laparoscopic nephrectomy (OR 2.53 per tertile of higher use; P=0.02). CONCLUSION Differences in center population do not fully account for differences in the use of LDKTx. To maximize opportunities for LDKTx, centers may accept more unrelated donors and adopt programs to overcome biological incompatibility.
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Rodrigue JR, Hanto DW, Curry MP. Patients' willingness to accept expanded criteria donor liver transplantation. Am J Transplant 2011; 11:1705-11. [PMID: 21672150 DOI: 10.1111/j.1600-6143.2011.03592.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Utilization of livers from expanded criteria donors (ECD) is one strategy to overcome the severe organ shortage. The decision to utilize an ECD liver is complex and fraught with uncertainty for both providers and patients. We assessed patients' willingness to accept ECD liver transplantation (LTx) and acceptable 1-year mortality risk. One hundred eight patients listed for LTx were asked to rate their willingness to accept ECD LTx and the associated 1-year mortality risk they were willing to accept. Also, patients completed the SF-36v2 and sociodemographic and health information was gathered from their medical records. Patients reported significantly higher willingness to accept standard criteria donor (SCD) versus ECD LTx (t = 13.8, p < 0.001), with more than one-third of patients reporting low willingness to accept ECD LTx. Relative to our center's 10% SCD LTx 1-year mortality rate, most patients (71%) were willing to accept moderately or substantially higher 1-year mortality risk for ECD LTx. In multivariable analyses, higher lab MELD score and white race were significant independent predictors of both ECD willingness and ECD increased mortality risk acceptability. Findings highlight the importance of assessing patients' willingness to pursue ECD LTx and the relative mortality risks they are willing to accept.
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Affiliation(s)
- J R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Brown W, McDermott J, Figueiredo AE, Loucaidou M, Galliford J, Papalois V. Invited manuscript poster on renal-related education American Society of Nephrology, Nov. 16-21, 2010. Improving access to kidney transplant information has increased preemptive living kidney donation. Ren Fail 2011; 33:658-62. [PMID: 21787154 DOI: 10.3109/0886022x.2011.589948] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Transplantation provides the best outcomes and quality of life for people with end-stage renal disease and therefore offers the optimum treatment of choice. Preemptive living donor (LD) transplantation is an increasingly preferable alternative to dialysis as transplantation outcomes indicate lower morbidity and mortality rates and greater graft and patient survival rates compared to those who are transplanted after dialysis has commenced. Despite nursing and medical teams giving information to patients regarding transplantation and living donation, the number of people coming forward for preemptive transplant work-up remained limited. Changing the format, environment, and quality of information given to patients and families seemed necessary in order to increase the number of preemptive transplants. Our data show that we have improved the access to the information seminars with attendance rising from 5 to 15 attendees per seminar (3 per year) in 2005 to average 65 attendees per seminar (6 per year) in 2010. By expanding the access to information for patients, their families and friends, living donation has increased with a growth in the proportion of preemptive LD transplants from 28% (23/81) in 2006 to 44% in 2010 (29/66; p = 0.05). We can conclude that expanding the pool accessing information has increased the number of preemptive (LD) transplants in our center.
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Affiliation(s)
- Wendy Brown
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London, UK.
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Reese PP, Bloom RD. The long and winding road to kidney transplantation. Am J Transplant 2011; 11:1357-8. [PMID: 21486389 DOI: 10.1111/j.1600-6143.2011.03523.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Gordon EJ, Bergeron A, McNatt G, Friedewald J, Abecassis MM, Wolf MS. Are informed consent forms for organ transplantation and donation too difficult to read? Clin Transplant 2011; 26:275-83. [PMID: 21585548 DOI: 10.1111/j.1399-0012.2011.01480.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Informed consent for organ transplantation and donation is an ethical obligation, legally required, and considered as part of the Patient's Rights Condition of Medicare Participation for hospitals. National policy-makers recommend that informed consent forms and patient education materials be written at a low reading level (5th-8th grade level) to facilitate patient comprehension. We assessed reading levels of informed consent forms (CFs) for adult organ transplant recipients and living organ donors across US transplant centers. CFs were analyzed using three measures of reading level: Lexile Measure, Flesch-Kincaid Grade Level, and the Gunning Fog Index. Of active transplant centers contacted (N=209), 75 (36%) sent a total of 332 CFs. CFs were written, on average, at the college level, which is a considerably higher reading level than the standards set by policy-makers. CF reading levels were negatively correlated with transplant center volume (r=-0.119; p<0.03). CFs for intestine transplantation and for evaluation/listing were the easiest to read, while consent forms for liver transplantation/donation and pre-transplant agreements were the most difficult to read. Reducing CFs' reading level may help to increase patient comprehension for adequate informed consent.
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Affiliation(s)
- Elisa J Gordon
- Department of Surgery, Comprehensive Transplant Center, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-3152, USA.
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