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Ahmed A, Winterbottom A, Ahmed S, Stoves J, Daga S. Decisional Needs of People From Minority Ethnic Groups Around Living Donor Kidney Transplantation: A UK Healthcare Professionals' Perspective. Transpl Int 2023; 36:11357. [PMID: 37554318 PMCID: PMC10405286 DOI: 10.3389/ti.2023.11357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/04/2023] [Indexed: 08/10/2023]
Abstract
Despite improved patient and clinical outcomes, living donor kidney transplantation is underutilized in the United Kingdom, particularly among minority ethnic groups, compared to deceased donor kidney transplantation. This may in part be due to the way in which kidney services present information about treatment options. With a focus on ethnicity, semi structured interviews captured the views of 19 kidney healthcare professionals from two renal centres in West Yorkshire, about the decisional needs and context within which people with advanced kidney disease make transplant decisions. Data were analysed using thematic analysis. Themes were categorized into three groups: 1) Kidney healthcare professionals: language, cultural awareness, trusted personnel, and staff diversity, 2) Patient information resources: timing and setting of education and suitability of patient-facing information and, 3) People with advanced kidney disease: knowledge, risk perception, and cultural/religious beliefs. To our knowledge, this is the first study in the United Kingdom to investigate in depth, healthcare professionals' views on living donor kidney transplantation decision making. Six recommendations for service improvement/delivery to support decision making around living donor kidney transplantation among minority ethnic groups are described.
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Affiliation(s)
- Ahmed Ahmed
- Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Anna Winterbottom
- Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
| | - Shenaz Ahmed
- Division of Psychological and Social Medicine, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - John Stoves
- Department of Renal Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Sunil Daga
- Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
- Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom
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Lagging E, Wadström J, Krekula LG, Tibell A. Red Flags in the Living Kidney Donor Process. Transplant Proc 2023; 55:279-287. [PMID: 36797163 DOI: 10.1016/j.transproceed.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 01/06/2023] [Accepted: 01/24/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Ideally, no live kidney donor should regret their decision or feel they were not fully prepared for the process. Unfortunately, this is not a reality for all donors. The aim of our study is to identify areas for improvement, focusing on factors (red flags) that predict less favorable outcomes from a donor perspective. MATERIALS AND METHODS A total of 171 living kidney donors responded to a questionnaire with 24 multiple-choice questions and space for comments. Less favorable outcomes were defined as lower satisfaction, extended physical recovery period, long-term fatigue, and longer sick leave. RESULTS Ten red flags were identified. Of these factors, more fatigue (range, P = .000-0.040) or pain (range, P = .005-0.008) than expected while still in hospital, the actual experience being harder or different than expected (range, P = .001-0.010), and the donor wishing to have had but not having been offered a previous donor as mentor (range, P = .008-.040) correlated significantly with at least 3 of the 4 less favorable outcomes. Another significant red flag was keeping existential issues to oneself (P = .006). CONCLUSION We identified several factors indicating that a donor could be at an increased risk for a less favorable outcome after donation. Four of these factors have, to our knowledge, not been described earlier: more early fatigue than expected, more postoperative pain than anticipated, not having been offered a mentor at an early stage, and keeping existential issues to oneself. Attention to these red flags already during the donation process could help health care professionals to act early to avoid unfavorable outcomes.
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Affiliation(s)
- Eva Lagging
- Center for Health Care Ethics, LIME, Karolinska Institutet, Stockholm, Sweden; Regional Donation Center Stockholm-Gotland, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
| | - Jonas Wadström
- Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Linda Gyllström Krekula
- Center for Health Care Ethics, LIME, Karolinska Institutet, Stockholm, Sweden; Regional Donation Center Stockholm-Gotland, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Annika Tibell
- Center for Health Care Ethics, LIME, Karolinska Institutet, Stockholm, Sweden; Department of Research, Education and Innovation, Karolinska University Hospital, Stockholm, Sweden
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Lagging E, Larsson K, Wadström J, Krekula LG, Tibell A. Potential living kidney donors' positive experiences of an information letter from healthcare: a descriptive qualitative study. BMC Nephrol 2022; 23:332. [PMID: 36242025 PMCID: PMC9569060 DOI: 10.1186/s12882-022-02959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients who need a live donor kidney transplant (LDKT) must often ask potential donors (PLDs) themselves. This is a difficult task and healthcare could unburden them by making this first contact, ensuring also that PLDs receive correct information. We investigated how PLDs experience receiving a letter from healthcare about LDKT, live kidney donation, and inviting them to meet with professionals to get more information. Methods The letter (LD-letter) was sent to a cohort of 46 individuals, from which a purposeful sample of 15 were interviewed using a semi-structured guide covering their experience of the letter, views on being approached by healthcare, and opinions on style and content. Interviews were analyzed using conventional inductive analysis. Results We identified three categories of experiences: Category (1) Reflections on receiving the letter, contains three subcategories relating to how the letter did not induce pressure to donate, did not affect the PLD’s relationship with the patient with kidney disease, and made the letter-receiver feel important in the transplant process; Category (2) The letter creates clarification and trust, also contains three subcategories, relating to how it clarified the voluntariness of donation and neutrality of healthcare providers with respect to the PLD’s decision, elucidated the patient with kidney disease’s current stage of disease (where transplantation was approaching), and unburdened patients from the responsibility of contacting PLDs on their own; Category (3) Opinions and suggestions about the letter and further communication, with four subcategories, relating to preference of a letter as the first step for communication about LDKT, suggestions on style and content, views on following up the letter, and how open meetings about LDKT were an important information source. Furthermore, 80% of the interviewees found the letter’s information comprehensive, 67% found it easy to read and respectful, and 86% rated it as good or very good. Conclusion Potential donors prefer and recommend a letter as the first step for communication regarding LD. The LD-letter unburdens patients from the task of asking PLDs and stresses the voluntariness of donation, does not leave PLDs feeling coerced or lead to negative effects in their relationship with the patient. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02959-5.
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Affiliation(s)
- Eva Lagging
- Center for Health Care Ethics, LIME, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Perioperative Medicine and Intensive Care, Regional Donation Center Stockholm-Gotland, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.
| | - Kjerstin Larsson
- Department of Public Health and Caring Sciences, Health equity and working life, Uppsala University, 752 37, Uppsala, Sweden
| | - Jonas Wadström
- Department of Transplantation Surgery, Karolinska University Hospital, 141 86, Huddinge, Stockholm, Sweden
| | - Linda Gyllström Krekula
- Center for Health Care Ethics, LIME, Karolinska Institutet, 171 77, Stockholm, Sweden.,Perioperative Medicine and Intensive Care, Regional Donation Center Stockholm-Gotland, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden
| | - Annika Tibell
- Center for Health Care Ethics, LIME, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Research, Education and Innovation, Karolinska University Hospital, 171 76, Stockholm, Sweden
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Davis LA, Iraheta YA, Ho EW, Murillo AL, Feinsinger A, Waterman AD. Living Kidney Donation Stories and Advice Shared Through a Digital Storytelling Library: A Qualitative Thematic Analysis. Kidney Med 2022; 4:100486. [PMID: 35755303 PMCID: PMC9218227 DOI: 10.1016/j.xkme.2022.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Rationale & Objective Despite the development of numerous educational interventions, there has been limited change in actual living donor kidney transplant (LDKT) rates over time. New strategies, such as the inclusion of patient stories in patient education, show promise to inspire more people to donate kidneys. This study identified the challenges faced, coping strategies used, and advice shared by transplant donors and recipients. Study Design Qualitative thematic analysis. Setting & Participants One hundred eighteen storytellers across the United States and Canada, including 82 living donors and 36 kidney recipients of living donor transplants who shared their stories on the Living Donation Storytelling Project (explorelivingdonation.org), an online digital storytelling platform and library. Analytical Approach A poststorytelling survey assessed participant demographics. Two coders conducted tool-assisted (Dedoose v.8.3.35) thematic analysis on narrative storytelling videos and transcripts. Results Storytellers were predominantly White (79/118, 66.95%), female (76/118, 64.41%), and non-Hispanic (109/118, 92.37%) with college/vocational education (50/118, 42.37%). Common themes were found related to living donation challenges for donors and recipients (eg, the fear of not being able to complete the LDKT process, of unsupportive family or rejected donation requests, and of unknown or adverse surgical outcomes and graft rejection) and recommended coping strategies (eg, seeking LDKT information, using prayer, and relying on a support network). Recipients provided advice that included being proactive and staying hopeful, whereas donors recommended seeking support, researching LDKT to comprehensively learn, and building a community of support. Limitations Limited representation of diverse demographics. Conclusions Although supplementary to traditional education about LDKT, digital storytelling provides a source of peer support that can enhance the experience of donors and recipients and encourage autonomy and self-management after transplant.
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Walker RC, Abel S, Palmer SC, Walker C, Heays N, Tipene-Leach D. Values, Perspectives, and Experiences of Indigenous Māori Regarding Kidney Transplantation: A Qualitative Interview Study in Aotearoa/New Zealand. Am J Kidney Dis 2022; 80:20-29.e1. [PMID: 35151826 DOI: 10.1053/j.ajkd.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/22/2021] [Indexed: 12/22/2022]
Abstract
RATIONALE AND OBJECTIVE In Aotearoa/New Zealand, Indigenous Māori experience inequitable delivery of kidney transplantation, despite disproportionately higher rates of kidney failure. This study describes Māori patients' and families' values, perspectives and experiences related to kidney transplantation. STUDY DESIGN Qualitative interview study: Setting and participants: We conducted 40 in-depth interviews of 40 Māori: eight who had received a transplant, twenty with chronic kidney disease which included ten on the deceased donor transplant list, nine who were interested in transplantation and not currently waitlisted or who were ineligible for waitlisting, and one who was not interested in transplantation. We interviewed four live kidney donors and eight family members including six who had experiences with donor assessment. ANALYTICAL APPROACH Data were analyzed inductively to generate themes and a conceptual framework. RESULTS We identified five major themes: actively seeking a kidney transplant; evolving attitudes toward traditional values and practices; being confronted by interpersonal and systemic racism; poor information and communication; and challenged by social determinants of health. LIMITATIONS Participants were recruited nationally through patient advocacy organisations and one regional kidney service. Potential participants unrelated to these groups or region could not be included. CONCLUSIONS Māori participants were highly motivated to seek kidney transplantation and were inspired by positive experiences through donating and receiving a kidney. However, they faced barriers including social determinants, racism, and lack of information that impacted both direct experiences of transplantation and access to transplantation services.
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Affiliation(s)
| | - Sally Abel
- Kaupapa Consulting Ltd, Napier 4110, New Zealand
| | - Suetonia C Palmer
- Department of Medicine, University of Otago Christchurch, 8140, New Zealand; Department of Nephrology, Canterbury District Health Board, Christchurch, New Zealand
| | - Curtis Walker
- Department of Medicine, Midcentral District Health Board, Palmerston North 4442, New Zealand
| | - Nayda Heays
- Hawke's Bay District Health Board, Hastings, New Zealand
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Laneuville L, Ballesteros F, Affdal A, Malo MF, Brassard L, Gagnon Chainey B, Millot P, Mavrikakis C, Harel S, Fortin MC. Perspectives of Kidney Transplant Recipients, Transplant Candidates, and Living Kidney Donors on the Role of Patients’ Self-Narratives and Experiences of Creative Writing Workshops: A Qualitative Study. Can J Kidney Health Dis 2022; 9:20543581221132742. [PMID: 36353517 PMCID: PMC9638699 DOI: 10.1177/20543581221132742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Kidney transplantation is the best treatment for kidney failure but is
associated with medical, psychological, and existential challenges for
patients. Patients’ experiential knowledge can help other patients facing
these challenges. Patients’ self-narratives and creative writings are ways
to operationalize this experiential knowledge. Creative writing has been
described as a therapeutic tool for patients with chronic disease. Over the
past year, we conducted creative writing workshops with kidney transplant
recipients (KTRs), living kidney donors (LKDs), kidney transplant candidates
(KTCs), and professional writers. During these workshops, patients were
invited to explore different aspects of their experiences of their
transplant or donation journey through narrative-writing, poetry, comic art,
and screenwriting. Objective: The objectives of this study were to gather the perspectives of KTRs, KTCs,
and LKDs on the role of patients’ self-narratives and creative writing, and
to collect patients’ experiences of the creative writing workshops. Design: Focus groups and individual interviews. Setting: The Center hospitalier de l’Université de Montréal (CHUM) kidney transplant
program. Participants: KTRs, LKDs, and KTCs attending the CHUM kidney transplant clinic between
February 2020 and January 2021. Methods: We conducted 2 focus groups and 8 semi-structured individual interviews with
7 KTRs, 8 LKDs, and 5 KTCs from the CHUM between June and November 2020,
before the creative writing workshops. We also conducted 10 semi-structured
interviews with 5 KTRs, 1 KTC, and 4 LKDs in March 2021, after their
participation in the creative writing workshops. The interviews were
recorded and transcribed. Thematic and content analyses were conducted. Results: KTRs, LKDs, and KTCs had multiple significant moments to share from their
transplant/donation journey. These moments were highly emotional and marked
by uncertainty. The creative writing workshops were described as therapeutic
by participants, because they offered a safe space for group-facilitated
reflection, including a discovery and learning process, and normalization,
relativization, and appreciation of the transplant/donation experience. The
creative writing workshops also provided an opportunity to give back to
others (helping other patients, promoting kidney donation and continuing
this process in the future through the web platform). Limitations: Our participants came from a single French-speaking urban transplant center
in Quebec and were highly educated. Conclusion: The study set out to capture the perspectives of KTRs, LKDs, and KTCs through
the sharing of self-narratives and their participation in creative writing
workshops related to their transplant or donation journey. A website was set
up to publish patients’ creative writings (https://recitsdudonetdelavie.lorganon.ca/les-recits/).
Further study is needed to assess the website’s impact on other
patients. Trial registration: Not registered.
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Affiliation(s)
- Laurence Laneuville
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Aliya Affdal
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
| | - Marie-Françoise Malo
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
| | - Léonore Brassard
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
| | - Benjamin Gagnon Chainey
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
| | - Pascale Millot
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département des littératures de langues française, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Catherine Mavrikakis
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département des littératures de langues française, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Simon Harel
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département de littératures et de langues du monde, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du CHUM, Montréal, QC, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Faculté de médecine, Université de Montréal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
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Pines R, Iraheta YA, Dahmani KA, Cooper M, Waterman AD. Understanding Patients' and Living Donors' Kidney Paired Donation Educational Experiences and Recommendations for Improvement. Prog Transplant 2021; 32:19-26. [PMID: 34894855 DOI: 10.1177/15269248211064878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Educating potential kidney patients and living donors about the risks and benefits of kidney paired donation to ensure they make informed decisions is complex. This study aimed to increase understanding of patients' and donors' decision-making about donation, the educational content they received, and their recommendations for educational improvements. METHOD We conducted a mixed methods study, including semistructured interviews and quantitative surveys, with 43 participants (25 living donors; 18 kidney recipients). FINDINGS Participants reported that the benefits of paired donation motivated them to participate (ie, helping multiple people, receiving a transplant sooner, flexible timing of donation). Although deciding to participate in paired donation was a systematic, logical, and carefully considered process for some. For most, it was a quickly made, often emotion-based decision. Paired donation educational content on different topics varied, with recipients reporting receiving less information than donors about donor protections and processes to ameliorate the challenges faced, such as broken swaps and chains, and delays in matching. Those who faced challenges requested more information about donor protections and support during and after paired donation. Although many acknowledged their transplant coordinators' helpfulness, participants also recommended being more proactive in learning about kidney paired donation and speaking to former donors and recipients beforehand. DISCUSSION Standardized, health literate educational content addressing the gaps and variability in education received may help increase paired donation informed decision-making.
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Affiliation(s)
- Rachyl Pines
- Cottage Health Research Institute, 22854Santa Barbara Cottage Hospital, Santa Barbara, CA, USA
| | - Yaquelin Arevalo Iraheta
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Katia A Dahmani
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Matthew Cooper
- Medstar Georgetown Transplant Institute, Washington, DC, USA
| | - Amy D Waterman
- Department of Surgery and J.C. Walter Jr. Center for Transplantation, 23534Houston Methodist Hospital, Houston, Texas, USA
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Wong K, Owen-Smith A, Caskey F, MacNeill S, Tomson CRV, Dor FJMF, Ben-Shlomo Y, Bouacida S, Idowu D, Bailey P. Investigating Ethnic Disparity in Living-Donor Kidney Transplantation in the UK: Patient-Identified Reasons for Non-Donation among Family Members. J Clin Med 2020; 9:E3751. [PMID: 33233422 DOI: 10.3390/jcm9113751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
There is ethnic inequity in access to living-donor kidney transplants in the UK. This study asked kidney patients from Black, Asian and minority ethnic groups why members of their family were not able to be living kidney donors. Responses were compared with responses from White individuals. This questionnaire-based mixed-methods study included adults transplanted between 1/4/13–31/3/17 at 14 UK hospitals. Participants were asked to indicate why relatives could not donate, selecting all options applicable from: Age; Health; Weight; Location; Financial/Cost; Job; Blood group; No-one to care for them after donation. A box entitled ‘Other—please give details’ was provided for free-text entries. Multivariable logistic regression was used to analyse the association between the likelihood of selecting each reason for non-donation and the participant’s self-reported ethnicity. Qualitative responses were analysed using inductive thematic analysis. In total, 1240 questionnaires were returned (40% response). There was strong evidence that Black, Asian and minority ethnic group individuals were more likely than White people to indicate that family members lived too far away to donate (adjusted odds ratio (aOR) = 3.25, 95% Confidence Interval (CI) 2.30–4.58), were prevented from donating by financial concerns (aOR = 2.95, 95% CI 2.02–4.29), were unable to take time off work (aOR = 1.88, 95% CI 1.18–3.02), were “not the right blood group” (aOR = 1.65, 95% CI 1.35–2.01), or had no-one to care for them post-donation (aOR = 3.73, 95% CI 2.60–5.35). Four qualitative themes were identified from responses from Black, Asian and minority ethnic group participants: ‘Burden of disease within the family’; ‘Differing religious interpretations’; ‘Geographical concerns’; and ‘A culture of silence’. Patients perceive barriers to living kidney donation in the UK Black, Asian and minority ethnic population. If confirmed, these could be targeted by interventions to redress the observed ethnic inequity.
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Waterman AD, Gleason J, Lerminiaux L, Wood EH, Berrios A, Meacham LA, Osuji A, Pines R, Peipert JD. Amplifying the Patient Voice: Key Priorities and Opportunities for Improved Transplant and Living Donor Advocacy and Outcomes During COVID-19 and Beyond. Curr Transplant Rep 2020; 7:301-310. [PMID: 32904875 PMCID: PMC7462355 DOI: 10.1007/s40472-020-00295-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose of Review To define patient advocacy and engagement for modern transplant and living donation care, particularly in light of the COVID-19 pandemic, describe the patient experience when transplant advocacy and engagement are optimized, and recommend opportunities for advocacy within three key areas: (1) including the patient voice in healthcare decisions and drug development, (2) access to the best evidence-based treatments and informed decision-making, and (3) present and future care innovations and policies. Recent Findings There are many avenues for transplant and living donation advocacy and engagement at the patient, provider, family, system, community, and policy levels. Key recommendations include the following: (1) simplifying education to be health literate, written at the appropriate reading level, culturally sensitive, and available in multiple languages and across many delivery platforms, (2) inviting transplant patients and donors to the conversation through advisory panels, consensus conferences, and new mediums like digital storytelling and patient-reported outcomes (PROs), (3) training all members of the health team to understand their role as advocates, and (4) advancing policies and programs that support the financial neutrality of living donation, and support recipients with the cost of immunosuppressive drugs. Key recommendations specific to the COVID-19 pandemic include providing up-to-date, health literate, concise information about preventing COVID-19 and accessing care including telehealth. Summary Enhancing advocacy and engagement for transplant patients and donors along the pre-to-post transplant/donation continuum can improve clinical outcomes and quality of life generally, and more so, in light of the COVID-19 pandemic.
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Affiliation(s)
- Amy D. Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Jim Gleason
- Transplant Recipients International, Beverly, NJ USA
| | - Louise Lerminiaux
- Transplant Diagnostics, Thermo Fisher Scientific, Los Angeles, CA USA
| | - Emily H. Wood
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Alexander Berrios
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Laurie A. Meacham
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Anne Osuji
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Rachyl Pines
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - John D. Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University Transplant Outcomes Research Collaborative, Chicago, IL USA
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