A Website Intervention to Increase Knowledge About Living Kidney Donation and Transplantation Among Hispanic/Latino Dialysis Patients

Gordon, Elisa J.; Feinglass, Joe; Carney, Paula; Vera, Karina; Oliveró, María Mercedes Balcells; Black, Arthur D.; O’Connor, Kate; Baumgart, Jessica Mac Lean; Caicedo, Juan C.

doi:10.1177/1526924816632124

Cited by 49 publications

(59 citation statements)

References 40 publications

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“…These findings offer a potential explanation for the previously reported disparities of AA donor candidates being less likely to convert to donors and less likely to donate overall. Current strategies to achieve growth in living donor kidney transplantation do not take this into consideration . We hypothesized that the disparity in this specific step could be explained by the fact that AA nationally have a higher prevalence of hypertension, obesity, diabetes .…”

Section: Discussionmentioning

confidence: 99%

“…Current strategies to achieve growth in living donor kidney transplantation do not take this into consideration. 5,10,[19][20][21][22][23][24][25] We hypothesized that the disparity in this specific step could be explained by the fact that AA nationally have a higher prevalence of hypertension, obesity, diabetes. 26 As such, our study was able to demonstrate that a substantial proportion of AA donor candidates were biologically related.…”

Section: Discussionmentioning

confidence: 99%

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Racial differences in completion of the living kidney donor evaluation process

Kumar

Tonascia

Muzaale

et al. 2018

Clinical Transplantation

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Racial disparities in living donor kidney transplantation (LDKT) persist but the most effective target to eliminate these disparities remains unknown. One potential target could be delays during completion of the live donor evaluation process. We studied racial differences in progression through the evaluation process for 247 African American (AA) and 664 non-AA living donor candidates at our center between January 2011 and March 2015. AA candidates were more likely to be obese (38% vs 22%: P < .001), biologically related (66% vs 44%: P < .001), and live ≤50 miles from the center (64% vs 37%: P < .001) than non-AAs. Even after adjusting for these differences, AAs were less likely to progress from referral to donation (aHR for AA vs non-AA: 0.47 P = .01). We then assessed racial differences in completion of each step of the evaluation process and found disparities in progression from medical screening to in-person evaluation (aHR: 0.62 P = .02) and from clearance to donation (aHR: 0.51 P = .02), compared with from referral to medical screening (aHR: 1.02 P = .95) and from in-person evaluation to clearance (aHR: 0.93 P = .54). Delays may be a manifestation of the transplant candidate's social network, thus, targeted efforts to optimize networks for identification of donor candidates may help address LDKT disparities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Racial differences in completion of the living kidney donor evaluation process

Kumar

Tonascia

Muzaale

et al. 2018

Clinical Transplantation

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“…More recently, studies have shown that trained kidney transplant recipients serving as patient navigators for patients with ESKD within dialysis facilities doubled the number of steps that a patient completed in the transplant process (15) and increased access to living donor transplantation (16), but the effectiveness of a patient navigator program among a historically disadvantaged group of patients with ESKD has not been studied. The kidney transplant community has called for targeted interventions among disadvantaged groups as one approach to eliminate health disparities in transplantation (17)(18)(19)(20)(21)(22)(23); however, to reduce disparities, an intervention must be either more effective among the disparate group or implemented among the disparate group only (17).…”

Section: Introductionmentioning

confidence: 99%

Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population

Basu¹,

Petgrave-Nelson

Smith

et al. 2018

CJASN

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Background and objectives Barriers exist in access to kidney transplantation, where minority and patients with low socioeconomic status are less likely to complete transplant evaluation. The purpose of this study was to examine the effectiveness of a transplant center-based patient navigator in helping patients at high risk of dropping out of the transplant evaluation process access the kidney transplant waiting list.Design, setting, participants & measurements We conducted a randomized, controlled trial of 401 patients (n=196 intervention and n=205 control) referred for kidney transplant evaluation (January 2013 to August 2014; followed through May 2016) at a single center. A trained navigator assisted intervention participants from referral to waitlisting decision to increase waitlisting (primary outcome) and decrease time from referral to waitlisting (secondary outcome). Time-dependent Cox proportional hazards models were used to determine differences in waitlisting between intervention and control patients.Results At study end, waitlisting was not significantly different among intervention (32%) versus control (26%) patients overall (P=0.17), and time from referral to waitlisting was 126 days longer for intervention patients. However, the effectiveness of the navigator varied from early (,500 days from referral) to late ($500 days) followup. Although no difference in waitlisting was observed among intervention (50%) versus control (50%) patients in the early period (hazard ratio, 1.03; 95% confidence interval, 0.69 to 1.53), intervention patients were 3.3 times more likely to be waitlisted after 500 days (75% versus 25%; hazard ratio, 3.31; 95% confidence interval, 1.20 to 9.12). There were no significant differences in intervention versus control patients who started evaluation (85% versus 79%; P=0.11) or completed evaluation (58% versus 51%; P=0.14); however, intervention patients had more living donor inquiries (18% versus 10%; P=0.03).Conclusions A transplant center-based navigator targeting disadvantaged patients improved waitlisting but not until after 500 days of follow-up. However, the absolute effect was relatively small.

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“…These increases in knowledge were sustained at the 3-week follow-up [46]. Informate was also evaluated in a pretest-posttest among 63 dialysis patients and was shown to significantly increase LDKT knowledge [69]. …”

Section: Introductionmentioning

confidence: 99%

Decision Aids to Increase Living Donor Kidney Transplantation

2017

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Purpose of review For the more than 636,000 adults with end-stage renal disease (ESRD) in the U.S., kidney transplantation is the preferred treatment compared to dialysis. Living donor kidney transplantation (LDKT) comprised 31% of kidney transplantations in 2015, an 8% decrease since 2004. We aimed to summarize the current literature on decision aids that could be used to improve LDKT rates. Recent findings Decision aids are evidence-based tools designed to help patients and their families make difficult treatment decisions. LDKT decision aids can help ESRD patients, patients’ family and friends, and healthcare providers engage in treatment decisions and thereby overcome multifactorial LDKT barriers. Summary We identified 12 LDKT decision aids designed to provide information about LDKT, and/or to help ESRD patients identify potential living donors, and/or to help healthcare providers make decisions about treatment for ESRD or living donation. Of these, 4 were shown to be effective in increasing LDKT, donor inquiries, LDKT knowledge, and willingness to discuss LDKT. Although each LDKT decision aid has limitations, adherence to decision aid development guidelines may improve decision aid utilization and access to LDKT.

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A Website Intervention to Increase Knowledge About Living Kidney Donation and Transplantation Among Hispanic/Latino Dialysis Patients

Cited by 49 publications

References 40 publications

Racial differences in completion of the living kidney donor evaluation process

Racial differences in completion of the living kidney donor evaluation process

Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population

Decision Aids to Increase Living Donor Kidney Transplantation

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