Achieving Equity in Referrals for Renal Transplant Evaluations with African-American Patients

Abstract

Research over the last 12 years has repeatedly shown that African-American ESRD patients are less likely than white patients to be referred for a transplant evaluation. This article takes an exploratory look at issues surrounding this racial disparity. Among the issues focused on are: (a) the multiple ramifications from this racial disparity; (b) neglected factors which may be militating against the equitable referral of African-American patients; and (c) the vulnerabilities of this patient population. The final focus is on intervention strategies for nephrology social workers and how they might help to facilitate a greater equity in this area of health care with African-American patients.

A Mixed-Methods Approach to Understanding Variation in Social Support Requirements and Implications for Access to Transplantation in the United States

“…Placing the burden on patients to advocate for reevaluation may increase barriers for patients with limited means, low socioeconomic status, low health literacy, or distrust of the health-care system. 25 Our findings reinforce the importance of clearer definitions for ensuring equity in access to transplantation and for supporting psychosocial providers tasked with carrying out these challenging evaluations. 26…”

Assessing knowledge of end-stage kidney disease and treatment options in hospitalized African American patients undergoing hemodialysis

“…37 Programs that integrate CKD education, provide information on treatment modalities, and discuss the personal benefits and risks of all options would help improve decision-making in minoritized patients. 37 After documenting barriers to patientinformed decision-making, effective interventions should be developed, evaluated, and consistently implemented. Many interventions such as decision aids also have been developed to improve KRT decision-making.…”

“…33 All healthcare staff can be better educated about and work to challenge social injustice and structural racism that exists within healthcare systems to create positive change and increase equity in health care facilities. 37 It is the responsibility of all the staff, including physicians, nurses, dialysis technicians, and nephrology social workers, not only to provide the necessary KRT information but also to also confirm the patients understanding of all available options to improve their health. 37 Programs that integrate CKD education, provide information on treatment modalities, and discuss the personal benefits and risks of all options would help improve decision-making in minoritized patients.…”

“…37 Programs that integrate CKD education, provide information on treatment modalities, and discuss the personal benefits and risks of all options would help improve decision-making in minoritized patients. 37…”

“…17 Another promising intervention is teaching healthcare workers more about heath disparities and its impact on CKD care. 37 One policy intervention would be for Centers for Medicare & Medicaid Services (CMS) to provide financial incentives to dialysis units that increase the proportion of patients on home modalities and referred for transplant. 38 Similarly, CMS could also provide incentives to dialysis units that reduce disparities between African American and Whites’ use of these modalities.…”