Explore Transplant at Home: a randomized control trial of an educational intervention to increase transplant knowledge for Black and White socioeconomically disadvantaged dialysis patients

Abstract

BackgroundCompared to others, dialysis patients who are socioeconomically disadvantaged or Black are less likely to receive education about deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT) before they reach transplant centers, often due to limited availability of transplant education within dialysis centers. Since these patients are often less knowledgeable or ready to pursue transplant, educational content must be simplified, made culturally sensitive, and presented gradually across multiple sessions to increase learning and honor where they are in their decision-making about transplant. The Explore Transplant at Home (ETH) program was developed to help patients learn more about DDKT and LDKT at home, with and without telephone conversations with an educator.Methods and Study DesignIn this randomized controlled trial (RCT), 540 low-income Black and White dialysis patients with household incomes at or below 250 % of the federal poverty line, some of whom receive financial assistance from the Missouri Kidney Program, will be randomly assigned to one of three education conditions: (1) standard-of-care transplant education provided by the dialysis center, (2) patient-guided ETH (ETH-PG), and (3) health educator-guided ETH (ETH-EG). Patients in the standard-of-care condition will only receive education provided in their dialysis centers. Those in the two ETH conditions will receive four video and print modules delivered over an 8 month period by mail, with the option of receiving supplementary text messages weekly. In addition, patients in the ETH-EG condition will participate in multiple telephonic educational sessions with a health educator. Changes in transplant knowledge, decisional balance, self-efficacy, and informed decision making will be captured with surveys administered before and after the ETH education.DiscussionAt the conclusion of this RCT, we will have determined whether an education program administered to socioeconomically disadvantaged dialysis patients, over several months directly in their homes, can help more individuals learn about the options of DDKT and LDKT. We also will be able to examine the efficacy of different educational delivery approaches to further understand whether the addition of a telephone educator is necessary for increasing transplant knowledge.Trial RegistrationClinicalTrials.gov, NCT02268682

Cultural competency of a mobile, customized patient education tool for improving potential kidney transplant recipients’ knowledge and decision-making

“…The MTC app resulted in statistically and clinically significant increases in patient knowledge The need for effective educational interventions in patients with ESRD is crucial as patients must choose between dramatically different renal replacement therapy options, especially given the ongoing and profound disparities in access to transplantation [22][23][24][25]. Patients with reduced access to specialty care and health information (e.g.…”

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

“…Larger, multicenter studies testing the effectiveness of a patient navigator may be warranted, particularly because the absolute effect of the navigator was small after the 500 days (15 versus five waitlisting events). Perhaps future studies should administer multiple interventions along with patient navigation, such as educational interventions that take place in either a patient's home (21) or the dialysis facility (39) and/ or culturally sensitive education within a transplant center focusing on living donor transplant (38), to potentially have a synergistic effect on waitlisting and help address the major barriers faced by this population. Larger studies with longer follow-up could also examine important outcomes beyond waitlisting, including receipt of a living or deceased donor transplant.…”

“…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).…”

Educating Prospective Kidney Transplant Recipients and Living Donors about Living Donation: Practical and Theoretical Recommendations for Increasing Living Donation Rates

“…While a few validated scales focusing on general kidney dis- ease and transplant knowledge have been published [31, 32], the Rotterdam Renal Replacement Knowledge Test (R3K-T) features a well-validated subscale focusing on LDKT knowledge particularly [33]. O'Connor and colleagues’ Decisional Conflict Scale [34] and Decisional Self-Efficacy Scale [35] have been employed in trials of educational programs to in- crease LDKT [36, 37]. Other studies have assessed intermediate LDKT pursuit attitudes using measures for which no psychometric properties are reported [38].…”

“…The AST Consensus Conference also duly recommended that future research must still occur to understand how modifying different possible causes for racial disparities affects pursuit of LDKT among different racial/ethnic minority groups [64••]. For example, past LDKT educational programs targeting Black and/or Hispanic kidney patients have aimed to increase knowledge or address fears by providing improved educational materials and longer educational conversations [37], supporting patients in completing small steps toward LDKT [24], providing individually guided navigation services [40], and assisting patients in obtaining financial resources to address socioeconomic barriers [36]. For donor candidates, there is now a debate as to whether they should be compensated some amount for the uncovered costs associated with the evaluation and donation processes to work to- ward a goal of financial neutrality [11••].…”