Identifying and Addressing Barriers to African American and Non—African American Families' Discussions about Preemptive Living Related Kidney Transplantation

Boulware, L. Ebony; Hill‐Briggs, Felicia; Kraus, Edward S.; Melancon, J. Keith; Senga, Mikiko; Evans, Kira; Troll, Misty U.; Ephraim, Patti L.; Jaar, Bernard G.; Myers, Donna I.; McGuire, Raquel; Falcone, Brenda; Bonhage, Bobbie; Powe, Neil R.

doi:10.1177/152692481102100203

Cited by 57 publications

(55 citation statements)

References 19 publications

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“…A survey conducted in the United States found that public attitudes toward incentives for living kidney donation varied by ethnicity and income levels (38). We did not observe any apparent differences in opinion among the focus group participants by sociodemographic characteristics, including ethnicity, sex, age, or employment status (including poverty or reduced income).…”

Section: Discussioncontrasting

confidence: 63%

Focus Group Study of Public Opinion About Paying Living Kidney Donors in Australia

Tong

Ralph

Chapman

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives The unmet demand for kidney transplantation has generated intense controversy about introducing incentives for living kidney donors to increase donation rates. Such debates may affect public perception and acceptance of living kidney donation. This study aims to describe the range and depth of public opinion on financial reimbursement, compensation, and incentives for living kidney donors.

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Section: Discussioncontrasting

confidence: 63%

Focus Group Study of Public Opinion About Paying Living Kidney Donors in Australia

Tong

Ralph

Chapman

et al. 2015

Clinical Journal of the American Society of Nephrology

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“…24 Patient-, system-, and donor-related factors may all contribute to the lower likelihood of living donor transplantation in African-American ESRD patients, but available studies have primarily focused on patient-level factors, many of which overlap with determinants of living donor transplantation in lowincome populations. [25][26][27][28][29] More recently, attention has shifted to transplant center-level practices that affect LKD. 22 However, there has been less emphasis on donor-related factors in the published literature, and most of the available studies actually address recipient-related factors contributing to decreased identification of potential living donors in ethnic minority groups.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Race and Income on Living Kidney Donation in the United States

Gill

Dong

Rose

et al. 2013

Journal of the American Society of Nephrology

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Studies of racial disparities in access to living donor kidney transplantation focus mainly on patient factors, whereas donor factors remain largely unexamined. Here, data from the US Census Bureau were combined with data on all African-American and white living kidney donors in the United States who were registered in the United Network for Organ Sharing (UNOS) between 1998 and 2010 (N=57,896) to examine the associations between living kidney donation (LKD) and donor median household income and race. The relative incidence of LKD was determined in zip code quintiles ranked by median household income after adjustment for age, sex, ESRD rate, and geography. The incidence of LKD was greater in higher-income quintiles in both African-American and white populations. Notably, the total incidence of LKD was higher in the African-American population than in the white population (incidence rate ratio [IRR], 1.20; 95% confidence interval [95% CI], 1.17 to 1.24]), but ratios varied by income. The incidence of LKD was lower in the African-American population than in the white population in the lowest income quintile (IRR, 0.84; 95% CI, 0.78 to 0.90), but higher in the African-American population in the three highest income quintiles, with IRRs of 1.31 (95% CI, 1.22 to 1.41) in Q3, 1.50 (95% CI, 1.39 to 1.62) in Q4, and 1.87 (95% CI, 1.73 to 2.02) in Q5. Thus, these data suggest that racial disparities in access to living donor transplantation are likely due to socioeconomic factors rather than cultural differences in the acceptance of LKD.

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“…Prior studies indicate that patient concerns and perceived knowledge about end stage dialysis treatment options are determinants of patient behavior (3, 6, 8, 9, 12, 15). Also, patient education has been associated with improved graft and patient survival following transplantation as well as decreased racial disparities in transplantation (16, 17).…”

Section: Discussionmentioning

confidence: 99%

“…Studies of barriers to transplantation have often been focused on racial disparities (11, 12). An expanded assessment of patient-reported thoughts, beliefs and concerns, beyond considerations of racial disparities, is necessary to better understand factors that may contribute to patient’s not completing their evaluation.…”

Section: Introductionmentioning

confidence: 99%

Understanding Patient Barriers to Kidney Transplant Evaluation

et al. 2015

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Background Some patients referred for kidney transplant evaluation fail to attend the visit. Our goal was to compare demographic, socioeconomic, and psychological factors between evaluation visit attendees and absentees. Methods A convenience sample of patients referred and scheduled for kidney transplant evaluation at a single center from November 2012 to December 2013 participated in a phone survey reporting socioeconomic, demographic and clinical characteristics; health literacy; and perceived knowledge and concerns about transplantation. Absentees were matched by race with attendees. Analyses of differences between groups were performed with Chi-square, Fisher’s exact test, and t-tests. Multivariable logistic regression adjusted for relevant demographic characteristics. Results 104 adults participated (61% male, 46% Caucasian, 52±12 years). Financial concerns were the most prevalent (67.3% affording medication, 64.1% affording operation). Prior evaluation at a different transplant center (p=0.029) and being on dialysis (p=0.008) were significantly associated with absence. Attendance was associated with concerns about finding a living donor (p=0.038) and higher perceived general knowledge about transplantation (p ≤0.001). No differences were appreciated in demographic, socioeconomic or health literacy factors between groups. Conclusions Both attendee and absentee patients were most concerned with the financial burden of kidney transplantation. While concerns and perceived knowledge are important correlates of behavior, other considerations such as psychological factors and prior medical experiences may influence patients’ ability to complete the kidney transplant evaluation process. Although this pilot study was conducted in a small sample and has limited generalizability, our findings can guide future research.

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Identifying and Addressing Barriers to African American and Non—African American Families' Discussions about Preemptive Living Related Kidney Transplantation

Abstract: Families identified several barriers to discussing preemptive LRKT that could be addressed by social workers. Further research must be done to determine whether social workers need to tailor interventions to address families' cultural differences.

Cited by 57 publications

References 19 publications

Focus Group Study of Public Opinion About Paying Living Kidney Donors in Australia

Focus Group Study of Public Opinion About Paying Living Kidney Donors in Australia

The Effect of Race and Income on Living Kidney Donation in the United States

Understanding Patient Barriers to Kidney Transplant Evaluation

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