Limited health literacy and adverse outcomes among kidney transplant candidates

Warsame, Fatima; Haugen, Christine E.; Hua, Ying; Garonzik-Wang, Jacqueline; Desai, Niraj M.; Hall, Rasheeda K.; Kambhampati, Rekha; Crews, Deidra C.; Purnell, Tanjala S.; Segev, Dorry L.; McAdams‐DeMarco, Mara

doi:10.1111/ajt.14994

Cited by 54 publications

(75 citation statements)

References 47 publications

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“…We also found study participants with lower health literacy and lower education were more likely to report they felt less knowledgeable about LDKT. Previous studies have demonstrated decreased likelihood of referral for transplant evaluation and lower odds of wait listing among patients with limited health literacy. Poor health literacy may also limit patients' understanding and knowledge of LDKT.…”

Section: Discussionmentioning

confidence: 99%

Associations of perceived information adequacy and knowledge with pursuit of live donor kidney transplants and living donor inquiries among African American transplant candidates

Cabacungan

Ellis

Sudan

et al. 2020

Clinical Transplantation

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We studied associations between perceived adequacy of live donor kidney transplant (LDKT) information or knowledge with pursuit of LDKT or receipt of live donor inquiries among 300 African American kidney transplant candidates. Participants reported via questionnaire how informed or knowledgeable they felt regarding LDKT. Participants also reported their pursuit of LDKT, categorized as “low” (no discussion with family or friends about LDKT and no identified donor), “intermediate” (discussed LDKT with family but no identified donor) or “high” (discussed LDKT with family and identified a potential donor). We reviewed participants' electronic health records to identify potential donors' transplant center inquiries on participants' behalves. A minority of participants reported they felt “very” or “extremely” well informed about LDKT (39%) or had “a great deal” of LDKT knowledge (38%). Participants perceiving themselves as “very” or “extremely” (vs “not” or “slightly”) well informed about LDKT had statistically significantly greater odds of intermediate or high (vs low) pursuit of LDKT (odds ratio [95% confidence interval] 2.71 [1.02‐7.17]). Perceived LDKT knowledge was not associated with pursuit of LDKT. Neither perceived information adequacy nor knowledge was associated with living donor inquiries. Efforts to better understand the role of education in the pursuit of LDKT among African American transplant candidates are needed.

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Section: Discussionmentioning

confidence: 99%

Associations of perceived information adequacy and knowledge with pursuit of live donor kidney transplants and living donor inquiries among African American transplant candidates

Cabacungan

Ellis

Sudan

et al. 2020

Clinical Transplantation

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“…37 Although we did not measure health literacy directly, education level has been shown to correlate with health literacy in the transplant population. 38,39 Navigating the transplant process, from referral through surgery, has been shown to depend heavily on education, and this need is especially true for living-donor transplantation. 40,41 Fortunately, evidence exists from clinical trials of adult kidney transplant candidates that educational programs can lead to higher knowledge and fewer concerns with living donation as well as an increase in the number of donor inquiries.…”

Section: Discussionmentioning

confidence: 99%

Barriers to access in pediatric living‐donor liver transplantation

Mogul

Lee

Purnell

et al. 2019

Pediatric Transplantation

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Children receiving a LDLT have superior post‐transplant outcomes, but this procedure is only used for 10% of transplant recipients. Better understanding about barriers toward LDLT and the sociodemographic characteristics that influence these underlying mechanisms would help to inform strategies to increase its use. We conducted an online, anonymous survey of parents/caregivers for children awaiting, or have received, a liver transplant regarding their knowledge and attitudes about LDLT. The survey was completed by 217 respondents. While 97% of respondents understood an individual could donate a portion of their liver, only 72% knew the steps in evaluation, and 69% understood the donor surgery was covered by the recipient's insurance. Individuals with public insurance were less likely than those with private insurance to know the steps for LDLT evaluation (44% vs 82%; P < 0.001). Respondents with public insurance were less likely to know someone that had been a living donor (44% vs 56%; P = 0.005) as were individuals without a college degree (64% vs 85%; P = 0.007). Nearly all respondents generally trusted their healthcare team. Among respondents, 82% believed they were well‐informed about LDLT but individuals with public insurance were significantly less likely to feel well‐informed (67% vs 87%; P = 0.03) and to understand how donor surgery might impact donor work/time off (44% vs 81%; P = 0.001). Substantial gaps exist in parental understanding about LDLT, including its evaluation, potential benefits, and complications. Greater emphasis on addressing these barriers, especially to individuals with fewer resources, will be helpful to expand the use of LDLT.

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“…We speculate that several reasons could have contributed to our finding of lower likelihood of KT wait‐listing with cognitive impairment. Although we did not aim to use the MoCA score as a proxy for health literacy, patients with MCI have been shown to have lower health numeracy as well as health literacy . Furthermore, many studies have demonstrated a high prevalence of impaired executive function in patients with ESRD .…”

Section: Discussionmentioning

confidence: 99%

Cognitive assessment in a predominantly Hispanic and Native American population in New Mexico and its association with kidney transplant wait‐listing

Mawed

Pankratz

et al. 2019

Clinical Transplantation

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The association between cognitive function and the likelihood of kidney transplant (KT) wait-listing, especially in minority populations, has not been clearly delineated.We performed a retrospective review of our pre-KT patients, who consist mainly of Hispanics and Native Americans, over a 16-month period. We collected data on baseline demographics and the Montreal Cognitive Assessment (MoCA) score, at the initial KT evaluation. We defined cognitive impairment as MoCA scores of <24. We constructed linear regression models to identify associations between baseline characteristics with MoCA scores and used Cox proportional hazards models to assess associations between MoCA score and KT wait-listing. During the study period, 154 patients completed the MoCA during their initial evaluation. Mean (standard deviation) MoCA scores were 23.9 (4.6), with 58 (38%) participants scoring <24. Advanced age, lower education and being on dialysis were associated with lower MoCA scores.For every one-point increase in MoCA, the likelihood of being wait-listed increased 1.10-fold (95% CI 1.01-1.19, P = .022). Being Native American and having kidney disease due to diabetes or hypertension were associated with longer time to wait-listing.Cognitive impairment was common in our pre-KT patients and was associated with a lower likelihood of KT wait-listing.

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Limited health literacy and adverse outcomes among kidney transplant candidates

Cited by 54 publications

References 47 publications

Associations of perceived information adequacy and knowledge with pursuit of live donor kidney transplants and living donor inquiries among African American transplant candidates

Associations of perceived information adequacy and knowledge with pursuit of live donor kidney transplants and living donor inquiries among African American transplant candidates

Barriers to access in pediatric living‐donor liver transplantation

Cognitive assessment in a predominantly Hispanic and Native American population in New Mexico and its association with kidney transplant wait‐listing

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