Process evaluation of the RaDIANT community study: a dialysis facility-level intervention to increase referral for kidney transplantation

Abstract

BackgroundThe Reducing Disparities in Access to kidNey Transplantation Community Study (RaDIANT) was an End-Stage Renal Disease (ESRD) Network 6-developed, dialysis facility-level randomized trial testing the effectiveness of a 1-year multicomponent education and quality improvement intervention in increasing referral for kidney transplant evaluation among selected Georgia dialysis facilities.MethodsTo assess implementation of the RaDIANT intervention, we conducted a process evaluation at the conclusion of the intervention period (January–December 2014). We administered a 20-item survey to the staff involved with transplant education in 67 dialysis facilities randomized to participate in intervention activities. Survey items assessed facility participation in the intervention (fidelity and reach), helpfulness and willingness to continue intervention activities (sustainability), suggestions for improving intervention components (sustainability), and factors that may have influenced participation and study outcomes (context). We defined high fidelity to the intervention as completing 11 or more activities, and high participation in an activity as having at least 75% participation across intervention facilities.ResultsStaff from 65 of the 67 dialysis facilities completed the questionnaire, and more than half (50.8%) reported high adherence (fidelity) to RaDIANT intervention requirements. Nearly two-thirds (63.1%) of facilities reported that RaDIANT intervention activities were helpful or very helpful, with 90.8% of facilities willing to continue at least one intervention component beyond the study period. Intervention components with high participation emphasized staff and patient-level education, including in-service staff orientations, patient and family education programs, and patient educational materials. Suggested improvements for intervention activities emphasized addressing financial barriers to transplantation, with financial education materials perceived as most helpful among RaDIANT educational materials. Variation in facility-level fidelity of the RADIANT intervention did not significantly influence the mean difference in proportion of patients referred pre- (2013) and post-intervention (2014).ConclusionsWe found high fidelity to the RaDIANT multicomponent intervention at the majority of intervention facilities, with sustainability of select intervention components at intervention facilities and feasibility for dissemination across ESRD Networks. Future modification of the intervention should emphasize financial education regarding kidney transplantation and amend intervention components that facilities perceive as time-intensive or non-sustainable.Trial registrationClinicaltrials.gov number NCT02092727. Registered 13 Mar 2014 (retrospectively registered).Electronic supplementary materialThe online version of this article (10.1186/s12882-017-0807-z) contains supplementary material, which is available to authorized users.

Your Path to Transplant: A randomized controlled trial of a tailored expert system intervention to increase knowledge, attitudes, and pursuit of kidney transplant

“…At the provider and system level, research has found that transplant facilities with specifically tailored toolkits to coordinate patient care, 46,47 and risk‐based approaches identifying patients in need of targeted care 48,49 were more successful. Interventions including multiple levels of the socioecological model may be needed, perhaps in combination 50‐52 …”

Storytelling to Inspire Dialysis Patients to Learn about Living Donor Kidney Transplant

“…Previous research has found 5 common barriers to delivering LDKT education to dialysis patients and to increasing patient curiosity and learning about it. These barriers are (1) limited provider knowledge and comfort educating about transplant and LDKT [6,7], (2) limited time to educate about transplant and LDKT [6][7][8]16], (3) insufficient educational resources for patients with low health literacy [9][10][11], diverse patients [14,17,18], and those less ready to pursue transplant [19], (4) high rates of patient fears and misconceptions about transplant and LDKT [12,14,18], and (5) difficulty reaching family, friends, or potential living donors to learn about transplant and LDKT [7,20].…”

“…Previous research has demonstrated the prevalence of low health literacy among patients with CKD and ESRD, which is associated with lower likelihood to pursue transplant, especially LDKT [9][10][11], and the need for culturally tailored materials for use with African American and Latinx populations [14,17,18]. While interventions us-Blood Purif 2021;50:655-661 DOI: 10.1159/000512651 ing health literate, culturally sensitive educational resources in print, Web, or video formats have been shown to be effective with minority groups [21,22] and patients who are earlier in their readiness to pursue transplant and LDKT [19,23], this type of tailored information written for low health literacy audiences is not always available.…”

“…With these new policies linking dialysis funding to transplant referrals, dialysis centers need to continue improving their ability to educate and refer more patients for transplant, particularly black and Latinx patients who are still less likely to receive DDKTs or LDKTs than whites [5]. Past research has identified many provider barriers to effectively delivering education about transplant such as time limitations and poor access to materials [6][7][8] and patient barriers to learning such as fears, low health literacy, and medical mistrust [9][10][11][12][13][14].…”

Effect of the ASCENT Intervention to Increase Knowledge of Kidney Allocation Policy Changes Among Dialysis Providers

“…[20][21][22][23] Evidence also suggests that audit and feedback reports combined with multicomponent and multilevel educational interventions in dialysis facilities can reduce racial disparities in transplant access. [24][25][26] In this study, we assess the effectiveness of a multicomponent educational intervention on changes in knowledge of the impact new KAS on transplantation among dialysis facility providers in US dialysis facilities with low waitlisting. The outcome of the present analysis, provider knowledge, is a secondary outcome in the ASCENT trial.…”