Your Path to Transplant: a randomized controlled trial of a tailored computer education intervention to increase living donor kidney transplant

Abstract

BackgroundBecause of the deceased donor organ shortage, more kidney patients are considering whether to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although Blacks and Hispanics are 3.4 and 1.5 times more likely, respectively, to develop end stage renal disease (ESRD) than Whites, they are less likely to receive LDKTs. To address this disparity, a new randomized controlled trial (RCT) will assess whether Black, Hispanic, and White transplant patients’ knowledge, readiness to pursue LDKT, and receipt of LDKTs can be increased when they participate in the Your Path to Transplant (YPT) computer-tailored intervention.Methods/DesignNine hundred Black, Hispanic, and White ESRD patients presenting for transplant evaluation at University of California, Los Angeles Kidney and Pancreas Transplant Program (UCLA-KPTP) will be randomly assigned to one of two education conditions, YPT or Usual Care Control Education (UC). As they undergo transplant evaluation, patients in the YPT condition will receive individually-tailored telephonic coaching sessions, feedback reports, video and print transplant education resources, and assistance with reducing any known socioeconomic barriers to LDKT. Patients receiving UC will only receive transplant education provided by UCLA-KPTP. Changes in transplant knowledge, readiness, pros and cons, and self-efficacy to pursue LDKT will be assessed prior to presenting at the transplant center (baseline), during transplant evaluation, and 4- and 8-months post-baseline, while completion of transplant evaluation and receipt of LDKTs will be assessed at 18-months post-baseline. The RCT will determine, compared to UC, whether Black, Hispanic, and White patients receiving YPT increase in their readiness to pursue LDKT and transplant knowledge, and become more likely to complete transplant medical evaluation and pursue LDKT. It will also examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with YPT to affect patients’ transplant decision-making and behavior. Statistical analyses will be performed under an intent-to-treat approach.DiscussionAt the conclusion of the study, we will have assessed the effectiveness of an innovative and cost-effective YPT intervention that could be utilized to tailor LDKT discussion and education based on the needs of individual patients of different races in many healthcare settings.Trial registrationClinicalTrials.gov, number NCT02181114.

Invariance of measures to understand decision-making for pursuing living donor kidney transplant

“…In addition, validated measures that are relevant and consistent across patient groups are necessary to assess the efficacy of the proposed interventions. The finding that the distribution of SOC did not vary by gender or education level, but did vary across race/ethnicity group is consistent with the goals of LDKT interventions (Waterman et al, 2015, 2014) in facilitating readiness to change for LDKT in minority groups.…”

Living Donor Kidney Transplantation

“…Innovative strategies have been developed to reduce racial/ethnic disparities in LDKT, particularly at the transplant center level. These include the use of transplant navigators (61,62), transplant educators making house calls to patients and their social network (63,64), recruiting and training living donor champions (65), and more effective communication with and education of patients and family members about LDKT and LKD (66)(67)(68)(69). Although these strategies are promising, they have not yet been widely adopted and their utility with patients earlier in their disease process (i.e., before transplant referral) has not yet been established.…”

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

“…There is evidence that patients who receive educational messages tailored to their readiness stage have twice the chance of taking a health behavior in the following 6 months compared with patients receiving general health recommendations [22, 23]. While there are no published trials on the impact of LDKT education explicitly tailored to the readiness stage of individual patients, a novel trial is currently underway that uses computerized assessments of LDKT readiness to generate unique tailored educational messages appropriate for each individual [24]. …”

“…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••].…”