A randomized controlled trial of Explore Transplant at Home to improve transplant knowledge and decision-making for CKD 3-5 patients at Kaiser Permanente Southern California

Amy D. Waterman*, Crystal Anderson, Angelika Alem, John Devin Peipert, Jennifer L. Beaumont, Shayna L. Henry, Bhanuja Dub, Lizeth Ambriz, Neha Bijjala, Amanda Faye Lipsey, Brian Mittman

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Background: Five-year survival on dialysis is only 40%, compared to 74% with a deceased donor kidney transplant (DDKT) and 87% with a living donor kidney transplant (LDKT). An American Society of Transplantation (AST) Consensus Conference recommended that patients with chronic kidney disease (CKD) Stages 3-5 have the opportunity to learn about and decide which treatment option is right for them, particularly about LDKT. However, early education about LDKT and DDKT outside of transplant centers is inconsistent and often poor, with patients in CKD 3 and 4 and ethnic/racial minorities even less likely to receive it. A new randomized control trial (RCT), in partnership with Kaiser Permanente Southern California (KPSC), will assess knowledge gaps and the effectiveness of a supplementary video-guided, print and technology-based education intervention for English- and Spanish-speaking patients in CKD Stages 3, 4, and 5 to increase LDKT knowledge and decision-making. To date, no published LDKT educational interventions have studied such a large and diverse CKD population. Methods: In this RCT, 1200 English and Spanish-speaking CKD Stage 3-5 patients will be randomly assigned to one of two education conditions: ET@Home or KPSC standard of care education. Randomization will be stratified by CKD stage and primary language spoken. Those in the ET@Home condition will receive brochures, postcards, DVDs, and text messages delivering educational content in modules over a six-month period. Baseline data collection will measure demographics, transplant derailers, and the amount of previous CKD and transplant education they have received. Changes in CKD and transplant knowledge, ability to make an informed decision about transplant, and self-efficacy to pursue LDKT will be captured with surveys administered at baseline and at six months. Discussion: At the conclusion of the study, investigators will understand key knowledge gaps for patients along the CKD continuum and between patients who speak different languages and have assessed the effectiveness of both English- and Spanish-language supplementary education in increasing KPSC patients' knowledge about the opportunities for and risks and benefits of LDKT. We hope this program will reduce disparities in access to transplant. Trial Registration: ClinicalTrials.gov Identifier: NCT03389932; date registered: 12/26/2017.

Original languageEnglish (US)
Article number78
JournalBMC Nephrology
Volume20
Issue number1
DOIs
StatePublished - Mar 4 2019

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Chronic Renal Insufficiency
Decision Making
Randomized Controlled Trials
Transplants
Living Donors
Kidney
Education
Language
Tissue Donors
Text Messaging
Pamphlets
Aptitude
Self Efficacy
Standard of Care
Random Allocation
Dialysis
Consensus

Keywords

  • African-Americans
  • Health knowledge/attitudes
  • Hispanics
  • Kidney transplantation
  • Living donor
  • Patient education
  • Racial disparities
  • Transtheoretical model

ASJC Scopus subject areas

  • Nephrology

Cite this

Waterman, Amy D. ; Anderson, Crystal ; Alem, Angelika ; Peipert, John Devin ; Beaumont, Jennifer L. ; Henry, Shayna L. ; Dub, Bhanuja ; Ambriz, Lizeth ; Bijjala, Neha ; Lipsey, Amanda Faye ; Mittman, Brian. / A randomized controlled trial of Explore Transplant at Home to improve transplant knowledge and decision-making for CKD 3-5 patients at Kaiser Permanente Southern California. In: BMC Nephrology. 2019 ; Vol. 20, No. 1.
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A randomized controlled trial of Explore Transplant at Home to improve transplant knowledge and decision-making for CKD 3-5 patients at Kaiser Permanente Southern California. / Waterman, Amy D.; Anderson, Crystal; Alem, Angelika; Peipert, John Devin; Beaumont, Jennifer L.; Henry, Shayna L.; Dub, Bhanuja; Ambriz, Lizeth; Bijjala, Neha; Lipsey, Amanda Faye; Mittman, Brian.

In: BMC Nephrology, Vol. 20, No. 1, 78, 04.03.2019.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A randomized controlled trial of Explore Transplant at Home to improve transplant knowledge and decision-making for CKD 3-5 patients at Kaiser Permanente Southern California

AU - Waterman, Amy D.

AU - Anderson, Crystal

AU - Alem, Angelika

AU - Peipert, John Devin

AU - Beaumont, Jennifer L.

AU - Henry, Shayna L.

AU - Dub, Bhanuja

AU - Ambriz, Lizeth

AU - Bijjala, Neha

AU - Lipsey, Amanda Faye

AU - Mittman, Brian

PY - 2019/3/4

Y1 - 2019/3/4

N2 - Background: Five-year survival on dialysis is only 40%, compared to 74% with a deceased donor kidney transplant (DDKT) and 87% with a living donor kidney transplant (LDKT). An American Society of Transplantation (AST) Consensus Conference recommended that patients with chronic kidney disease (CKD) Stages 3-5 have the opportunity to learn about and decide which treatment option is right for them, particularly about LDKT. However, early education about LDKT and DDKT outside of transplant centers is inconsistent and often poor, with patients in CKD 3 and 4 and ethnic/racial minorities even less likely to receive it. A new randomized control trial (RCT), in partnership with Kaiser Permanente Southern California (KPSC), will assess knowledge gaps and the effectiveness of a supplementary video-guided, print and technology-based education intervention for English- and Spanish-speaking patients in CKD Stages 3, 4, and 5 to increase LDKT knowledge and decision-making. To date, no published LDKT educational interventions have studied such a large and diverse CKD population. Methods: In this RCT, 1200 English and Spanish-speaking CKD Stage 3-5 patients will be randomly assigned to one of two education conditions: ET@Home or KPSC standard of care education. Randomization will be stratified by CKD stage and primary language spoken. Those in the ET@Home condition will receive brochures, postcards, DVDs, and text messages delivering educational content in modules over a six-month period. Baseline data collection will measure demographics, transplant derailers, and the amount of previous CKD and transplant education they have received. Changes in CKD and transplant knowledge, ability to make an informed decision about transplant, and self-efficacy to pursue LDKT will be captured with surveys administered at baseline and at six months. Discussion: At the conclusion of the study, investigators will understand key knowledge gaps for patients along the CKD continuum and between patients who speak different languages and have assessed the effectiveness of both English- and Spanish-language supplementary education in increasing KPSC patients' knowledge about the opportunities for and risks and benefits of LDKT. We hope this program will reduce disparities in access to transplant. Trial Registration: ClinicalTrials.gov Identifier: NCT03389932; date registered: 12/26/2017.

AB - Background: Five-year survival on dialysis is only 40%, compared to 74% with a deceased donor kidney transplant (DDKT) and 87% with a living donor kidney transplant (LDKT). An American Society of Transplantation (AST) Consensus Conference recommended that patients with chronic kidney disease (CKD) Stages 3-5 have the opportunity to learn about and decide which treatment option is right for them, particularly about LDKT. However, early education about LDKT and DDKT outside of transplant centers is inconsistent and often poor, with patients in CKD 3 and 4 and ethnic/racial minorities even less likely to receive it. A new randomized control trial (RCT), in partnership with Kaiser Permanente Southern California (KPSC), will assess knowledge gaps and the effectiveness of a supplementary video-guided, print and technology-based education intervention for English- and Spanish-speaking patients in CKD Stages 3, 4, and 5 to increase LDKT knowledge and decision-making. To date, no published LDKT educational interventions have studied such a large and diverse CKD population. Methods: In this RCT, 1200 English and Spanish-speaking CKD Stage 3-5 patients will be randomly assigned to one of two education conditions: ET@Home or KPSC standard of care education. Randomization will be stratified by CKD stage and primary language spoken. Those in the ET@Home condition will receive brochures, postcards, DVDs, and text messages delivering educational content in modules over a six-month period. Baseline data collection will measure demographics, transplant derailers, and the amount of previous CKD and transplant education they have received. Changes in CKD and transplant knowledge, ability to make an informed decision about transplant, and self-efficacy to pursue LDKT will be captured with surveys administered at baseline and at six months. Discussion: At the conclusion of the study, investigators will understand key knowledge gaps for patients along the CKD continuum and between patients who speak different languages and have assessed the effectiveness of both English- and Spanish-language supplementary education in increasing KPSC patients' knowledge about the opportunities for and risks and benefits of LDKT. We hope this program will reduce disparities in access to transplant. Trial Registration: ClinicalTrials.gov Identifier: NCT03389932; date registered: 12/26/2017.

KW - African-Americans

KW - Health knowledge/attitudes

KW - Hispanics

KW - Kidney transplantation

KW - Living donor

KW - Patient education

KW - Racial disparities

KW - Transtheoretical model

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