Direct Delivery of Kidney Transplant Education to Black and Low-Income Patients Receiving Dialysis

A Randomized Controlled Trial

Amy D. Waterman*, John Devin Peipert, Anna Michelle McSorley, Christina J. Goalby, Jennifer L. Beaumont, Leanne Peace

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

Rationale & Objective: Compared with others, black and low-income patients receiving dialysis are less likely to receive kidney transplantation (KT) education within dialysis centers. We examined the efficacy of 2 supplementary KT education approaches delivered directly to patients. Study Design: Prospective, 3-arm parallel-group, randomized, controlled trial. Settings & Participants: Adult, black, and white low-income patients receiving dialysis in Missouri. Intervention: Patients were randomly assigned to 1 of 3 educational conditions: (1) standard of care, usual KT education provided in dialysis centers (control); (2) Explore Transplant @ Home patient-guided, 4 modules of KT education sent directly to patients using print, video, and text messages; and (3) Explore Transplant @ Home educator-guided, the patient-guided intervention plus 4 telephonic discussions with an educator. Outcomes: Primary: patient knowledge of living (LDKT) and deceased donor KT (DDKT). Secondary: informed decision making, change in attitudes in favor of LDKT and DDKT, and change in the number of new steps taken toward KT. Results: In intent-to-treat analyses, patients randomly assigned to educator- and patient-guided interventions had greater knowledge gains (1.4 point increase) than control patients (0.8 point increase; P = 0.02 and P = 0.01, respectively). Compared with control patients, more patients randomly assigned to educator- and patient-guided interventions were able to make informed decisions about starting KT evaluation (82% vs 91% and 95%; P = 0.003), pursuing DDKT (70% vs 84% and 84%; P = 0.003), and pursuing LDKT (73% vs 91% and 92%; P < 0.001). Limitations: Potential contamination because of patient-level randomization; no assessment of clinical end points. Conclusions: Education presented directly to dialysis patients, with or without coaching by telephone, increased dialysis patients’ KT knowledge and informed decision making without increasing educational burden on providers. Funding Source: This project was funded by the National Institutes of Health and Health Resources and Services Administration. Trial Registration: Registered at ClinicalTrials.gov with study number NCT02268682.

Original languageEnglish (US)
Pages (from-to)640-649
Number of pages10
JournalAmerican Journal of Kidney Diseases
Volume74
Issue number5
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Dialysis
Randomized Controlled Trials
Transplants
Kidney
Education
Kidney Transplantation
Tissue Donors
Decision Making
United States Health Resources and Services Administration
Text Messaging
National Institutes of Health (U.S.)
Standard of Care
Random Allocation
Telephone
Arm

Keywords

  • Kidney transplantation
  • dialysis
  • end-stage renal disease (ESRD)
  • low income
  • patient education
  • poverty
  • racial disparities
  • randomized controlled trial (RCT)
  • socioeconomic disparities
  • socioeconomic status (SES)

ASJC Scopus subject areas

  • Nephrology

Cite this

Waterman, Amy D. ; Peipert, John Devin ; McSorley, Anna Michelle ; Goalby, Christina J. ; Beaumont, Jennifer L. ; Peace, Leanne. / Direct Delivery of Kidney Transplant Education to Black and Low-Income Patients Receiving Dialysis : A Randomized Controlled Trial. In: American Journal of Kidney Diseases. 2019 ; Vol. 74, No. 5. pp. 640-649.
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abstract = "Rationale & Objective: Compared with others, black and low-income patients receiving dialysis are less likely to receive kidney transplantation (KT) education within dialysis centers. We examined the efficacy of 2 supplementary KT education approaches delivered directly to patients. Study Design: Prospective, 3-arm parallel-group, randomized, controlled trial. Settings & Participants: Adult, black, and white low-income patients receiving dialysis in Missouri. Intervention: Patients were randomly assigned to 1 of 3 educational conditions: (1) standard of care, usual KT education provided in dialysis centers (control); (2) Explore Transplant @ Home patient-guided, 4 modules of KT education sent directly to patients using print, video, and text messages; and (3) Explore Transplant @ Home educator-guided, the patient-guided intervention plus 4 telephonic discussions with an educator. Outcomes: Primary: patient knowledge of living (LDKT) and deceased donor KT (DDKT). Secondary: informed decision making, change in attitudes in favor of LDKT and DDKT, and change in the number of new steps taken toward KT. Results: In intent-to-treat analyses, patients randomly assigned to educator- and patient-guided interventions had greater knowledge gains (1.4 point increase) than control patients (0.8 point increase; P = 0.02 and P = 0.01, respectively). Compared with control patients, more patients randomly assigned to educator- and patient-guided interventions were able to make informed decisions about starting KT evaluation (82{\%} vs 91{\%} and 95{\%}; P = 0.003), pursuing DDKT (70{\%} vs 84{\%} and 84{\%}; P = 0.003), and pursuing LDKT (73{\%} vs 91{\%} and 92{\%}; P < 0.001). Limitations: Potential contamination because of patient-level randomization; no assessment of clinical end points. Conclusions: Education presented directly to dialysis patients, with or without coaching by telephone, increased dialysis patients’ KT knowledge and informed decision making without increasing educational burden on providers. Funding Source: This project was funded by the National Institutes of Health and Health Resources and Services Administration. Trial Registration: Registered at ClinicalTrials.gov with study number NCT02268682.",
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Direct Delivery of Kidney Transplant Education to Black and Low-Income Patients Receiving Dialysis : A Randomized Controlled Trial. / Waterman, Amy D.; Peipert, John Devin; McSorley, Anna Michelle; Goalby, Christina J.; Beaumont, Jennifer L.; Peace, Leanne.

In: American Journal of Kidney Diseases, Vol. 74, No. 5, 01.11.2019, p. 640-649.

Research output: Contribution to journalArticle

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T1 - Direct Delivery of Kidney Transplant Education to Black and Low-Income Patients Receiving Dialysis

T2 - A Randomized Controlled Trial

AU - Waterman, Amy D.

AU - Peipert, John Devin

AU - McSorley, Anna Michelle

AU - Goalby, Christina J.

AU - Beaumont, Jennifer L.

AU - Peace, Leanne

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Rationale & Objective: Compared with others, black and low-income patients receiving dialysis are less likely to receive kidney transplantation (KT) education within dialysis centers. We examined the efficacy of 2 supplementary KT education approaches delivered directly to patients. Study Design: Prospective, 3-arm parallel-group, randomized, controlled trial. Settings & Participants: Adult, black, and white low-income patients receiving dialysis in Missouri. Intervention: Patients were randomly assigned to 1 of 3 educational conditions: (1) standard of care, usual KT education provided in dialysis centers (control); (2) Explore Transplant @ Home patient-guided, 4 modules of KT education sent directly to patients using print, video, and text messages; and (3) Explore Transplant @ Home educator-guided, the patient-guided intervention plus 4 telephonic discussions with an educator. Outcomes: Primary: patient knowledge of living (LDKT) and deceased donor KT (DDKT). Secondary: informed decision making, change in attitudes in favor of LDKT and DDKT, and change in the number of new steps taken toward KT. Results: In intent-to-treat analyses, patients randomly assigned to educator- and patient-guided interventions had greater knowledge gains (1.4 point increase) than control patients (0.8 point increase; P = 0.02 and P = 0.01, respectively). Compared with control patients, more patients randomly assigned to educator- and patient-guided interventions were able to make informed decisions about starting KT evaluation (82% vs 91% and 95%; P = 0.003), pursuing DDKT (70% vs 84% and 84%; P = 0.003), and pursuing LDKT (73% vs 91% and 92%; P < 0.001). Limitations: Potential contamination because of patient-level randomization; no assessment of clinical end points. Conclusions: Education presented directly to dialysis patients, with or without coaching by telephone, increased dialysis patients’ KT knowledge and informed decision making without increasing educational burden on providers. Funding Source: This project was funded by the National Institutes of Health and Health Resources and Services Administration. Trial Registration: Registered at ClinicalTrials.gov with study number NCT02268682.

AB - Rationale & Objective: Compared with others, black and low-income patients receiving dialysis are less likely to receive kidney transplantation (KT) education within dialysis centers. We examined the efficacy of 2 supplementary KT education approaches delivered directly to patients. Study Design: Prospective, 3-arm parallel-group, randomized, controlled trial. Settings & Participants: Adult, black, and white low-income patients receiving dialysis in Missouri. Intervention: Patients were randomly assigned to 1 of 3 educational conditions: (1) standard of care, usual KT education provided in dialysis centers (control); (2) Explore Transplant @ Home patient-guided, 4 modules of KT education sent directly to patients using print, video, and text messages; and (3) Explore Transplant @ Home educator-guided, the patient-guided intervention plus 4 telephonic discussions with an educator. Outcomes: Primary: patient knowledge of living (LDKT) and deceased donor KT (DDKT). Secondary: informed decision making, change in attitudes in favor of LDKT and DDKT, and change in the number of new steps taken toward KT. Results: In intent-to-treat analyses, patients randomly assigned to educator- and patient-guided interventions had greater knowledge gains (1.4 point increase) than control patients (0.8 point increase; P = 0.02 and P = 0.01, respectively). Compared with control patients, more patients randomly assigned to educator- and patient-guided interventions were able to make informed decisions about starting KT evaluation (82% vs 91% and 95%; P = 0.003), pursuing DDKT (70% vs 84% and 84%; P = 0.003), and pursuing LDKT (73% vs 91% and 92%; P < 0.001). Limitations: Potential contamination because of patient-level randomization; no assessment of clinical end points. Conclusions: Education presented directly to dialysis patients, with or without coaching by telephone, increased dialysis patients’ KT knowledge and informed decision making without increasing educational burden on providers. Funding Source: This project was funded by the National Institutes of Health and Health Resources and Services Administration. Trial Registration: Registered at ClinicalTrials.gov with study number NCT02268682.

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KW - dialysis

KW - end-stage renal disease (ESRD)

KW - low income

KW - patient education

KW - poverty

KW - racial disparities

KW - randomized controlled trial (RCT)

KW - socioeconomic disparities

KW - socioeconomic status (SES)

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