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 language | English (US) |
|---|---|
| Pages (from-to) | 640-649 |
| Number of pages | 10 |
| Journal | American Journal of Kidney Diseases |
| Volume | 74 |
| Issue number | 5 |
| DOIs | |
| State | Published - Nov 2019 |
Funding
Amy D. Waterman, PhD, John Devin Peipert, PhD, Anna-Michelle McSorley, BA, Christina J. Goalby, MSW, Jennifer L. Beaumont, MS, and Leanne Peace, MSW, MHA. Research idea and study design: ADW, JDP; data acquisition: ADW, JDP, A-MM, CJG, LP; data analysis/interpretation: ADW, JDP, JLB. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved. This project received support from the National Institutes of Health National Center for Advancing Translational Sciences UCLA Clinical and Translational Science Institute, grant number UL1TR001881, and from the Health Resources and Services Administration, grant number R39OT25725. The funding organizations had no role in the study design; collection, analysis, and interpretation of data; writing of the report, or the decision to submit for publication. Dr Waterman owns the intellectual property to the transplantation education product Explore Transplant and has licensed it at no cost to a nonprofit, Health Literacy Media (HLM), which retains all sales revenue. Dr Waterman serves as an unpaid consultant to HLM to ensure the accuracy of educational content. The remaining authors declare that they have no relevant financial interests. We thank the team of research assistants who supported this program, including Lizeth Ambriz, AuBre Parnicky, Marisa Torres, and Grace Park; and Amanda Faye Lipsey, for assistance in preparing and editing this manuscript, as funded by the Terasaki Research Institute. Aspects of this work were presented at the 2018 American Transplant Congress; June 4, 2018; Seattle, WA. Received June 18, 2018. Evaluated by 2 external peer reviewers, with direct editorial input from a Statistics/Methods Editor, an Associate Editor, and the Editor-in-Chief. Accepted in revised form March 26, 2019. This project received support from the National Institutes of Health National Center for Advancing Translational Sciences UCLA Clinical and Translational Science Institute , grant number UL1TR001881 , and from the Health Resources and Services Administration , grant number R39OT25725 . The funding organizations had no role in the study design; collection, analysis, and interpretation of data; writing of the report, or the decision to submit for publication. We thank the team of research assistants who supported this program, including Lizeth Ambriz, AuBre Parnicky, Marisa Torres, and Grace Park; and Amanda Faye Lipsey, for assistance in preparing and editing this manuscript, as funded by the Terasaki Research Institute.
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