Abstract
BackgroundRacial/ethnic, gender, and age disparities in access to renal transplantation among end-stage renal disease (ESRD) patients have been well documented, but few studies have explored health care staff attitudes towards these inequalities. Staff perceptions can influence patient care and outcomes, and identifying staff perceptions on disparities could aid in the development of potential interventions to address these health inequities. The objective of this study was to investigate dialysis staff (n = 509), primarily social workers and nurse managers, perceptions of renal transplant disparities in the Southeastern United States.MethodsThis is a mixed methods study that uses both deductive and inductive qualitative analysis of a dialysis staff survey conducted in 2012 using three open-ended questions that asked staff to discuss their perceptions of factors that may contribute to transplant disparities among African American, female, and elderly patients.ResultsStudy results suggested that the majority of staff (n = 255, 28%) perceived patients’ low socioeconomic status as the primary theme related to why renal transplant disparities exist between African Americans and non-Hispanic whites. Staff cited patient perception of old age as a primary contributor (n = 188, 23%) to the disparity between young and elderly patients. The dialysis staff responses on gender transplant disparities suggested that staff were unaware of differences due to limited experience and observation (n = 76, 14.7%) of gender disparities.ConclusionsThese findings suggest that dialysis facilities should educate staff on existing renal transplantation disparities, particularly gender disparities, and collaboratively work with transplant facilities to develop strategies to actively address modifiable patient barriers for transplant.
Highlights
Racial/ethnic, gender, and age disparities in access to renal transplantation among end-stage renal disease (ESRD) patients have been well documented, but few studies have explored health care staff attitudes towards these inequalities
Insights garnered from this study could inform the development of dialysis facility-based efforts to identify and address dialysis staff misperceptions regarding kidney transplant disparities
Among the 586 dialysis facilities that were contacted and asked to participate, 545 staff members in 509 facilities responded to the survey, yielding an 86.9% facility-level response rate
Summary
Racial/ethnic, gender, and age disparities in access to renal transplantation among end-stage renal disease (ESRD) patients have been well documented, but few studies have explored health care staff attitudes towards these inequalities. Prior research has shown that dialysis staff have the ability to influence patient’s decision making and health behaviors such as completion of advanced directives and adhering to fluid and glycemic control recommendations [20,21,22,23,24]. Their close and frequent proximity to dialysis patients makes them privy to patients’ needs, allows occasions to advocate on patients’ behalf, and leaves opportunities to shape patients’ medical decision making [22, 23].
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