Disparities in Provision of Transplant Education by Profit Status of the Dialysis Center

Abstract

Kidney transplant education is associated with higher transplantation rates; however national policies regarding optimal timing and content of transplant education are lacking. We aimed to characterize nephrologists' attitudes regarding kidney transplant education, and to compare practices between nephrologists at for-profit and nonprofit centers. We surveyed 906 nephrologist practicing in the United States. Most respondents (81%) felt the ideal time to spend on transplant education was >20 min, but only 43% reported actually doing so. Spending >20 min was associated with covering more topics, having one-on-one and repeated conversations, involving families in discussions and initiating discussions at CKD-stage 4. Providers at for-profit centers were significantly less likely to spend >20 min (RR = 0.89, 95%CI: 0.80-0.99) or involve families (RR = 0.57, 95%CI: 0.38-0.87); they reported that fewer of their patients received transplant counseling (RR = 0.58, 95%CI: 0.37-0.96), initiated transplant discussions (RR = 0.58, 95%CI: 0.38-0.88), or were eligible for transplantation (RR = 0.45, 95%CI: 0.30-0.68). Of nephrologists who spent ≤20 min, those at for-profit centers more often cited lack of reimbursement as a reason (30.0% vs. 18.9%, p = 0.02). Disparities in quality of education at for-profit centers might partially explain previously documented disparities in access to transplantation for patients at these centers. National policies detailing the optimal timing and content of transplant education are needed to improve equity.