Abstract
BackgroundAfrican Americans have persistently poor access to living donor kidney transplants (LDKT). We conducted a small randomized trial to provide preliminary evidence of the effect of informational decision support and donor financial assistance interventions on African American hemodialysis patients’ pursuit of LDKT.MethodsStudy participants were randomly assigned to receive (1) Usual Care; (2) the Providing Resources to Enhance African American Patients’ Readiness to Make Decisions about Kidney Disease (PREPARED); or (3) PREPARED plus a living kidney donor financial assistance program. Our primary outcome was patients’ actions to pursue LDKT (discussions with family, friends, or doctor; initiation or completion of the recipient LDKT medical evaluation; or identification of a donor). We also measured participants’ attitudes, concerns, and perceptions of interventions’ usefulness.ResultsOf 329 screened, 92 patients were eligible and randomized to Usual Care (n = 31), PREPARED (n = 30), or PREPARED plus financial assistance (n = 31). Most participants reported interventions helped their decision making about renal replacement treatments (62%). However there were no statistically significant improvements in LDKT actions among groups over 6 months. Further, no participants utilized the living donor financial assistance benefit.ConclusionsFindings suggest these interventions may need to be paired with personal support or navigation services to overcome key communication, logistical, and financial barriers to LDKT.Trial registrationClinicalTrials.gov [NCT01439516] [August 31, 2011].
Highlights
African Americans have persistently poor access to living donor kidney transplants (LDKT)
Inadequate access to LDKT has been especially problematic for African Americans who have had persistently lower rates of LDKT compared to others [7, 8]
Evidence shows African Americans are less likely than Whites to be fully informed of their treatment options, including LDKT, before initiating hemodialysis [9, 10]
Summary
African Americans have persistently poor access to living donor kidney transplants (LDKT). We conducted a small randomized trial to provide preliminary evidence of the effect of informational decision support and donor financial assistance interventions on African American hemodialysis patients’ pursuit of LDKT. For over 10 years, there have been growing efforts to improve patients’ access to living donor kidney transplantation (LDKT). The National Living Donor Assistance Program [19] provides financial assistance to low income LDKT donors to help address disparities. While these efforts have been in place for some time, their uptake and effectiveness to improve LDKT rates among African Americans have not been well studied
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