If you can't comply with dialysis, how do you expect me to trust you with transplantation? Australian nephrologists' views on indigenous Australians' 'non-compliance' and their suitability for kidney transplantation
If you can't comply with dialysis, how do you expect me to trust you with transplantation? Australian nephrologists' views on indigenous Australians' 'non-compliance' and their suitability for kidney transplantation
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DOI：
10.1186/1475-9276-11-21
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发表时间：
2012-04-18
影响因子：
4.8
通讯作者：
Cass, Alan
中科院分区：
文献类型：
--
作者：
Anderson, Kate;Devitt, Jeannie;Cass, Alan
导言：澳大利亚土著居民罹患终末期肾病(ESKD)的比例明显较高，但接受移植的可能性低于非土著居民。这种差异不能用可测量的临床差异来完全解释。先前的研究表明，澳大利亚土著患者可能会被专家视为“不遵从者”，这可能会对移植转诊产生负面影响。然而，这种决策并没有得到很好的理解。这项研究的目的是调查：土著患者是否通常被描述为不遵从者；患者依从性因素的估计如何影响澳大利亚肾脏科医生关于移植转诊的决策；这是否会对土著患者获得移植造成特定的障碍。方法：作为一项更大研究的一部分，2005-06年间采访了来自8个肾脏单位的19名肾脏科医生，他们治疗了大多数澳大利亚土著肾脏患者。结果：专家普遍认为土著患者既是不遵从者，又是高风险的移植对象。对“遵守”的定义和评估既不正式也不系统。依从性状态在预测移植后结果方面的价值存在不确定性，器官稀缺的问题渗透到参与者的反应中。总体而言，专家们在决策中权衡依从性和风险的看法存在显著差异。结论：在移植转诊决策中依赖患者‘依从性’的概念可能会导致澳大利亚本土ESKD患者继续处于不利地位。在缺乏关于移植后预后预测因素的有力证据的情况下，转诊决策过程需要关注和辩论。
Introduction: Indigenous Australians suffer markedly higher rates of end-stage kidney disease (ESKD) but are less likely than their non-Indigenous counterparts to receive a transplant. This difference is not fully explained by measurable clinical differences. Previous work suggests that Indigenous Australian patients may be regarded by treating specialists as 'non-compliers', which may negatively impact on referral for a transplant. However, this decision-making is not well understood. The objectives of this study were to investigate: whether Indigenous patients are commonly characterised as 'non-compliers'; how estimations of patient compliance factor into Australian nephrologists' decision-making about transplant referral; and whether this may pose a particular barrier for Indigenous patients accessing transplants.Methods: Nineteen nephrologists, from eight renal units treating the majority of Indigenous Australian renal patients, were interviewed in 2005-06 as part of a larger study. Thematic analysis was undertaken to investigate how compliance factors in specialists' decision-making, and its implications for Indigenous patients' likelihood of obtaining transplants.Results: Specialists commonly identified Indigenous patients as both non-compliers and high-risk transplant candidates. Definition and assessment of 'compliance' was neither formal nor systematic. There was uncertainty about the value of compliance status in predicting post-transplant outcomes and the issue of organ scarcity permeated participants' responses. Overall, there was marked variation in how specialists weighed perceptions of compliance and risk in their decision-making.Conclusion: Reliance on notions of patient 'compliance' in decision-making for transplant referral is likely to result in continuing disadvantage for Indigenous Australian ESKD patients. In the absence of robust evidence on predictors of post-transplant outcomes, referral decision-making processes require attention and debate.