Physicians' beliefs about racial differences in referral for renal transplantation
Physicians' beliefs about racial differences in referral for renal transplantation
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DOI：
10.1053/j.ajkd.2003.10.022
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发表时间：
2004-02-01
影响因子：
13.2
通讯作者：
Epstein, AM
中科院分区：
文献类型：
--
作者：
Ayanian, JZ;Cleary, PD;Epstein, AM
背景资料：患有终末期肾病的黑人患者比白色患者接受肾移植的可能性要小得多，但以前的研究表明，黑人患者对这种手术的渴望只是稍微低一点。更好地了解医生对获得移植的种族差异的看法可能有助于减少护理方面的差异。研究方法：我们调查了美国4个地区的278名肾病学家，了解接受肾移植的黑人和白色患者的生活质量和生存率，以及接受移植的种族差异的原因。我们还调查了606名患者的护理情况。结果如下：与白人相比，医生不太可能相信移植能改善黑人的生存率（69%对81%; P = 0.001），但同样可能相信它能改善生活质量（84%对86%）。医生通常认为黑人比白人更不可能接受移植评估的重要原因包括患者的偏好（66%），活体供体的可用性（66%），未能完成评估（53%）和共病（52%）。较少的医生认为医患沟通和信任（38%）或医生偏见（12%）是重要原因。黑人患者比白色患者更不可能报告收到一些或大量关于移植的信息（55%对74%; P = 0.006），当他们的医生不认为患者与医生的沟通和信任是种族差异的重要原因。结论：肾脏病学家对肾移植的好处的看法以及接受这种手术的种族差异的原因可能会影响他们如何向黑人和白色患者提供这种治疗选择。
Background: Black patients with end-stage renal disease are much less likely than white patients to undergo renal transplantation, but previous research has shown that black patients are only slightly less likely to desire this procedure. A better understanding of physicians' views about racial differences in access to transplantation may help reduce disparities in care. Methods: We surveyed 278 nephrologists in 4 US regions about quality of life and survival for black and white patients undergoing renal transplantation and reasons for racial differences in access to transplantation. We also surveyed 606 of their patients about their care. Results: Physicians were less likely to believe transplantation improves survival for blacks than whites (69% versus 81%; P = 0.001), but similarly likely to believe it improves quality of life (84% versus 86%). Factors commonly cited by physicians as important reasons why blacks are less likely than whites to be evaluated for transplantation included patients' preferences (66%), availability of living donors (66%), failure to complete evaluations (53%), and comorbid illnesses (52%). Fewer physicians perceived patient-physician communication and trust (38%) or physician bias (12%) as important reasons. Black patients were less likely than white patients to report receiving some or a lot of information about transplantation (55% versus 74%; P = 0.006) when their physicians did not view patient-physician communication and trust as an important reason for racial differences in care. Conclusion: Nephrologists' views about the benefits of renal transplantation and reasons for racial differences in access to this procedure may affect how they present this treatment option to black and white patients.