Perception about transplant of rural and urban patients with chronic kidney disease; a qualitative study.
Perception about transplant of rural and urban patients with chronic kidney disease; a qualitative study.
复制标题
DOI：
10.5812/numonthly.15726
复制
发表时间：
2014-03
影响因子：
--
通讯作者：
Tandon A
中科院分区：
文献类型：
--
作者：
Ghahramani N;Wang C;Sanati-Mehrizy A;Tandon A
慢性肾脏病（CKD）是一个全球性的公共卫生问题，其发病率和患病率以及相关费用不断增加。探讨农村和城市慢性肾脏病（CKD）患者对肾移植的不同认知。我们进行了四个焦点小组，每个小组包括5或6名生活在农村或城市地区的5期CKD或终末期肾病患者。开放式问题探讨了患者对肾移植的熟悉程度，对肾移植益处的看法，对肾移植障碍的看法以及对活体捐赠的看法。所有的会议都被记录和专业转录。对答复进行了汇总、去识别化，并使用定性主题内容分析进行了分析。城市患者更有可能获得补充信息，并被他们的肾脏科医生强烈鼓励寻求移植。所有参与者都承认“独立性”是移植的主要优势。只有城市群体提到旅行自由增加和预期寿命提高。所有组中关于移植障碍的主要主题是繁琐的移植前测试和检查费用。在农村人群中，有一种看法认为，距离移植中心阻碍了移植评估。一个农村小组的参与者提到了赞成和反对移植的宗教原因。有些成员认为，既然疾病是上帝的旨意，我们就不应该改变它。同一团体的其他成员则认为，“上帝还没有准备好让我们放弃”。所有群体都对活体捐赠者表示赞扬和感谢，但仅在农村群体中讨论了对捐赠者结果的担忧。在讨论对已知或匿名捐赠者的偏好时，一个城市团体的成员提到了对匿名捐赠者的偏好，理由是对终身负债感的不安。观察到的农村和城市患者对移植各方面的看法差异可能导致移植的地理差异。这些发现可能有助于指导未来CKD患者移植的个性化，文化敏感的教育干预。
Chronic kidney disease (CKD) is a worldwide public health problem with increasing incidence and prevalence and associated expenses. To explore different perceptions of rural and urban patients with chronic kidney disease (CKD) about kidney transplant. We conducted four focus groups, each including 5 or 6 patients with stage 5 CKD or end stage renal disease living in a rural or urban area. Open-ended questions probed patient familiarity with kidney transplant, perceptions of benefits of kidney transplant, perceived barriers to kidney transplant, and views about living donation. All the sessions were recorded and professionally transcribed. Responses were pooled, de-identified, and analyzed using qualitative thematic content analysis. Urban patients were more likely to receive supplementary information and being strongly encouraged by their nephrologists to seek transplant. All participants acknowledged “independence” as the main advantage of transplantation. Increased freedom to travel and improved life expectancy were mentioned only among the urban groups. The main themes in all groups regarding perceived barriers to transplant were the tedious pre-transplant testing and workup expenses. Among rural groups, there was a perception that distance from transplant centers impedes transplant evaluation. Religious reasons favoring and opposing transplant were mentioned by participants in a rural group. Some members contended that since illness is God’s will, we should not change it. Others in the same group argued that “God is not ready for us to give up”. Praise and gratitude for the living donor were expressed in all groups, but concerns about donor’s outcome were discussed only within the rural groups. In discussing preference about known or anonymous donors, members of an urban group mentioned favoring an anonymous donor, citing unease with a sense of life-long indebtedness. Observed differences in perceptions among rural and urban patients about aspects of transplant may contribute to geographic disparities in transplant. The findings could be helpful to guide future individualized, culturally sensitive educational interventions about transplant for patients with CKD.