Social Network Interventions to Reduce Race Disparities in Living Kidney Donation

项目摘要 终末期肾病（ESRD）是美国人十大死亡原因之一，其发病率和患病率 尤其是在非白人群体中。肾移植是最有效的治疗选择， 美国人，但目前需要肾脏的美国人数量要大得多，而且增长速度比目前快得多 移植水平。寻求移植的患者有两种选择之一：等待已故捐赠者的肾脏成为 或者从活体肾脏捐赠者那里获得移植。预计死亡供体肾移植水平将增长 随着时间的推移，受人口老龄化和死亡率模式的限制， (LDD如果健康人群愿意并能够捐献，KT）拥有大幅增长的前景。 不幸的是，在LDD KT率方面存在着巨大和持续的种族和族裔差异， 的ESRD。先前的研究假设，在候选人的社交网络中，对健康、相容的捐赠者的不同访问可能 解释使用LDD KT的种族差异。然而，这项工作的一个局限性是，它侧重于那些谁是评估 对于捐赠，不是移植候选人的社交网络中的许多成员可以被评估为捐赠，而是 没有我们提出了一项多中心研究，以收集移植候选人社交网络的新数据，并测试有希望的 可减少土地退化和干旱的KT障碍的社会干预措施。基于定性访谈和对72例移植患者的初步调查， 我们之前在一个大型移植中心收集的候选人，我们怀疑差异接入假设不成立， 研究人员有希望通过社会干预来减少LDD KT中的种族差异。这些试点 数据显示，对于所有候选人来说，LDD的KT都没有得到充分利用，而且黑人候选人可以获得有希望的活体捐赠者 支持率高于白色候选人。基于这些发现，我们假设消除的主要障碍 在LDD KT方面的差距以及促进所有群体更多地利用LDD KT的问题，其根源是社会问题，而不是生物医学问题。在这 建议，我们将扩展我们以前的工作，以开发和测试基于证据的随机社交网络干预措施， 针对LDD KT的社会障碍，跟踪候选人的医疗记录，以评估这些干预措施的有效性。 具体来说，我们将比较对照组的候选人，那些分配到两个治疗，我们将试点和测试： 搜索干预，其中一部分候选人接受辅导，以接近有希望的家庭成员， 根据我们的试点数据，未充分利用，以及B）我们鼓励一部分候选人使用脚本的修辞干预 与家庭成员讨论移植，我们发现在调查小插曲实验和重点 组通过对所有候选人18个月的医疗记录的跟踪，我们将获得关于他们的大量数据。 社交网络，我们将评估导致LDD KT利用不足的社会障碍，这些因素如何因种族而异， 如何通过有前景的社会网络干预来减少这些问题。LDD KT具有解决公共问题的巨大潜力 围绕ESRD日益增长的患病率的健康挑战，以及我们将发展的基础和应用知识， 这项提议将有助于释放这一潜力。

Project Summary End stage renal disease (ESRD) is among the ten leading causes of death for Americans, and its incidence and prevalence are rising, especially among non-White groups. Kidney transplantation is the most effective treatment option for many Americans, but the number of Americans needing kidneys is currently much larger and rising much faster than current transplant levels. Patients who seek transplants have one of two options: wait for a kidney from a deceased donor to become available, or obtain a transplant from a living kidney donor. Deceased donor kidney transplant levels are projected to grow little over time, constrained by population aging and mortality patterns, but living donation donor kidney transplantation (LDD KT) holds the prospect of substantial growth if healthy population members are willing and able to donate. Unfortunately, there are large and persistent racial and ethnic disparities in LDD KT rates that compound disparities in rates of ESRD. Prior research hypothesizes that differential access to healthy, compatible donors in candidates' social networks may explain racial disparities in usage of LDD KT. However, a limitation of this work is that it focuses on those who are evaluated for donation, not the many members of transplant candidates' social networks who could be evaluated for donation, but are not. We propose a multi-center study to collect novel data on transplant candidates' social networks and to test promising social interventions that could reduce barriers to LDD KT. Based on qualitative interviews and a pilot survey of 72 transplant candidates we previously collected in a large transplant center, we suspect that the differential access hypothesis does not hold, and that there are promising points of social intervention for researchers to reduce racial disparities in LDD KT. These pilot data show large LDD KT underutilization for all candidates, and that Black candidates have access to promising living donors at higher rates than White candidates. Based on these findings, we hypothesize that the primary barrier to eliminating disparities in LDD KT and promoting greater utilization of LDD KT for all groups is social, not biomedical, in origin. In this proposal, we will extend our prior work to develop and test evidence based, randomized social network interventions that will target social barriers to LDD KT and follow up with candidate medical records to evaluate the efficacy of these interventions. Specifically, we will compare a control group of candidates to those assigned to two treatments that we will pilot and test: a) a search intervention where a subset of candidates is coached to approach promising family members that seem to be underutilized based on our pilot data, and b) a rhetorical intervention where we encourage a subset of candidates to use scripts for discussing transplantation with family members that we find to be effective in survey vignette experiments and focus groups. With eighteen month medical records follow up of all candidates and the large amount of data we will obtain on their social networks, we will assess the social barriers that lead to underutilization of LDD KT, how those factors vary by race, and how they can be reduced through promising social network interventions. LDD KT has substantial potential to solve public health challenges around the growing prevalence of ESRD, and the basic and applied knowledge that we will develop as part of this proposal will help to unlock this potential.