TAILORED COMPUTER EDUCATION TO INCREASE LIVING DONATION IN AFRICAN-AMERICANS

描述（由申请人提供）：与维持透析相比，肾移植为终末期肾病（ESRD）患者提供了3至17年的额外寿命和改善的生活质量。由于死者供体器官短缺，越来越多的肾脏患者选择从家人和朋友那里接受肾脏，这一过程称为活体肾脏移植（LDKT）。虽然非洲裔美国人患ESRD的可能性是其他人的3.7倍，但他们接受LDKT的可能性较低。因此，本项目将评估当ESRD患者使用Explore Transplant计算机化专家系统获得个性化指导和个性化反馈时，移植知识、是否准备进行LDKT、完成移植医学评估和接受LDKT方面的种族差异是否可以减少。这项多层次的研究还将研究其他已知的患者，家庭和医疗保健系统的障碍，LDKT如何影响专家系统的有效性。在密苏里州圣路易斯的Barnes-Jewish Transplant Center接受移植医学评估的ESRD患者（465名非洲裔美国人，465名白人）将按种族分层，并随机分配至两种教育条件之一（探索移植专家系统与标准教育对照）。当他们完成移植医学评估时，专家系统条件下的患者将收到个性化定制的反馈报告和个性化指导，解决对行为改变重要的变量，并与LDKT健康差异相关。对照组患者将只接受移植中心提供的标准护理教育。将在4个时间点（住院评价日（IHED）前2个月（基线）、IHED后2个月和6个月以及基线后18个月）评估关键结局的变化。该赠款有四个目标：目标1（主要）：与对照组相比，确定接受专家系统的非裔美国人和白色患者在IHED后6个月是否增加了LDKT准备和移植知识。 目标二：与对照组相比，确定接受专家系统的非裔美国人和白色患者是否更有可能完成移植医学评价并在基线后18个月继续LDKT。 目标3：研究专家系统在改变LDKT决策和行为方面的有效性在非洲裔美国人和白人之间是否等同。 目标4：研究已知的患者、家庭和医疗保健系统对LDKT的障碍如何单独起作用，以及与专家系统相结合，以影响非裔美国人的决策和行为。 在研究结束时，我们将开发出一个创新且具有成本效益的探索移植专家系统，该系统可供5，000个透析中心和250个移植中心的供应商使用，以根据不同种族患者的需求定制LDKT讨论和教育。

DESCRIPTION (provided by applicant): Kidney transplantation offers patients in end-stage renal disease (ESRD) 3 to 17 additional years of life and improved quality-of-life compared to remaining on dialysis. Because of the deceased donor organ shortage, more kidney patients are choosing to receive kidneys from family and friends, a process called living donor kidney transplantation (LDKT). Although African-Americans are 3.7 times more likely to develop ESRD, they are less likely to receive LDKTs. Therefore, this project will assess whether racial disparities in transplant knowledge, readiness to pursue LDKT, completion of transplant medical evaluation, and receipt of LDKTs can be reduced when ESRD patients receive access to personalized coaching and individually-tailored feedback using an Explore Transplant computerized Expert System. This multilevel study will also examine how other known patient, family, and healthcare system barriers to LDKT impact the Expert System's effectiveness. ESRD patients presenting for transplant medical evaluation at Barnes-Jewish Transplant Center in St. Louis, Missouri (465 African-Americans, 465 Whites) will be stratified by race and randomized to one of two education conditions (Explore Transplant Expert System vs. Standard Education Control). As they complete transplant medical evaluation, patients in the Expert System condition will receive individually tailored feedback reports and personalized coaching addressing variables important to behavior change and associated with LDKT health disparities. Control patients will only receive standard-of-care education provided by the transplant center. Changes in key outcomes will be assessed at four time points (2-months before in-hospital evaluation day (IHED) (baseline), 2- and 6-months post-IHED, and 18-months post-baseline). The grant has four aims: Aim 1 (Primary): Compared to the Control Group, to determine whether African-American and White patients receiving the Expert System increase in their LDKT readiness and transplant knowledge 6-months post-IHED. Aim 2: Compared to the Control group, to determine whether African-American and White patients receiving the Expert System are more likely to complete transplant medical evaluation and pursue LDKT 18- months post-baseline. Aim 3: To examine whether the Expert System's effectiveness in changing LDKT decision-making and behavior is equivalent between African-Americans and Whites. Aim 4: To examine how known patient, family, and healthcare system barriers to LDKT act alone and in combination with the Expert System to affect African-Americans' decision-making and behavior. At the conclusion of the study, we will have developed an innovative and cost-effective Explore Transplant Expert System that could be utilized by providers in 5,000 dialysis and 250 transplant centers to tailor LDKT discussion and education based on the needs of individual patients of different races.