Social Network Interventions to Reduce Race Disparities in Living Kidney Donation

项目摘要 终末期肾病(ESRD)是美国人的十大死因之一，其发病率和患病率 正在上升，特别是在非白人群体中。肾移植是许多疾病最有效的治疗选择。 美国人，但目前需要肾脏的美国人的数量要比现在多得多，而且增长得更快 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 或从活着的肾脏捐赠者那里获得移植。已故捐赠者的肾脏移植水平预计将上升 随着时间的推移，受人口老龄化和死亡率模式的限制，但活体捐赠者肾脏移植 (LDD KT)持有大幅增长的前景，如果健康的人口成员愿意并能够捐赠。 不幸的是，在LDD KT比率中存在着巨大且持续的种族和民族差异，这加剧了比率的差异 ESRD。先前的研究假设，在候选人的社交网络中区别对待健康、相容的捐赠者可能会 解释使用LDD KT的种族差异。然而，这项工作的局限性是它侧重于那些被评估的人 对于捐赠，不是许多移植候选人的社交网络上的成员可以接受捐赠评估，而是 不。我们提出了一项多中心研究，以收集移植患者社交网络上的新数据，并测试有前景的 可以减少LDD KT障碍的社会干预措施。基于对72例移植患者的定性访谈和试点调查 我们之前在一个大型移植中心收集的候选人，我们怀疑差异访问假说不成立， 对于研究人员来说，减少LDD KT的种族差异有希望的社会干预点。这些飞行员 数据显示，所有候选人的LDD KT使用率都很低，黑人候选人可以接触到有前途的活体捐赠者 比白人候选人的支持率更高。基于这些发现，我们假设，消除 促进所有群体更多地使用LDD KT是社会性的，而不是生物医学的。在这 提案中，我们将扩展我们之前的工作，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，跟踪候选医疗记录，以评估这些干预措施的效果。 具体地说，我们将比较一组候选者和那些被分配到我们将试点和测试的两种治疗方法的人：a)a) 搜索干预，即训练一部分候选人接近看似有前途的家庭成员 根据我们的试点数据，未得到充分利用，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，我们发现这在调查Vignette实验和焦点方面是有效的 组。通过对所有候选人的18个月的医疗记录进行跟踪，以及我们将获得的关于他们的大量数据 社交网络，我们将评估导致LDD KT未得到充分利用的社会障碍，这些因素如何因种族而异，以及 如何通过有希望的社交网络干预来减少这些问题。LDD KT具有解决公众问题的巨大潜力 围绕ESRD日益流行的健康挑战，以及我们将作为一部分发展起来的基本和应用知识 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.