Modifiable factors affecting racial disparities in live kidney donation

影响活体肾脏捐赠种族差异的可改变因素

• 批准号: 9248215
• 负责人: Amy Doggette Waterman
• 金额: $ 33.32万
• 依托单位: ST. BARNABAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-10 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9248215
• 关键词: Affect; American; Behavior; California; Caring; Characteristics; Chronic; Complex; Decision Making; Dialysis patients; Dialysis procedure; Education; Evaluation; Future; Goals; Health Services; Healthcare Systems; Hispanics; Immunologics; Individual; Intervention; Interview; Kidney; Kidney Failure; Kidney Transplantation; Knowledge; Life; Los Angeles; Measures; Medical; Medical center; Methods; Minority; Motivation; New Jersey; Outcome; Patient Care; Patients; Perception; Persons; Population Heterogeneity; Process; Prospective cohort study; Quality of life; Research; Saints; System; Testing; Transplantation; Universities; base; behavioral health; cohort; cost; design; experience; health literacy; improved; interest; novel; programs; prospective; public health relevance; racial and ethnic disparities; racial disparity; satisfaction; social; socioeconomics; volunteer

DESCRIPTION (provided by applicant): The best treatment for kidney failure is usually a live donor kidney transplant (LDKT), which provides an average of 10 additional years of life compared to staying on chronic dialysis. Unfortunately, large racial/ethnic disparities persist in receipt of LDKTs. Blacks and Hispanics comprise over 58 percent of all dialysis patients but receive less than 28 percent of LDKTs. A little-studied and likely crucial cause of LDKT disparities is the lower likelihood that Black and Hispanic donor volunteers (persons interested in donating a live kidney) will complete the multi-step donor evaluation and actually donate. While minority donor volunteers are more likely to have medical contraindications to donation, they are also much more likely to discontinue the donor evaluation or decline participation in paired exchange (programs that permit LDKT using immunologically incompatible donor-recipient pairs). Based upon limited prior research, the outcomes of the donor evaluation may be especially affected by several potentially modifiable individual and health care system factors, such as donor volunteers' motivation to donate, health literacy, knowledge/education about donation, satisfaction with the patient care experience, and socioeconomic barriers to donation. These factors, however, have not been prospectively examined in a well-powered, multi-center, and diverse cohort of donor volunteers. The objective of this study is to determine how differences in modifiable individual and system factors are associated with Black and Hispanic donor volunteers' lower likelihood of actually donating. Our overall hypothesis is that donor volunteers who are Black or Hispanic are more likely to discontinue the donor evaluation, due to modifiable differences that either (1) are already present at the start of the evaluation, o (2) arise later in the evaluation process. To test this hypothesis, we propose a sequential mixed methods study. First, we will perform qualitative interviews of donor volunteers who previously discontinued their donor evaluations, to identify all the potentially modifiable causes of discontinuation of the donor evaluation (Aim 1). Then, in the quantitative component, we will perform a prospective cohort study of 2,800 live kidney donor volunteers at two large transplant centers in New Jersey and California. Among 575 Black, 875 Hispanic, and 1,350 White donor volunteers, we will determine differences in potentially modifiable factors that are present at the start of the donor evaluation (Aim 2) or arise during the evaluation (Aim 3), and also determine the impact of modifiable factors upon successful completion of the donor evaluation (Aim 4) and actual donation, directly or via paired exchange (Aim 5). At the end of this study, we will understand how Black, Hispanic, and White live donor volunteers differ in their potentially modifiable social, behavioral, and health services characteristics and how these factors impact both completion of the evaluation and actual donation. Our results, generalizable to the 230+ kidney transplant centers in the U.S., will enable us to design future interventions to improve the education, support, and care of live donor volunteers, to ultimately decrease racial/ethnic disparities in LDKT.

描述（由申请人提供）：肾衰竭的最佳治疗方法通常是活体供肾移植（LDKT），与长期透析相比，平均可延长10年寿命。不幸的是，在接受LDKT方面仍然存在着很大的种族/民族差异。黑人和西班牙裔占所有透析患者的58%以上，但接受LDKT的不到28%。LDKT差异的一个很少研究的可能关键原因是黑人和西班牙裔捐赠者志愿者（有兴趣捐赠活体肾脏的人）完成多步捐赠者评估并实际捐赠的可能性较低。虽然少数捐赠者志愿者更有可能有捐赠的医学禁忌症，但他们也更有可能停止捐赠者评估或拒绝参与配对交换（允许LDKT使用免疫不相容的捐赠者-接受者对的计划）。基于有限的先前研究，捐赠者评估的结果可能特别受到几个潜在的可修改的个人和医疗保健系统因素的影响，例如捐赠者志愿者的捐赠动机，健康素养，关于捐赠的知识/教育，对患者护理体验的满意度，以及捐赠的社会经济障碍。然而，这些因素尚未在一个具有良好把握度的、多中心的、多样化的供体志愿者队列中进行前瞻性研究。这项研究的目的是确定如何在可修改的个人和系统因素的差异与黑人和西班牙裔捐赠志愿者的实际捐赠的可能性较低。我们的总体假设是，黑人或西班牙裔的供体志愿者更有可能停止供体评价，这是由于（1）在评价开始时已经存在的可修改差异，或（2）在评价过程后期出现的差异。为了验证这一假设，我们提出了一个顺序混合方法的研究。首先，我们将对先前停止其供体评价的供体志愿者进行定性访谈，以确定停止供体评价的所有潜在可修改原因（目标1）。然后，在定量部分，我们将在新泽西和加州的两个大型移植中心对2,800名活体肾脏供体志愿者进行前瞻性队列研究。在575名黑人、875名西班牙裔和1,350名白色捐赠者志愿者中，我们将确定在不同的年龄段存在的潜在可改变因素的差异。 在供体评估开始时（目标2）或评估期间（目标3）出现，并确定成功完成供体评估（目标4）和直接或通过配对交换（目标5）进行实际捐赠时可修改因素的影响。在本研究结束时，我们将了解黑人，西班牙裔和白色活体捐赠志愿者在其潜在的可改变的社会，行为和健康服务特征方面的差异，以及这些因素如何影响评估和实际捐赠的完成。我们的研究结果可推广到美国230多个肾移植中心，将使我们能够设计未来的干预措施， 教育、支持和照顾活体捐赠志愿者，最终减少LDKT的种族/民族差异。