Addressing Inactive Kidney Transplant Waitlist Status through Adapting a Tailored Psycho-Social-Environmental Program

项目摘要/摘要 肾移植(KT)是治疗老年终末期肾病(ESRD)的一种日益成熟的治疗方法，但 KT结果存在巨大的异质性。老年人更有可能被列为不活跃(在等待名单上 但不符合接受KT的条件)，这与等待名单死亡率增加和手术后预后较差有关。 等待KT的人还会经历抑郁症状、疼痛、身体功能丧失和社会孤立， 这可能会增加等待名单上的死亡率，降低KT的机会。截至2022年4月，94249人 等待KT，目前估计有44%的人处于非活跃状态。迫切需要改进的护理模式 改善非活动等待名单结果。这项研究的目的是适应和试行基于证据的 社区老龄化-为老年人提供更好的生活(有能力)干预措施，以解决以下问题 KT等待名单激活，涉及症状负担、自我管理、社会支持、健康素养、患者 激活和居家功能。有能力使用个人指导让老年人在家中变老 护士、职业治疗师和临时工的优先事项和基于优势的量身定做方法(PI： 桑顿，联合初选导师)。能够改善功能、疼痛、抑郁症状和生活质量 同时减少住院和疗养院的入院人数。Capable还可以改善医疗保健 参与度和自我效能感是在KT等待名单上保持活跃的关键因素。我们的改编版 功能强大-移植模式将扩展服务，以包括互联网接入、培训、患者门户等选项 使用和以患者为导向的在线社交参与，以解决注意到的孤立问题。我们假设 减少患者和临床医生报告的障碍将减少KT等待名单状态的非活动时间。我们计划 在两阶段发育的非活跃KT等待名单状态的人中检查有能力的移植 研究利用与JHU综合移植中心的伙伴关系和持续的、预期的NIA R01资助的等待KT招募的个人队列研究(PI：McAdams-DeMarco，联合初选 导师)通过以下目标：(1)开发有能力针对当前KT的改编 不活动，(2)迭代地为那些当前KT不活动的人改进有能力的移植原型，以及(3) 在30人1：1随机等待名单对照试验中进行有能力的移植干预试验 超过16周的结果(例如，等待名单状态、症状负担、社交网络)评估为0、16和32 随机化后数周测试CABLE移植的可行性、可接受性、保真度和评估 未来疗效试验的初步效应大小。据我们所知，没有其他以家庭为基础的程序 这解决了患者导向的目标和那些不活跃的等待KT的人的家庭环境。这部作品 将成为未来R01扩展到其他KT中心和/或其他移植人群的基础 进行一项更大规模的基于社区的疗效试验。

PROJECT SUMMARY/ ABSTRACT Kidney transplantation (KT) is a growing treatment for older adults with end-stage renal disease (ESRD), but there is vast heterogeneity in KT outcomes. Older adults are more likely to be listed as inactive (on the waitlist but ineligible for KT), which is associated with increased waitlist mortality and worse post-surgical outcomes. Those awaiting KT also experience depressive symptoms, pain, loss of physical function, and social isolation, which can contribute to waitlist mortality and decrease chances of KT. As of April 2022, 94,249 people were awaiting KT with an estimated 44% currently inactive. There is a critical need for enhanced models of care to improve inactive waitlist outcomes. The purpose of this study is to adapt and pilot test the evidence-based Community Aging in Place- Advancing Better Living for Elders (CAPABLE) intervention to address barriers for KT waitlist activation which involve symptom burden, self-management, social support, health literacy, patient activation and home function. CAPABLE equips older adults to age in their homes using person-directed priorities and a strengths-based tailored approach by a nurse, occupational therapist and handy worker (PI: Szanton, co-primary mentor). CAPABLE improves function, pain, depressive symptoms, and quality of life while decreasing hospitalizations and nursing home admissions. CAPABLE also improves healthcare engagement and self-efficacy which are key components to remaining active on the KT waitlist. Our adapted CAPABLE–Transplant model will extend services to include options for internet access, training, patient portal usage and patient-directed online social engagement to address the noted isolation. We hypothesize that decreasing patient and clinician reported barriers will decrease time inactive on the KT waitlist status. We plan to examine CAPABLE-Transplant among those with inactive KT waitlist status in a two-phase developmental study leveraging partnership with the JHU Comprehensive Transplant Center and an ongoing, prospective NIA R01-funded cohort study of individuals awaiting KT for recruitment (PI: McAdams-DeMarco, co-primary mentor) through the following aims: (1) To develop an adaptation of CAPABLE targeting those currently KT inactive, (2) To iteratively refine the CAPABLE -Transplant prototype for those currently KT inactive and, (3) To pilot test the CAPABLE-Transplant intervention in a 30 person 1:1 randomized waitlist control trial delivered over 16 weeks with outcomes (e.g. waitlist status, symptom burden, social networks) evaluated at 0,16, and 32 weeks post-randomization to test feasibility, acceptability, fidelity of CAPABLE-Transplant and estimate preliminary effects sizes for a future efficacy trial. To our knowledge, there are no other home-based programs that address patient-directed goals and the home environment among those inactive awaiting KT. This work will form the basis for a future R01 to expand to other KT centers and/or into other transplant populations conducting a larger community-based, efficacy trial.