Virtual coaching for potential kidney transplant candidates and their social support networks

项目总结/摘要 与透析相比，肾移植显著改善了终末期肾病患者的生存率和生活质量。 阶段性肾病（ESKD），但在美国约50万名接受透析的ESKD患者中， 等待移植尽管人们普遍认识到需要改善移植的机会， 在服务不足的社区，包括个人， 社会经济地位低和代表性不足的种族/族裔群体。目前的制度， 教育患者是压倒性的，旨在优化临床效率。潜在移植 候选人必须完成一个漫长的评估过程，通常还有额外的任命和要求 取决于合并症，同时还要管理治疗负担高的严重慢性病。因此 并不奇怪，很高比例的患者从未进入等待名单或活体供体移植， 该系统无意中有利于具有高健康素养和社会经济地位的患者。虽然障碍 移植是复杂的，可改变的个人层面障碍显着导致移植机会低。 先前的研究支持向患者及其社会支持网络（SN）提供干预， 许多有效的干预措施都需要大量资源，无法在实践中实施。迫切需要 确定可行、有效的干预措施，支持服务不足的患者和SN， 肾脏移植该提案旨在进行一项关于Journey to的试点随机对照试验（RCT）。 移植（JtT），一个虚拟的咨询会议与潜在的候选人沿着与他们的SN与通常的预- 安全网医院环境中的移植教育（目标1）。该研究将评估JtT对 寻求移植的意图和行为变化的决定因素，受影响的 干预此外，该提案将评估多中心RCT实施结果，包括入组情况 率和调查完成率，以及与患者和提供者就障碍进行的定性访谈 在其他安全网医院环境中实施该方案（目标2）。这一建议是为了回应PAS- 20-160：针对NIDDK使命内疾病的临床试验的小型R 01，不需要 初步疗效数据，并将促进未来的多中心，充分把握度RCT，以评估JtT对 改善服务不足人群的移植机会。本研究议程旨在改变 移植前咨询的范例，使服务不足的患者及其支持网络， 改善围绕肾移植的改变生活的关键决定。

PROJECT SUMMARY / ABSTRACT Kidney transplant compared to dialysis dramatically improves survival and quality of life for patients with end stage kidney disease (ESKD), but of the ~500,000 patients with ESKD in the US on dialysis, less than 1/5 are listed for transplant. Despite widespread recognition of the need to improve access to transplant, rates of waitlisting and transplant are substantially lower in patients in underserved communities, including individuals with low socioeconomic status and those in underrepresented racial/ethnic groups. The current system for educating patients is overwhelming and is designed to optimize clinical efficiency. Potential transplant candidates must complete a lengthy evaluation process, often with additional appointments and requirements depending on comorbidities, while also managing a severe chronic illness with high treatment burden. Thus, it is not surprising that a high proportion of patients never access the waitlist or living donor transplant, and that the system inadvertently favors patients with high health literacy and socioeconomic status. While the barriers to transplant are complex, modifiable individual-level barriers contribute significantly to low transplant access. Prior research supports an intervention provided to both patients and their social support networks (SN) but many efficacious interventions are too resource intensive to implement in practice. There is a critical need to identify feasible, efficacious interventions supporting underserved patients and SNs to improve access to kidney transplant. This proposal seeks to conduct a pilot randomized controlled trial (RCT) of Journey to Transplant (JtT), a virtual counseling session with the potential candidate along with their SN versus usual pre- transplant education in a safety net hospital setting (Aim 1). The study will evaluate the effect of JtT on intention to pursue transplant and on the determinants of behavioral change that are impacted by the intervention. In addition, the proposal will assess multisite RCT implementation outcomes, including enrollment rates and survey completion rates, as well as qualitative interviews with patients and providers on the barriers to implementing the protocol in other safety net hospital settings (Aim 2). This proposal is in response to PAS- 20-160: Small R01s for clinical trials targeting diseases within the mission of NIDDK, that does not require preliminary efficacy data, and will facilitate a future multisite, fully powered RCT to evaluate the effect of JtT on improving transplant access in underserved populations. This research agenda is aimed at transforming the paradigm of pre-transplant counseling, empowering underserved patients and their support networks to improve critical life-altering decisions surrounding kidney transplantation.