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

为潜在肾移植候选人及其社会支持网络提供虚拟辅导

• 批准号: 10634985
• 负责人: allyson hart
• 金额: $ 26.27万
• 依托单位: HENNEPIN HEALTHCARE RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-03-15 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634985
• 关键词: Address; Appointment; Behavioral; Behavioral trial; Body Weight decreased; Cardiac; Chronic Disease; Clinic; Clinical; Clinical Trials; Collaborations; Complex; Conflict (Psychology); Counseling; Data; Decision Making; Development; Dialysis patients; Dialysis procedure; Disease; Donor person; Education; End stage renal failure; Enrollment; Equity; Ethnic Population; Evaluation; Feedback; Future; Healthcare Systems; Home visitation; Hospitals; Improve Access; Individual; Intention; Intervention; Interview; Kidney Transplantation; Life; Living Donors; Longevity; Medical; Minnesota; Mission; Motivation; Multicenter Trials; National Institute of Diabetes and Digestive and Kidney Diseases; Patient Education; Patient risk; Patients; Physicians; Population; Process; Protocols documentation; Provider; Quality of life; Randomized; Randomized, Controlled Trials; Relative Risks; Research; Research Support; Resources; Risk; Self Efficacy; Site; Social support; Socioeconomic Status; Surveys; System; Testing; Transplantation; Underserved Population; United States; Waiting Lists; Work; acceptability and feasibility; clinical practice; clinically significant; comorbidity; design; efficacious intervention; efficacy evaluation; empowerment; health care settings; health literacy; implementation evaluation; implementation outcomes; improved; insight; low socioeconomic status; member; novel; patient engagement; post-transplant; racial population; randomized trial; randomized, clinical trials; response; risk perception; safety net; support network; treatment as usual; underserved community; virtual; virtual coach; virtual intervention

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.

项目摘要 /摘要 与透析相比，肾脏移植极大地改善了终点患者的生存和生活质量 肾脏疾病（ESKD），但在美国透析的约500,000例ESKD患者中，小于1/5 列出了用于移植的。尽管人们广泛认识到需要改善移植的访问，但 在服务不足的社区（包括个体 社会经济地位低下，以及代表性不足的种族/族裔群体。当前的系统 对患者进行教育是压倒性的，旨在优化临床效率。潜在移植 候选人必须完成冗长的评估过程，通常还有其他任命和要求 根据合并症的不同，同时还管理着严重的慢性疾病，具有高治疗负担。因此，它 毫不奇怪的是，很大比例的患者永远无法访问候补名单或活着的捐助者移植，并且 该系统无意中利用具有高健康素养和社会经济地位的患者。而障碍 移植是复杂的，可修改的个人层屏障对低移植通道的贡献显着贡献。 先前的研究支持为患者及其社会支持网络（SN）提供的干预措施，但 许多有效的干预措施过于大量资源，无法在实践中实施。迫切需要 确定可行，有效的干预措施，以支持服务不足的患者和SN，以改善获得的机会 肾脏移植。该提议旨在进行一项飞行员随机对照试验（RCT） 移植（JTT），与潜在候选人的虚拟咨询会议以及他们的SN与通常的预期 在安全网医院环境中移植教育（AIM 1）。该研究将评估JTT对 打算追求移植和行为改变的决定因素。 干涉。此外，该提案将评估多站点RCT实施结果，包括入学 费率和调查完成率，以及对障碍的患者和提供者的定性访谈 在其他安全网医院设置中实施该协议（AIM 2）。该建议是对PAS-的回应 20-160：针对NIDDK任务内疾病的临床试验的小型R01，不需要 初步疗效数据，并将促进未来的多站点，全功率的RCT，以评估JTT的影响 改善服务不足人群的移植通道。该研究议程旨在改变 移植前咨询的范式，赋予服务不足的患者及其支持网络的能力 改善围绕肾脏移植的关键改变的决定。