A Randomized Trial and Reduce to Disparity in Live Donor Kidney Transplantation

描述(由申请人提供)： 非洲裔美国人在肾移植等待名单中所占的比例高于基于人口参数的预期，他们等待肾移植的时间更长，他们接受活体供肾移植(LDKT)的可能性要小得多。虽然教育努力帮助提高了患有终末期肾病的非裔美国人对LDKT的需求和益处的认识，但很少有人试图系统地研究在这一患者群体中增加LDKT的策略。这项研究计划的长期目标是改善向非裔美国人提供的教育，从而提高LDKT的比率。这项申请的目的是确定提高非裔美国人LDKT发生率的三种策略的相对有效性。中心假设是，与移植中心提供的教育干预相比，涉及患者和重要他人的基于家庭的干预在非裔美国人群体中产生更高的LDKT发生率。在强大的初步数据的指导下，这一假设将通过追求两个具体目标来检验：1)确定三种不同的LDKT教育方法在非裔美国患者中的临床有效性；2)确定与追求LDKT最密切相关的社会人口、医学和捐献特定变量。180名患有终末期肾病(ESRD)的非洲裔美国成年人将被随机分配到骨灰盒接受三种教育干预之一：基于家庭的(HB)、基于小组的(GB)或标准护理(SC)。HB(在家里)和GB(在移植中心)干预措施将为患者及其直系亲属和亲属、重要的其他人和朋友提供教育。干细胞干预(在移植中心)反映了目前在该移植中心所做的事情，将只向个别患者提供教育。主要结果是接受LDKT的患者比例。次要结果包括活体捐赠者询问、活体捐赠者评估、受过教育的潜在活体捐赠者的数量以及LDKT的知识、关切和意愿。将收集招聘率、流失率、不参与和流失率的原因、遵守协议和参与者满意度评分。这项拟议的研究具有创新性，因为它评估了三种旨在提高非裔美国人LDKT比率的教育战略的相对有效性。这项研究的发现有可能通过确定循证教育策略来缩小这种种族差距，这些策略可以被肾移植中心用来提高非裔美国人的LDKT发生率。该提案直接涉及2010年保健人民的三个优先领域(4-1、4-5、4-6)。

DESCRIPTION (provided by applicant): African Americans comprise a higher percentage of the waiting list for kidney transplantation than would be expected based on population parameters, they wait longer for kidney transplantation, and they are far less likely to receive live donor kidney transplantation (LDKT). While educational efforts have helped to expand awareness about the need for and benefits of LDKT among African Americans with ESRD, there have been very few attempts to systematically examine strategies for increasing LDKT in this patient population. The long-term goal of this research program is to improve education provided to African Americans and, thereby, increase rates of LDKT. The objective of this application is to determine the relative effectiveness of three strategies for increasing LDKT rates in African Americans. The central hypothesis is that a home-based intervention that involves the patient and significant others yields higher LDKT rates in an African American population relative to educational interventions delivered in the transplant center. Guided by strong preliminary data, this hypothesis will be tested by pursuing two specific aims: 1) Determine the clinical effectiveness of three separate LDKT educational approaches with African American patients; and 2) Determine the sociodemographic, medical, and donation-specific variables that are most strongly associated with pursuing LDKT. One hundred eighty African American adults with end-stage renal disease (ESRD) will be urn randomized to receive one of three educational interventions: home-based (HB), group-based (GB), or standard care (SC). The HB (in the home) and GB (in the transplant center) interventions will provide education to patients and their immediate and extended family members, significant others, and friends. The SC intervention (in the transplant center) mirrors what is currently done at this transplant center and will provide education to individual patients only. The primary outcome is the proportion of patients who receive LDKT. Secondary outcomes include live donor inquiries, live donor evaluations, number of potential live donors educated, and LDKT knowledge, concerns, and willingness. Recruitment rates, attrition rates, reasons for nonparticipation and attrition, protocol adherence, and participant satisfaction ratings will be gathered. The proposed research is innovative because it evaluates the relative effectiveness of three educational strategies designed to increase LDKT rates in African Americans. Findings from this study have the potential to close this racial disparity gap by identifying evidence-based educational strategies that can be used by kidney transplant centers to increase LDKT rates in African Americans. This proposal directly addresses three of the priority areas of HealthyPeople2010 (4-1, 4-5, 4-6).