Potential Barriers and Facilitators to Living Donor Kidney Transplantation Among Black Americans

描述（由申请人提供）：活体供肾移植（LDKT）是许多患者的最佳治疗方法。然而，与白人相比，非洲裔美国人接受LDKT的可能性一直很小。为LDKT寻找和建立活体供体的过程需要潜在的供体克服LKDT的几个潜在障碍。作为寻求LDKT的关键第一步，患者必须让他们的医生及其家人或朋友（为患者的健康决策提供支持，也可能是潜在的捐赠者）参与LDKT的讨论，以确定LDKT是否是一种可行和/或理想的治疗选择。LDKT与医生的讨论帮助患者和家庭成员了解LDKT对潜在接受者和任何潜在捐赠者的风险和益处。家庭的LDKT讨论帮助他们确定是否有可能确定愿意和医学上合格的活体捐赠者，他们帮助家庭讨论 LDKT对患者和家庭的潜在心理、身体和经济压力。一旦进行了讨论，潜在的捐助者必须面对后勤问题（例如，儿童保育或前往移植中心）和财务（例如，与LDKT相关的无薪工作时间）的挑战。研究表明，即使非洲裔美国人希望LDKT，LDKT讨论率也是次优的。此外，非洲裔美国人潜在的活体肾脏捐赠者不太可能比他们的白色同行完成捐赠者评估过程，他们可能比白人更敏感的后勤和财务障碍LDKT。创新的战略，以克服人际，后勤和财政障碍LDKT是非常需要的非裔美国人，特别是那些谁可能是高度积极寻求这种疗法。移植社会工作者定期对潜在的LDKT接受者和捐赠者进行心理社会评估，非常适合支持家庭导航LDKT讨论。移植社会工作者也精通LDKT的财务方面（例如，保险覆盖规则），并经常向潜在的LDKT接受者和捐助者提供财务指导。我们建议研究创新的移植社会工作者主导的干预措施，这将有助于非洲裔美国人潜在的LDKT接受者及其家人克服人际，后勤和财务障碍LDKT。我们将随机分配非裔美国人在死者肾脏捐赠者等待名单上接受移植名单上的常规护理或两个社会工作者领导的干预措施之一，一个是帮助患者和家庭相互讨论LDKT，并与患者的医生，一个是为家庭提供经济支持，以克服LDKT的后勤和经济障碍。作为一个主要结果，我们将衡量干预措施是否会激活非裔美国人潜在受者的活体肾脏捐赠。这项拟议的研究利用了我们的多学科团队在研究文化敏感干预措施以克服非裔美国人中LDKT障碍方面的丰富经验。

DESCRIPTION (provided by applicant): Live donor kidney transplantation (LDKT) represents an optimal therapy for many patients. However, African Americans have been persistently and significantly less likely to receive LDKT when compared to Whites. The process of seeking and establishing a live donor for LDKT requires potential donors overcome several potential obstacles to LKDT. As a critical first step to seeking LDKT, patients must engage their physicians and their family members or friends (who provide support for patients' health decisions and could also be potential donors) in discussions about LDKT to determine whether LDKT is a viable and/or desirable treatment option. LDKT discussions with physicians help patients and family members understand the risks and benefits of LDKT to both the potential recipient and any potential donors. Families' LDKT discussions help them establish whether it is possible to identify willing and medically eligible live donors, and they help families discuss the potential psychological, physical, and financial strains of LDKT on patients and families. Once discussions have occurred, potential donors must confront logistical (e.g., childcare or travel to transplant centers) and financial (e.g., unpaid time away from work) challenges associated with LDKT. Studies have shown that even when African American patients desire LDKT, rates of LDKT discussions are suboptimal. Further, African American potential live kidney donors are less likely than their White counterparts to complete the donor evaluation process, and they may be more sensitive than Whites to logistical and financial barriers to LDKT. Innovative strategies to overcome interpersonal, logistical and financial barriers to LDKT are sorely needed for African Americans, particularly those who may be highly motivated to seek this therapy. Transplant social workers routinely perform psychosocial evaluations on potential LDKT recipients and donors and are well suited to support families' navigation of LDKT discussions. Transplant social workers are also well versed in the financial aspects of LDKT (e.g., insurance coverage rules) and frequently provide financial guidance to potential LDKT recipients and donors. We propose to study innovative transplant social worker led interventions that will help African American potential LDKT recipients and their families overcome interpersonal, logistical and financial barriers to LDKT. We will randomly assign African Americans on the deceased kidney donor waiting list to receive their usual care on the transplant list or to one of two socia worker led interventions-one which helps patients and families discuss LDKT with each other and with patients' physicians, and one which provides families with financial support to overcome logistical and financial barriers to LDKT. As a primary outcome, we will measure whether the interventions activate live kidney donation on African American potential recipients' behalves. The proposed study leverages our multidisciplinary team's substantial prior experience studying culturally sensitive interventions to overcome barriers to LDKT among African Americans.