Information and Financial Interventions for Kidney Donation in African Americans

描述(由申请人提供)： 非洲裔美国人接受肾脏移植的可能性比白人低，尽管他们患终末期肾病(ESRD)的可能性是白人的两倍多。活体亲属肾移植(LD)为患者提供了绕过接受已故肾脏移植的许多障碍(例如，等待名单和免疫不相容)的机会，但少数族裔接受活体亲属肾脏移植(LRT)的可能性较小。有证据表明，非裔美国人可能没有以最佳的比率与他们的家人或医生讨论LD/LRT，因此可能没有足够的信息来启动或参与关于LD/LRT的共同决策。非洲裔美国人也可能对康复和与残疾/轻便铁路有关的自付费用有经济上的担忧，这是阻碍残疾/轻便铁路的另一个障碍。 这项研究的主要目的，是要克服这些重要障碍，方法是促进少数族裔人士共同参与有关轻铁/轻铁的决策，以及提供财政援助以支付自付费用，从而加强少数族裔对低收入/轻铁的考虑。我们的具体目标是：a)开发对文化敏感的信息(视听)和财政干预措施；b)进行一项随机对照试验，以评估它们在增加ESRD非裔美国患者及其家人对LD/LRT的追求方面的有效性。我们将领导焦点小组改进信息(视听)干预的内容/交付，以促进患者和家庭共同决策，并设计一份书面小册子，说明经济援助(针对失业、儿童保育和旅行费用)干预。我们将从巴尔的摩大都会地区的4个地点(9个透析设施)招募210名新发ESRD的成年非裔美国患者，并衡量他们追求LD/LRT的初步承诺(使用行为改变阶段的跨理论模型)。然后参与者将被随机分成三组：1)仅信息激励组，2)信息干预+经济援助组，3)不干预组(通常护理)。我们会在长达12个月的时间内跟踪参与者对土地/轻便铁路的承诺(预想阶段、考虑阶段、准备阶段、行动阶段、完成阶段)。如果干预措施成功地促使患者及其家人考虑和接受LD/LRT，我们将广泛传播。有效的干预措施可以提高非裔美国人的LD/LRT比率，有助于消除接受ESRD器官方面的巨大差异。我们团队在设计和实施与供受者健康、少数民族健康和肾脏疾病相关的行为、流行病学和干预性研究方面的丰富经验为这项研究提供了坚实的基础。

DESCRIPTION (provided by applicant): African Americans are less likely than Whites to receive kidney transplants, despite their being more than two-fold as likely as Whites to develop end stage renal disease (ESRD). Living related kidney donation (LD) offers patients an opportunity to bypass many barriers to receipt of deceased kidney transplants (e.g. waiting lists and immunological incompatibility), but minorities are less likely to receive living related kidney transplants (LRT). Evidence suggests African Americans may not discuss LD/LRT with their families or physicians at optimal rates, and thus may not have adequate information to initiate or participate in shared decision-making regarding LD/LRT. African Americans may also have financial concerns regarding convalescence and out of pocket expenses related to LD/LRT, another barrier impeding LD/LRT. The primary goals of this study are to overcome these important barriers by enhancing ethnic minorities' consideration of LD/LRT through the promotion of shared decision-making regarding LD/LRT and provision of financial assistance for out of pocket expenses. Our specific aims are: a) to develop culturally sensitive informational (audiovisual) and financial interventions and b) to perform a randomized controlled trial to assess their effectiveness in increasing pursuit of LD/LRT among African American patients with ESRD and their families. We will conduct focus groups to refine the content/delivery of the informational (audiovisual) intervention to promote patient and family shared-decision making and design a written brochure describing the financial assistance (for work loss, childcare and travel costs) intervention. We will enroll 210 adult African American patients with new-onset ESRD from 4 sites (9 dialysis facilities) in the Baltimore metropolitan area and measure their initial commitment to pursue LD/LRT (using the Transtheoretical Model for stages of behavior change). Participants will then be randomized to one of three groups: 1) informational incentive alone, 2) informational intervention plus financial assistance, and 3) no intervention (usual care). We will follow participants for up to 12 months for progression in their commitment to LD/LRT (precontemplation stage to contemplation stage to preparation stage to action stage to completion stage (receipt of LD/LRT)). If the interventions are successful in activating patients and their families to consider and undergo LD/LRT, we will disseminate them widely. Effective interventions to improve rates of LD/LRT in African Americans could help eliminate large disparities in receipt of organs for ESRD. The substantial experience of our team in the design and conduct of behavioral, epidemiologic and interventional studies related to donor/recipient health, minority health and kidney disease provides a strong foundation for this research.