Communicating about Choices in Transplantation: An Educational Intervention

描述（由申请人提供）：目前有超过111，000名美国人等待实体器官移植，其中约89，000人需要可移植肾脏。与持续透析或死亡供体移植（DDT）相比，活体供体移植（LDT）与更好的患者和移植物存活率相关。尽管移植中心通常向新上市的候选人提供关于移植的基本教育，但肾移植候选人追求LDT的主要障碍是缺乏与家人和朋友关于该主题的沟通（例如，社交网络）。本研究建议开发和试点测试的教育干预，沟通选择在移植（教练），旨在增加肾移植候选人的滴滴涕和LDT的知识，以及他们的信心和能力，讨论这些移植的选择，特别是LDT，在他们的社交网络。将召集一个社区咨询委员会（CAB），以协助对文化敏感的COACH计划的最终设计和实施，该计划将教授移植候选人与其社交网络成员讨论LDT和DDT所需的沟通技巧。将使用实验设计评估COACH计划的有效性。 具体而言，一项随机对照试验将提供有关该计划对候选人的LDT/DDT知识，沟通能力，自我效能，与家人和朋友讨论移植选择的意图以及自我报告的讨论的初步数据。 LDT/DDT。在两个大西洋中部移植中心被列为肾移植候选人的个人（n=158）将被邀请参加。移植候选人将被随机分配到两个研究组之一：1）由移植中心提供的标准教育;或2）由中心提供的标准教育加上教练计划。该申请有以下具体目标：目标1。制定文化相关的沟通干预措施，以提高肾移植候选人对LDT和DDT相关过程、益处和风险的理解，并提高候选人的关系和沟通能力、自我效能、沟通恐惧和沟通相关障碍，以进行有关移植的讨论;目标2。对该计划进行试点测试，以评估其对移植候选人的LDT和DDT知识，关系和沟通能力，自我效能，沟通相关障碍，与家人和朋友讨论移植的意图以及两种移植选择的自我报告讨论的影响。 公共卫生相关性：活体供体移植（LDT）是近89，000名等待肾移植的候选人的首选治疗方案。然而，许多移植候选人将不会接受活体供体移植，这是由于不愿意与他们的社交网络的成员（例如，家人和朋友）。这项研究建议进行一项干预试验，以增加肾移植候选人对LDT和死亡供体移植的了解，以及候选人对这些治疗方案的沟通。

DESCRIPTION (provided by applicant): There are currently over 111,000 Americans awaiting a solid organ transplant, approximately 89,000 of which are in need of a transplantable kidney. As compared to sustained dialysis or deceased donor transplantation (DDT), live donor transplantation (LDT) is associated with better patient and graft survival. Although transplant centers routinely provide basic education on transplantation to newly listed candidates, a major barrier to kidney transplant candidates' pursuit of LDT is lack of communication about the topic with family members and friends (e.g., social networks). This study proposes to develop and pilot test an educational intervention, communicating about Choices in Transplantation (COACH), designed to increase kidney transplant candidates' knowledge of DDT and LDT as well as their confidence and ability discussing these transplant options, specifically LDT, within their social networks. A Community Advisory Board (CAB) will be convened to assist in the final design and implementation of the culturally-sensitive COACH Program that will teach transplant candidates the communication skills needed to discuss LDT and DDT with members of their social networks. The efficacy of the COACH Program will be evaluated using an experimental design. Specifically, a randomized, controlled trial will provide preliminary data on the effects f the program on candidates' LDT/DDT knowledge, communication competence, self-efficacy, intent to discuss their transplant options with family and friends, and self-reported discussion of LDT/DDT. Individuals (n=158) listed as candidates for kidney transplantation at two mid-Atlantic transplant centers will be invited to participate. Consenting candidates will be randomized to one of two study arms: 1) standard education provided by the transplant center; or, 2) standard education provided by the center coupled with the COACH Program. The application has the following specific aims: Aim 1. Develop a culturally-relevant communication intervention to improve kidney transplant candidates' understanding of the process, benefits and risks associated with LDT and DDT and to enhance candidates' relational and communication competence, self-efficacy, communication apprehension, and communication-related barriers to holding discussions about transplantation; Aim2. Conduct a pilot test of the program to evaluate its impact on transplant candidates' knowledge of LDT and DDT, relational and communication competence, self-efficacy, communication-related barriers, intent to discuss transplantation with family and friends, and self-reported discussion of the two transplant options. PUBLIC HEALTH RELEVANCE: Live donor transplantation (LDT) is the preferred treatment option for the nearly 89,000 candidates awaiting kidney transplants. Many transplant candidates, however, will not receive a live donor transplant due to a reluctance to communicate about LDT with members of their social networks (e.g., family and friends). This research proposes to pilot an intervention to increase kidney transplant candidates' knowledge of both LDT and deceased-donor transplantation as well as candidates' communication about these treatment options.