Transplant Social Worker Support for Live Kidney Donation in African 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，非裔美国人接受LDKT的可能性一直很低，而且明显较少。为LDKT寻找和建立活体捐赠者的过程需要潜在的捐赠者克服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和他们的家人或朋友(他们为患者的健康决策提供支持，也可能是潜在的捐赠者)参与关于LDKT的讨论，以确定LDKT是否是一种可行和/或可取的治疗方案。与医生讨论LDKT有助于患者和家属了解LDKT对潜在受者和任何潜在捐赠者的风险和好处。家庭的LDKT讨论帮助他们确定是否有可能确定自愿和符合医疗条件的活体捐赠者，并帮助家庭讨论 LDKT对患者和家属的潜在心理、身体和经济压力。一旦进行了讨论，潜在的捐赠者必须面对与LDKT相关的后勤(例如，儿童保育或前往移植中心的旅行)和财务(例如，无薪休假)挑战。研究表明，即使非裔美国患者渴望LDKT，讨论LDKT的比率也不是最理想的。此外，非洲裔美国人潜在的活体肾脏捐赠者比他们的白人捐赠者更不可能完成捐赠者评估过程，而且他们可能比白人对LDKT的后勤和经济障碍更敏感。对于非裔美国人来说，迫切需要创新的战略来克服LDKT的人际、后勤和经济障碍，特别是那些可能非常有动力寻求这种疗法的人。移植社会工作者经常对潜在的LDKT接受者和捐赠者进行心理社会评估，并非常适合支持家庭导航LDKT讨论。移植社会工作者还精通LDKT的财务方面(例如，保险覆盖规则)，并经常向潜在的LDKT接受者和捐赠者提供财务指导。我们建议研究创新的移植社会工作者主导的干预措施，以帮助非洲裔美国人潜在的LDKT接受者及其家人克服LDKT的人际、后勤和经济障碍。我们将随机将已故肾脏捐赠者等待名单上的非裔美国人分配到移植名单上接受他们通常的护理，或将其分配到两种社会工作者主导的干预措施中-一种是帮助患者和家属彼此以及与患者的医生讨论LDKT，另一种是为家属提供经济支持，以克服LDKT的后勤和经济障碍。作为主要结果，我们将衡量干预措施是否激活了非裔美国人潜在接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方面的丰富经验，以克服非裔美国人中LDKT的障碍。

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.