Information and Financial Interventions for Kidney Donation in African Americans

描述（由申请人提供）： 非裔美国人接受肾移植的可能性低于白人，尽管他们患终末期肾病（ESRD）的可能性是白人的两倍多。活体亲属肾脏捐赠（LD）为患者提供了绕过许多障碍接受已故肾脏移植（例如等待名单和免疫不相容性）的机会，但少数人接受活体亲属肾脏移植（LRT）的可能性较小。有证据表明，非裔美国人可能不会以最佳速率与家人或医生讨论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。非裔美国人也可能对康复和与LD/LRT相关的自付费用有财务上的担忧，这是阻碍LD/LRT的另一个障碍。 本研究的主要目的是透过促进有关LD/LRT的共同决策和提供自付费用的财政援助，加强少数族裔对LD/LRT的考虑，以克服这些重要障碍。我们的具体目标是：a）制定文化敏感的信息（视听）和财政干预措施，以及B）进行随机对照试验，以评估其在非洲裔美国ESRD患者及其家属中增加LD/LRT追求的有效性。我们将进行焦点小组，以完善信息（视听）干预的内容/交付，以促进患者和家庭共同决策，并设计一本书面手册，描述经济援助（失业，儿童保育和旅行费用）干预。我们将从巴尔的摩大都市区的4个研究中心（9家透析机构）入组210例新发ESRD的非洲裔美国成年患者，并测量他们对LD/LRT的初始承诺（使用行为改变阶段的跨理论模型）。然后，参与者将被随机分配到三组之一：1）单独的信息激励，2）信息干预加经济援助，3）无干预（常规护理）。我们将对参与者进行长达12个月的跟踪，以了解他们对LD/LRT的承诺（预先考虑阶段到考虑阶段到准备阶段到行动阶段到完成阶段（LD/LRT的接收））。如果这些干预措施成功地促使患者及其家属考虑并接受LD/LRT，我们将广泛传播。有效的干预措施，以提高非裔美国人的LD/LRT率，可以帮助消除在接受器官的ESRD的巨大差距。我们的团队在设计和进行与供体/受体健康、少数民族健康和肾脏疾病相关的行为学、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.