Increasing Equity in Live Donor Kidney Transplant through Effective Patient-Provider Communication (EPPCom)

项目摘要 活体供肾移植（LDKT）是慢性和终末期肾病患者的首选治疗方式。 肾病LDKT比长期透析更便宜，并可降低死亡率和发病率 而不是透析或死亡供体肾移植（DDKT）。然而，少数民族在很大程度上 比他们的白色同行更少接触LDKT。总的来说，黑人，亚洲人和西班牙裔人代表了 64.3%的肾移植等待名单，但在2019年仅接受了所有LDKT的36%。此外，LDKT的比率 在过去的十年里，黑人患者的死亡率下降了。数十年的研究表明， 沟通是健康和医疗保健结果中观察到的差异的促成因素。到目前为止， 然而，还没有尝试去评估在移植过程中发生的通信的影响 关于最不发达国家转让技术成果的评估协商。拟议的题为“提高妇女地位”的研究的长期目标是： 通过有效的患者-提供者沟通实现活体供肾移植的公平性， 为黑人患者提供LDKT。我们提出了一个社区参与，混合方法的研究，采用 并行三角设计，以确定导致活体供体的特定交流行为 询问和评估，以及白人和黑人患者的实际LDKT，为以下患者提供关键信息： 设计干预措施，以改善患者与提供者关于LDKT的沟通。具体来说，我们将 同时定量评估患者和供应商的因素与建立和假设 与接受LDKT的关联，并定性评估患者-提供者的离散要素 在白人和黑人患者的移植评估咨询期间发生的沟通（目标1）。 作为评价的一部分，在医疗咨询前后进行了简短的定量调查， 移植候选资格将捕获提供者（N=52）的信心和舒适度，讨论LDKT和患者的 对咨询的满意度，医疗不信任，健康素养和LDKT知识，态度和 准备就绪。我们还将对60名白人和60名黑人患者的移植评估咨询进行录音 （N=120）在两个研究中心- Saint Barnabas Medical Center（NJ）和Temple University Hospital (PA)，并对磋商期间的沟通进行定性评估。我们将利用调查结果 为移植提供者提供沟通技能培训的内容和形式， 评估培训对患者报告和LDKT过程结果的直接和间接影响（目的2 及3）。在提供者层面进行干预是可行的，因为所有移植候选人都必须 接受这种咨询，效率高，因为一个移植医生可以评估>100个移植 候选人每年因此，这项创新研究的结果有可能增加获得LDKT的机会。 等待肾脏移植的黑人患者在移植期间改善沟通 协商可能被证明是减轻LDKT族裔差异的有效和高效手段。

PROJECT SUMMARY Live donor kidney transplant (LDKT) is the preferred treatment modality for patients with chronic and end-stage kidney disease. LDKT is less expensive than prolonged dialysis and offers improved mortality and morbidity over either dialysis or deceased donor kidney transplants (DDKT). However, ethnic minorities have significantly less access to LDKT than their White counterparts. Collectively, Blacks, Asians, and Hispanics represent 64.3% of the kidney transplant wait list, yet received only 36% of all LDKTs in 2019. Further, rates of LDKTs have decreased for Black patients over the last decade. Decades of research point to patient-provider communication as a contributing factor to observed disparities in health and healthcare outcomes. To date, however, no attempt has been made to gauge the impact of the communication occurring during transplant evaluation consultations on LDKT outcomes. The long-term goal of the proposed study entitled, Increasing Equity in Live Donor Kidney Transplant through Effective Patient-Provider Communication, is to increase parity in access to LDKT for Black patients. We propose a community-engaged, mixed-methods study employing a concurrent triangulation design to identify the specific communicative behaviors that result in live donor inquiries and evaluations, and actual LDKTs for Caucasian and Black patients, providing critical information to the design of an intervention to improve patient-provider communication about LDKT. Specifically, we will simultaneously quantitatively assess patient and provider factors with established and hypothesized associations with receipt of LDKTs, and qualitatively assess discrete elements of patient-provider communication occurring during transplant evaluation consultations for Caucasian and Black patients (Aim 1). Brief quantitative surveys administered before and after medical consultations held as part of the evaluation for transplant candidacy will capture providers’ (N=52) confidence and comfort discussing LDKT and patients’ satisfaction with the consultation, medical mistrust, health literacy, and LDKT knowledge, attitudes and readiness. We will also audiorecord transplant evaluation consultations for 60 Caucasian and 60 Black patients (N=120) across the two study sites – Saint Barnabas Medical Center (NJ) and Temple University Hospital (PA), and qualitatively assess the communication occurring during the consultations. We will use the findings to inform development of the content and format of a communication skills training for transplant providers and evaluate the direct and indirect effects of the training on patient-reported and LDKT process outcomes (Aims 2 & 3). Intervening at the provider level is both practical, given that all transplant candidates already must undergo this consultation, and efficient, given that a single transplant physician can evaluate >100 transplant candidates per year. Thus, the results of this innovative study have the potential to increase access to LDKT for Black patients currently awaiting kidney transplant. Improving communication during the transplant consultation may prove to be an effective and efficient means of alleviating ethnic disparities in LDKT.