Effectiveness of informational decision aids and a live donor financial assistance program on pursuit of live kidney transplants in African American hemodialysis patients

BMC Nephrol. 2018 May 3;19(1):107. doi: 10.1186/s12882-018-0901-x.

Abstract

Background: African Americans have persistently poor access to living donor kidney transplants (LDKT). We conducted a small randomized trial to provide preliminary evidence of the effect of informational decision support and donor financial assistance interventions on African American hemodialysis patients' pursuit of LDKT.

Methods: Study participants were randomly assigned to receive (1) Usual Care; (2) the Providing Resources to Enhance African American Patients' Readiness to Make Decisions about Kidney Disease (PREPARED); or (3) PREPARED plus a living kidney donor financial assistance program. Our primary outcome was patients' actions to pursue LDKT (discussions with family, friends, or doctor; initiation or completion of the recipient LDKT medical evaluation; or identification of a donor). We also measured participants' attitudes, concerns, and perceptions of interventions' usefulness.

Results: Of 329 screened, 92 patients were eligible and randomized to Usual Care (n = 31), PREPARED (n = 30), or PREPARED plus financial assistance (n = 31). Most participants reported interventions helped their decision making about renal replacement treatments (62%). However there were no statistically significant improvements in LDKT actions among groups over 6 months. Further, no participants utilized the living donor financial assistance benefit.

Conclusions: Findings suggest these interventions may need to be paired with personal support or navigation services to overcome key communication, logistical, and financial barriers to LDKT.

Trial registration: ClinicalTrials.gov [ NCT01439516 ] [August 31, 2011].

Keywords: Decision aid; End stage renal disease; Financial support; Live donor kidney transplant; Race disparities.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • African Americans* / psychology
  • Aged
  • Decision Making
  • Decision Support Techniques*
  • Female
  • Financial Support*
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Kidney Transplantation / economics
  • Kidney Transplantation / methods*
  • Kidney Transplantation / psychology
  • Living Donors* / psychology
  • Male
  • Middle Aged
  • Patient Participation / economics
  • Patient Participation / methods
  • Patient Participation / psychology
  • Renal Dialysis / economics
  • Renal Dialysis / methods*
  • Renal Dialysis / psychology
  • Tissue and Organ Procurement
  • Treatment Outcome

Associated data

  • ClinicalTrials.gov/NCT01439516