Effectiveness of Educational and Social Worker Interventions to Activate Patients' Discussion and Pursuit of Preemptive Living Donor Kidney Transplantation: A Randomized Controlled Trial

Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD
American Journal of Kidney Diseases (Impact Factor: 5.9). 10/2012; 61(3). DOI: 10.1053/j.ajkd.2012.08.039
Source: PubMed


BACKGROUND: Many patients with chronic kidney disease (CKD) have difficulty becoming actively engaged in the pursuit of preemptive living donor kidney transplantation. STUDY DESIGN: The Talking About Live Kidney Donation (TALK) Study was a randomized controlled trial of the effectiveness of educational and social worker interventions designed to encourage early discussions and active pursuit of preemptive living donor kidney transplantation in patients with progressive CKD. SETTING & PARTICIPANTS: We recruited participants with progressive CKD from academically affiliated nephrology practices in Baltimore, MD. INTERVENTION: Participants randomly received: (1) usual care (routine care with their nephrologists), the (2) TALK education intervention (video and booklet), or the (3) TALK social worker intervention (video and booklet plus patient and family social worker visits). OUTCOMES: We followed participants for 6 months to assess their self-reported achievement of behaviors reflecting their discussions about and/or pursuit of living donor kidney transplantation (discussions with family, discussions with physicians, initiating recipient evaluation, completing recipient evaluation, and identifying a potential living donor). MEASUREMENTS: We assessed outcomes through a questionnaire at 1-, 3-, and 6-months follow-up. RESULTS: Participants receiving usual care with their nephrologists (n = 44), TALK education (n = 43), and the TALK social worker (n = 43) were similar at baseline. TALK Study interventions improved participants' living donor kidney transplantation discussion and pursuit behaviors, with the social worker leading to greater patient activation (participants' predicted probability of achieving living donor kidney transplantation discussions, evaluations, or donor identification over 6 months): probabilities were 30% (95% CI, 20%-46%), 42% (95% CI, 33%-54%), and 58% (95% CI, 41%-83%), respectively, in the usual care, TALK education, and TALK social worker groups (P = 0.03). LIMITATIONS: Our population was well educated and mostly insured, potentially limiting generalizability of our findings. CONCLUSIONS: TALK interventions improved discussion and active pursuit of living donor kidney transplantation in patients with progressive CKD and may improve their use of preemptive living donor kidney transplantation.

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    • "Surprisingly, few interventions have targeted CKD patients being evaluated at the transplant center [42,56]. Instead, most prior interventions have targeted CKD patients in nephrologists’ offices [57,58], dialysis units [59,60], and patients’ homes [56,61]. By bringing together CKD patients who have some preexisting interest in transplant, the transplant evaluation, offers an opportunity to efficiently and effectively educate these patients about LDKT. "
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    ABSTRACT: The best treatment option for end-stage renal disease is usually a transplant, preferably a live donor kidney transplant (LDKT). The most effective ways to educate kidney transplant candidates about the risks, benefits, and process of LDKT remain unknown.Methods/design: We report the protocol of the Enhancing Living Donor Kidney Transplant Education (ELITE) Study, a cluster randomized trial of an educational intervention to be implemented during initial transplant evaluation at a large, suburban U.S. transplant center. Five hundred potential transplant candidates are cluster randomized (by date of visit) to receive either: (1) standard-of-care ("usual") transplant education, or (2) intensive education that is based upon the Explore Transplant series of educational materials. Intensive transplant education includes viewing an educational video about LDKT, receiving print education, and meeting with a transplant educator. The primary outcome consists of knowledge of the benefits, risks, and process of LDKT, assessed one week after the transplant evaluation. As a secondary outcome, knowledge and understanding of LDKT are assessed 3 months after the evaluation. Additional secondary outcomes, assessed one week and 3 months after the evaluation, include readiness, self-efficacy, and decisional balance regarding transplant and LDKT, with differences assessed by race. Although the unit of randomization is the date of the transplant evaluation visit, the unit of analysis will be the individual potential transplant candidate. The ELITE Study will help to determine how education in a transplant center can best be designed to help Black and non-Black patients learn about the option of LDKT.Trial registration: number NCT01261910.
    BMC Nephrology 11/2013; 14(1):256. DOI:10.1186/1471-2369-14-256 · 1.69 Impact Factor
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    • "Currently, minority patients are less likely to receive LDKTs compared to White patients (Gore et al., 2009). Educational interventions to increase transplant knowledge and motivation to pursue LDKT have shown some success at increasing rates of LDKT (Boulware et al., 2012; Rodrigue et al., 2008b). However, as providers initiate conversations about the possibility of LDKT, having the ability to accurately assess individual patients' readiness to pursue LDKT, weighing of the risks and benefits of LDKT, and confidence in their own ability to find a living donor is very important. "
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    ABSTRACT: While educational interventions to increase patient motivation to pursue living donor kidney transplant have shown success in increasing living donor kidney transplant rates, there are no validated, theoretically consistent measures of Stage of Change, a measure of readiness to pursue living donor kidney transplant; Decisional Balance, a weighted assessment of living donor kidney transplant's advantages/disadvantages; and Self-Efficacy, a measure of belief that patients can pursue living donor kidney transplant in difficult circumstances. This study developed and validated measures of these three constructs. In two independent samples of kidney patients (N1 = 279 and N2 = 204), results showed good psychometric properties and support for their use in the assessment of living donor kidney transplant interventions.
    Journal of Health Psychology 10/2013; 20(2). DOI:10.1177/1359105313501707 · 1.88 Impact Factor
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    • "Social workers also are prepared to provide services that are both linguistically and culturally appropriate. They routinely work with clients who have low health literacy and are accustomed to devising effective communication strategies that minimize the barriers caused by low literacy (Boulware et al., 2013; Hendren et al., 2010; Leach & Segal, 2011; Nonzee et al., 2012). The navigation landscape is still largely uncharted , offering social workers an opportunity to lay claim to an enterprise that has been touted as " making or breaking " the experience people have in the new health care marketplace (Scott, 2012). "
    Health & social work 05/2013; 38(2):67-71. DOI:10.1093/hsw/hlt002 · 0.94 Impact Factor
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