Modifiable factors affecting racial disparities in live kidney donation

影响活体肾脏捐赠种族差异的可改变因素

• 批准号: 8771591
• 负责人: Amy Doggette Waterman
• 金额: $ 34.95万
• 依托单位: ST. BARNABAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-10 至 2019-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8771591
• 关键词: Academic Medical Centers; Affect; American; Behavior; California; Caring; Characteristics; Chronic; Cohort Studies; Complex; Decision Making; Dialysis patients; Dialysis procedure; Education; Evaluation; Future; Goals; Health Services; Healthcare Systems; Hispanics; Individual; Intervention; Interview; Kidney; Kidney Failure; Kidney Transplantation; Knowledge; Life; Living Donors; Los Angeles; Measures; Medical; Medical center; Methods; Minority; Motivation; New Jersey; Outcome; Outcomes Research; Patient Care; Patients; Perception; Persons; Population Heterogeneity; Process; Quality of life; Research; Saints; System; Testing; Transplantation; Universities; base; behavioral health; cohort; cost; design; experience; health literacy; improved; interest; novel; programs; prospective; public health relevance; racial and ethnic disparities; satisfaction; social; socioeconomics; volunteer

DESCRIPTION (provided by applicant): The best treatment for kidney failure is usually a live donor kidney transplant (LDKT), which provides an average of 10 additional years of life compared to staying on chronic dialysis. Unfortunately, large racial/ethnic disparities persist in receipt of LDKTs. Blacks and Hispanics comprise over 58 percent of all dialysis patients but receive less than 28 percent of LDKTs. A little-studied and likely crucial cause of LDKT disparities is the lower likelihood that Black and Hispanic donor volunteers (persons interested in donating a live kidney) will complete the multi-step donor evaluation and actually donate. While minority donor volunteers are more likely to have medical contraindications to donation, they are also much more likely to discontinue the donor evaluation or decline participation in paired exchange (programs that permit LDKT using immunologically incompatible donor-recipient pairs). Based upon limited prior research, the outcomes of the donor evaluation may be especially affected by several potentially modifiable individual and health care system factors, such as donor volunteers' motivation to donate, health literacy, knowledge/education about donation, satisfaction with the patient care experience, and socioeconomic barriers to donation. These factors, however, have not been prospectively examined in a well-powered, multi-center, and diverse cohort of donor volunteers. The objective of this study is to determine how differences in modifiable individual and system factors are associated with Black and Hispanic donor volunteers' lower likelihood of actually donating. Our overall hypothesis is that donor volunteers who are Black or Hispanic are more likely to discontinue the donor evaluation, due to modifiable differences that either (1) are already present at the start of the evaluation, o (2) arise later in the evaluation process. To test this hypothesis, we propose a sequential mixed methods study. First, we will perform qualitative interviews of donor volunteers who previously discontinued their donor evaluations, to identify all the potentially modifiable causes of discontinuation of the donor evaluation (Aim 1). Then, in the quantitative component, we will perform a prospective cohort study of 2,800 live kidney donor volunteers at two large transplant centers in New Jersey and California. Among 575 Black, 875 Hispanic, and 1,350 White donor volunteers, we will determine differences in potentially modifiable factors that are present at the start of the donor evaluation (Aim 2) or arise during the evaluation (Aim 3), and also determine the impact of modifiable factors upon successful completion of the donor evaluation (Aim 4) and actual donation, directly or via paired exchange (Aim 5). At the end of this study, we will understand how Black, Hispanic, and White live donor volunteers differ in their potentially modifiable social, behavioral, and health services characteristics and how these factors impact both completion of the evaluation and actual donation. Our results, generalizable to the 230+ kidney transplant centers in the U.S., will enable us to design future interventions to improve the education, support, and care of live donor volunteers, to ultimately decrease racial/ethnic disparities in LDKT.

描述（由申请人提供）：肾功能衰竭的最佳治疗方法通常是活体肾脏移植（LDKT），与保持慢性透析相比，它平均提供了10年的寿命。不幸的是，巨大的种族/种族差异仍然存在于LDKT的收到。黑人和西班牙裔占所有透析患者的58％以上，但不到28％的LDKT。 LDKT差异的有点研究的原因是，黑人和西班牙裔捐助志愿者（有兴趣捐赠活肾脏的人）将完成多步捐助者评估并实际捐款。尽管少数派捐助者志愿者更有可能捐赠医疗禁忌症，但他们也更有可能停止捐助者评估或拒绝对配对交换的参与（允许使用免疫学上不兼容的捐助者对供体的计划的计划）。基于先前的研究有限，捐助者评估的结果可能尤其受到几种可能修改的个人和医疗保健系统因素的影响，例如捐助者的捐赠，健康素养，知识/教育有关捐赠，对患者护理经验的满意度以及社会经济经济的捐赠障碍的动机。然而，这些因素尚未在供应良好，多中心和多样化的捐助志愿者队列中进行前瞻性检查。这项研究的目的是确定可修改的个体和系统因素的差异与黑人和西班牙裔捐助者志愿者实际捐款的较低可能性有关。我们的总体假设是，黑人或西班牙裔的捐助者志愿者更有可能停止捐助者评估，这是因为可修改的差异（1）在评估开始时已经存在，o（2）在评估过程中后来出现。为了检验这一假设，我们提出了一项顺序混合方法研究。首先，我们将对以前停止捐助者评估的捐助者志愿者进行定性访谈，以确定所有可能修改的捐助者评估原因（AIM 1）。然后，在定量组件中，我们将对新泽西州和加利福尼亚州两个大型移植中心进行2,800名活肾脏捐赠者志愿者进行前瞻性队列研究。在575个黑色，875个西班牙裔和1,350名白人供体志愿者中，我们将确定存在于潜在可修改因素的差异 在评估期间（AIM 3）开始捐助者评估（AIM 2）或出现，还确定了成功完成捐助者评估（AIM 4）和实际捐赠后，直接或通过配对交换（AIM 5）成功完成后的可修改因素的影响。在这项研究结束时，我们将了解黑人，西班牙裔和白人活的捐助者志愿者在潜在可修改的社会，行为和卫生服务特征方面有何不同，以及这些因素如何影响评估的完成和实际捐赠。我们的结果可推广到美国230多个肾脏移植中心，将使我们能够设计未来的干预措施以改善 对活捐助者志愿者的教育，支持和照顾，最终减少了LDKT的种族/族裔差异。