Social Network Interventions to Reduce Race Disparities in Living Kidney Donation

社交网络干预措施减少活体肾脏捐赠的种族差异

• 批准号: 9393673
• 负责人: Jonathan Kyle Daw
• 金额: $ 24.62万
• 依托单位: PENNSYLVANIA STATE UNIVERSITY, THE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9393673
• 关键词: Address; Affect; African American; Algorithms; American; Attention; Blood; Cause of Death; Characteristics; Clinic; Clinical; Control Groups; Data; Diagnosis; Donor person; Education; Effectiveness; End stage renal failure; Equilibrium; Ethics; Evaluation; Evidence based intervention; Family; Family member; Focus Groups; Friends; Genetic Models; Goals; Growth; Health; Health Insurance; Health Status; Hearing; Immunologics; Incidence; Individual; Insurance Coverage; Intervention; Interview; Kidney; Kidney Transplantation; Kinship Networks; Knowledge; Lead; Living Donors; Maps; Measures; Mediating; Mediation; Medical; Medical Records; Methods; Modeling; Multicenter Studies; Organ Donations; Outcome; Patients; Pattern; Perception; Pilot Projects; Population; Population Genetics; Prevalence; Probability; Process; Public Health; Race; Randomized; Recruitment Activity; Reporting; Research; Research Personnel; Respondent; Risk; Social Network; Structure; Surveys; Testing; Time; Transplantation; Treatment Efficacy; Variant; Work; aging population; arm; base; design; effective therapy; efficacy testing; evidence base; experience; experimental study; follow-up; improved; member; mortality; neglect; novel; operation; predictive modeling; programs; prospective; racial and ethnic disparities; racial disparity; racial diversity; social; success; therapy design; tool; volunteer; willingness

Project Summary End stage renal disease (ESRD) is among the ten leading causes of death for Americans, and its incidence and prevalence are rising, especially among non-White groups. Kidney transplantation is the most effective treatment option for many Americans, but the number of Americans needing kidneys is currently much larger and rising much faster than current transplant levels. Patients who seek transplants have one of two options: wait for a kidney from a deceased donor to become available, or obtain a transplant from a living kidney donor. Deceased donor kidney transplant levels are projected to grow little over time, constrained by population aging and mortality patterns, but living donation donor kidney transplantation (LDD KT) holds the prospect of substantial growth if healthy population members are willing and able to donate. Unfortunately, there are large and persistent racial and ethnic disparities in LDD KT rates that compound disparities in rates of ESRD. Prior research hypothesizes that differential access to healthy, compatible donors in candidates' social networks may explain racial disparities in usage of LDD KT. However, a limitation of this work is that it focuses on those who are evaluated for donation, not the many members of transplant candidates' social networks who could be evaluated for donation, but are not. We propose a multi-center study to collect novel data on transplant candidates' social networks and to test promising social interventions that could reduce barriers to LDD KT. Based on qualitative interviews and a pilot survey of 72 transplant candidates we previously collected in a large transplant center, we suspect that the differential access hypothesis does not hold, and that there are promising points of social intervention for researchers to reduce racial disparities in LDD KT. These pilot data show large LDD KT underutilization for all candidates, and that Black candidates have access to promising living donors at higher rates than White candidates. Based on these findings, we hypothesize that the primary barrier to eliminating disparities in LDD KT and promoting greater utilization of LDD KT for all groups is social, not biomedical, in origin. In this proposal, we will extend our prior work to develop and test evidence based, randomized social network interventions that will target social barriers to LDD KT and follow up with candidate medical records to evaluate the efficacy of these interventions. Specifically, we will compare a control group of candidates to those assigned to two treatments that we will pilot and test: a) a search intervention where a subset of candidates is coached to approach promising family members that seem to be underutilized based on our pilot data, and b) a rhetorical intervention where we encourage a subset of candidates to use scripts for discussing transplantation with family members that we find to be effective in survey vignette experiments and focus groups. With eighteen month medical records follow up of all candidates and the large amount of data we will obtain on their social networks, we will assess the social barriers that lead to underutilization of LDD KT, how those factors vary by race, and how they can be reduced through promising social network interventions. LDD KT has substantial potential to solve public health challenges around the growing prevalence of ESRD, and the basic and applied knowledge that we will develop as part of this proposal will help to unlock this potential.

项目摘要 末期肾脏疾病（ESRD）是美国人的十个主要死亡原因之一，其发病率和流行率 正在上升，尤其是在非白人群体中。肾脏移植是许多人最有效的治疗选择 美国人，但需要肾脏的美国人数量要大得多，而且速度比当前快得多 移植水平。寻求移植的患者有两种选择之一：等待已故捐赠者的肾脏成为 可用或从活肾脏供体获得移植。已故的供体肾脏移植水平预计会增长 随着时间的流逝，受人口衰老和死亡率模式的限制很少，但是活着的捐赠供体肾移植 （LDD KT）如果健康的人口愿意并且能够捐款，则保持着大幅增长的前景。 不幸的是，LDD KT率的种族和种族差异很大，持续的种族和种族差异会使费率增加 ESRD。先前的研究假设，在候选人的社交网络中获得健康，兼容捐助者的差异可能可能 解释使用LDD KT的种族差异。但是，这项工作的限制是它专注于评估的人 为了捐赠，不是可以评估捐赠但是移植候选人的社交网络的许多成员 不是。我们提出了一项多中心研究，以收集有关移植候选人的社交网络的新数据并测试有希望的 社会干预措施可能会减少核心KT的障碍。根据定性访谈和对72次移植的试点调查 我们以前在大型移植中心收集的候选人，我们怀疑差异访问假设不存在， 而且，研究人员在社会干预方面有一个有希望的要点，以减少LDD KT中的种族差异。这些飞行员 数据显示，所有候选人的LDD KT不足 比白人候选人更高。基于这些发现，我们假设消除的主要障碍 LDD KT的差异和促进所有群体的LDD KT的利用率更大，其起源是社会而非生物医学。在这个 提案，我们将扩大先前的工作来开发和测试基于证据的，随机的社交网络干预措施 将社会障碍定位到LDD KT，并跟进候选病历以评估这些干预措施的功效。 具体而言，我们将比较一个对照组的候选人与分配给我们将要进行的两种治疗方法的候选人：a）a） 搜索干预措施，其中一部分候选人被指导与有前途的家庭成员接触 根据我们的试验数据，未充分利用，b）一种修辞干预措施，我们鼓励一部分候选人使用脚本 用于与家人讨论移植，我们发现我们在调查小插图实验中有效并重点 组。有18个月的医疗记录随访所有候选人以及我们将获得的大量数据 社交网络，我们将评估导致LDD KT缺乏利用的社会障碍，这些因素如何因种族而异以及 如何通过有希望的社交网络干预来减少它们。 LDD KT具有巨大潜力来解决公众 健康挑战围绕ESRD越来越多，以及我们将作为一部分发展的基本和应用知识挑战 该提议将有助于释放这一潜力。