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

通过有效的医患沟通提高活体肾移植的公平性 (EPPCom)

基本信息

  • 批准号:
    10567329
  • 负责人:
  • 金额:
    $ 67.78万
  • 依托单位:
  • 依托单位国家:
    美国
  • 项目类别:
  • 财政年份:
    2023
  • 资助国家:
    美国
  • 起止时间:
    2023-06-05 至 2027-05-31
  • 项目状态:
    未结题

项目摘要

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.
项目概要 活体供肾移植(LDKT)是慢性和终末期患者的首选治疗方式 LDKT 比长期透析更便宜,并且可降低死亡率和发病率。 然而,少数族裔对透析或死者捐献肾移植 (DDKT) 的影响显着。 与白人同事相比,黑人、亚洲人和西班牙人获得 LDKT 的机会更少。 占肾移植等待名单的 64.3%,但 2019 年仅接受了所有 LDKT 的 36%。此外,LDKT 的比率 过去十年中黑人患者的患病率有所下降,数十年的研究表明患者提供者的情况有所改善。 迄今为止,沟通是造成健康和医疗保健结果差异的一个因素。 然而,尚未尝试评估移植过程中发生的沟通的影响 关于 LDKT 结果的评估磋商 拟议研究的长期目标,题为“增加”。 通过有效的医患沟通实现活体肾移植的公平性,旨在提高均等性 我们建议开展一项社区参与的混合方法研究,以帮助黑人患者获得 LDKT。 并发三角测量设计,以确定导致活体捐赠者的特定沟通行为 询问和评估,以及针对白人和黑人患者的实际 LDKT,为以下人员提供关键信息: 设计干预措施以改善患者与提供者关于 LDKT 的沟通。 同时定量评估患者和提供者因素,并确定和资本化 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进行沟通(目标 1)。 作为评估的一部分,在医疗咨询之前和之后进行了简短调查 移植候选资格将赢得提供者 (N=52) 讨论 LDKT 和患者的信心和舒适度 咨询满意度、医疗不信任、健康素养、LDKT知识、态度和 我们还将为 60 名白人和 60 名黑人患者进行移植评估咨询录音。 (N=120) 跨越两个研究地点——圣巴拿巴医疗中心(新泽西州)和天普大学医院 (PA),并对磋商期间发生的沟通进行定性评估,我们将使用调查结果。 为移植提供者沟通技巧培训的内容和格式的制定提供信息,以及 评估培训对患者报告和 LDKT 流程结果的直接和间接影响(目标 2 & 3). 鉴于所有移植候选者都必须进行干预,因此在提供者层面进行干预是可行的。 接受这种咨询,并且效率很高,因为单个移植医生可以评估 > 100 例移植手术 因此,这项创新研究的结果有可能增加获得 LDKT 的机会。 针对目前正在等待肾移植的黑人患者,改善移植期间的沟通。 事实证明,协商可能是缓解LDKT 中种族差异的有效且高效的手段。

项目成果

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Heather Marie Gardiner其他文献

Heather Marie Gardiner的其他文献

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{{ truncateString('Heather Marie Gardiner', 18)}}的其他基金

Symposium on Obesity and Transplantation: Comparing Medical Nutrition Therapy, Pharmacotherapy, and Bariatric Surgery
肥胖与移植研讨会:医学营养疗法、药物疗法和减肥手术的比较
  • 批准号:
    10828092
  • 财政年份:
    2023
  • 资助金额:
    $ 67.78万
  • 项目类别:
Symposium on Obesity and Kidney Transplantation
肥胖与肾脏移植研讨会
  • 批准号:
    10228360
  • 财政年份:
    2021
  • 资助金额:
    $ 67.78万
  • 项目类别:
Genetic Testing (APOL1) Decisional Support for Potential Living Kidney Donors
为潜在活体肾脏捐赠者提供基因检测 (APOL1) 决策支持
  • 批准号:
    10623335
  • 财政年份:
    2021
  • 资助金额:
    $ 67.78万
  • 项目类别:
Genetic Testing (APOL1) Decisional Support for Potential Living Kidney Donors
为潜在活体肾脏捐赠者提供基因检测 (APOL1) 决策支持
  • 批准号:
    10494134
  • 财政年份:
    2021
  • 资助金额:
    $ 67.78万
  • 项目类别:
Genetic Testing (APOL1) Decisional Support for Potential Living Kidney Donors
为潜在活体肾脏捐赠者提供基因检测 (APOL1) 决策支持
  • 批准号:
    10341558
  • 财政年份:
    2021
  • 资助金额:
    $ 67.78万
  • 项目类别:
Communicating about Choices in Transplantation: An Educational Intervention
交流移植的选择:教育干预
  • 批准号:
    8420186
  • 财政年份:
    2012
  • 资助金额:
    $ 67.78万
  • 项目类别:
Communicating about Choices in Transplantation: An Educational Intervention
交流移植的选择:教育干预
  • 批准号:
    8282151
  • 财政年份:
    2012
  • 资助金额:
    $ 67.78万
  • 项目类别:
Increasing Communication about Live Donor Kidney Transplant: A Proof of Concept
加强关于活体肾移植的交流:概念证明
  • 批准号:
    7895224
  • 财政年份:
    2010
  • 资助金额:
    $ 67.78万
  • 项目类别:
Increasing Communication about Live Donor Kidney Transplant: A Proof of Concept
加强关于活体肾移植的交流:概念证明
  • 批准号:
    8420185
  • 财政年份:
    2010
  • 资助金额:
    $ 67.78万
  • 项目类别:
Increasing Communication about Live Donor Kidney Transplant: A Proof of Concept
加强关于活体肾移植的交流:概念证明
  • 批准号:
    8044871
  • 财政年份:
    2010
  • 资助金额:
    $ 67.78万
  • 项目类别:

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