Information and Financial Interventions for Kidney Donation in African Americans

非裔美国人肾脏捐赠的信息和财务干预措施

• 批准号: 7922931
• 负责人: Leigh E Boulware
• 金额: $ 7.5万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-30 至 2010-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7922931
• 关键词: Adult; Affect; African American; Area; Attitude; Audiovisual Material; Baltimore; Behavioral; Bypass; Conflict (Psychology); Convalescence; Decision Making; Dialysis procedure; Effectiveness; End stage renal failure; Enrollment; Family; Family health status; Focus Groups; Foundations; General Population; Goals; Health; Health Personnel; Health Professional; Incentives; Individual; Intervention; Kidney; Kidney Diseases; Kidney Transplantation; Knowledge; Life; Measures; Minority; Modeling; Organ; Pamphlets; Participant; Patients; Persons; Physicians; Preparation; Process; Randomized; Randomized Controlled Trials; Research; Research Personnel; Site; Staging; Therapeutic; Transplantation; Travel; Uninsured Medical Expense; Waiting Lists; Work; Writing; behavior change; cost; design; effective intervention; ethnic minority population; experience; improved; intervention effect; metropolitan; minority health; programs; shared decision making; successful intervention; treatment as usual; willingness

DESCRIPTION (provided by applicant): African Americans are less likely than Whites to receive kidney transplants, despite their being more than two-fold as likely as Whites to develop end stage renal disease (ESRD). Living related kidney donation (LD) offers patients an opportunity to bypass many barriers to receipt of deceased kidney transplants (e.g. waiting lists and immunological incompatibility), but minorities are less likely to receive living related kidney transplants (LRT). Evidence suggests African Americans may not discuss LD/LRT with their families or physicians at optimal rates, and thus may not have adequate information to initiate or participate in shared decision-making regarding LD/LRT. African Americans may also have financial concerns regarding convalescence and out of pocket expenses related to LD/LRT, another barrier impeding LD/LRT. The primary goals of this study are to overcome these important barriers by enhancing ethnic minorities' consideration of LD/LRT through the promotion of shared decision-making regarding LD/LRT and provision of financial assistance for out of pocket expenses. Our specific aims are: a) to develop culturally sensitive informational (audiovisual) and financial interventions and b) to perform a randomized controlled trial to assess their effectiveness in increasing pursuit of LD/LRT among African American patients with ESRD and their families. We will conduct focus groups to refine the content/delivery of the informational (audiovisual) intervention to promote patient and family shared-decision making and design a written brochure describing the financial assistance (for work loss, childcare and travel costs) intervention. We will enroll 210 adult African American patients with new-onset ESRD from 4 sites (9 dialysis facilities) in the Baltimore metropolitan area and measure their initial commitment to pursue LD/LRT (using the Transtheoretical Model for stages of behavior change). Participants will then be randomized to one of three groups: 1) informational incentive alone, 2) informational intervention plus financial assistance, and 3) no intervention (usual care). We will follow participants for up to 12 months for progression in their commitment to LD/LRT (precontemplation stage to contemplation stage to preparation stage to action stage to completion stage (receipt of LD/LRT)). If the interventions are successful in activating patients and their families to consider and undergo LD/LRT, we will disseminate them widely. Effective interventions to improve rates of LD/LRT in African Americans could help eliminate large disparities in receipt of organs for ESRD. The substantial experience of our team in the design and conduct of behavioral, epidemiologic and interventional studies related to donor/recipient health, minority health and kidney disease provides a strong foundation for this research.

描述（由申请人提供）： 非洲裔美国人比白人接受肾脏移植的可能性要小，尽管他们的白人的可能性超过两倍，而是患有终结阶段肾脏疾病（ESRD）。与生活相关的肾脏捐赠（LD）为患者提供了绕过许多接收已故肾脏移植（例如等待名单和免疫学不兼容）的障碍的机会，但少数群体不太可能接受与生活相关的肾脏移植（LRT）。有证据表明，非洲裔美国人可能不会以最佳速度与家人或医生讨论LD/LRT，因此可能没有足够的信息来启动或参与有关LD/LRT的共同决策。非洲裔美国人也可能会对康复和与LD/LRT相关的袋装费用有财务关注，这是另一个阻碍LD/LRT的障碍。 这项研究的主要目标是通过促进有关LD/LRT的共同决策和为超出零售费用提供财政援助，从而通过增强少数民族对LD/LRT的考虑来克服这些重要障碍。我们的具体目的是：a）开发具有文化敏感的信息（视听）和财务干预措施以及b）进行随机对照试验，以评估其在ESRD及其家人中对LD/LRT追求LD/LRT的有效性。我们将进行焦点小组，以完善信息（视听）干预的内容/交付，以促进患者和家庭共享决定和设计的书面宣传册，描述了经济援助（用于工作损失，育儿和旅行成本）干预措施。我们将在巴尔的摩大都会区的4个地点（9个透析设施）中注册210名非裔美国人ESRD的非裔美国人ESRD，并衡量他们最初致力于追求LD/LRT（使用跨理论模型用于行为改变阶段）。然后，参与者将被随机分为三个组之一：1）单独使用信息激励措施，2）信息干预加上财务援助，以及3）不干预（通常的护理）。我们将跟随参与者进行长达12个月的时间，以进步他们对LD/LRT的承诺（预先成熟阶段到沉思阶段，到准备阶段到动作阶段到完成阶段（收到LD/LRT的收到））。如果干预措施成功激活患者及其家人以考虑并接受LD/LRT，我们将广泛传播它们。有效提高非裔美国人LD/LRT率的干预措施可以帮助消除ESRD的器官的巨大差异。我们团队在与捐助者/接受者健康，少数民族健康和肾脏疾病有关的行为，流行病学和介入研究的设计和行为方面的丰富经验为这项研究奠定了坚实的基础。