Effectiveness of educational and social worker interventions to activate patients' discussion and pursuit of preemptive living donor kidney transplantation: A randomized controlled trial

Leigh Boulware, Felicia Hill-Briggs, Edward Kraus, J. Keith Melancon, Brenda Falcone, Patti L Ephraim, Bernard Jaar, Luis Gimenez, Michael J Choi, Mikiko Senga, Maria Kolotos, Lapricia Lewis-Boyer, Courtney Cook, Laney Light, Nicole Depasquale, Todd Noletto, Neil R. Powe

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)476-486
Number of pages11
JournalAmerican Journal of Kidney Diseases
Volume61
Issue number3
DOIs
StatePublished - Mar 2013

Fingerprint

Living Donors
Kidney Transplantation
Randomized Controlled Trials
Kidney
Chronic Renal Insufficiency
Pamphlets
Education
Patient Participation
Social Workers
Baltimore
Nephrology
Tissue Donors
Physicians

Keywords

  • chronic kidney disease
  • education
  • live kidney donation
  • Live kidney transplantation
  • social worker

ASJC Scopus subject areas

  • Nephrology

Cite this

Effectiveness of educational and social worker interventions to activate patients' discussion and pursuit of preemptive living donor kidney transplantation : A randomized controlled trial. / Boulware, Leigh; Hill-Briggs, Felicia; Kraus, Edward; Melancon, J. Keith; Falcone, Brenda; Ephraim, Patti L; Jaar, Bernard; Gimenez, Luis; Choi, Michael J; Senga, Mikiko; Kolotos, Maria; Lewis-Boyer, Lapricia; Cook, Courtney; Light, Laney; Depasquale, Nicole; Noletto, Todd; Powe, Neil R.

In: American Journal of Kidney Diseases, Vol. 61, No. 3, 03.2013, p. 476-486.

Research output: Contribution to journalArticle

Boulware, Leigh ; Hill-Briggs, Felicia ; Kraus, Edward ; Melancon, J. Keith ; Falcone, Brenda ; Ephraim, Patti L ; Jaar, Bernard ; Gimenez, Luis ; Choi, Michael J ; Senga, Mikiko ; Kolotos, Maria ; Lewis-Boyer, Lapricia ; Cook, Courtney ; Light, Laney ; Depasquale, Nicole ; Noletto, Todd ; Powe, Neil R. / Effectiveness of educational and social worker interventions to activate patients' discussion and pursuit of preemptive living donor kidney transplantation : A randomized controlled trial. In: American Journal of Kidney Diseases. 2013 ; Vol. 61, No. 3. pp. 476-486.
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abstract = "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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AU - Kraus, Edward

AU - Melancon, J. Keith

AU - Falcone, Brenda

AU - Ephraim, Patti L

AU - Jaar, Bernard

AU - Gimenez, Luis

AU - Choi, Michael J

AU - Senga, Mikiko

AU - Kolotos, Maria

AU - Lewis-Boyer, Lapricia

AU - Cook, Courtney

AU - Light, Laney

AU - Depasquale, Nicole

AU - Noletto, Todd

AU - Powe, Neil R.

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N2 - 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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