Effectiveness of informational decision aids and a live donor financial assistance program on pursuit of live kidney transplants in African American hemodialysis patients

Leigh Boulware, Patti L Ephraim, Jessica Ameling, La Pricia Lewis-Boyer, Hamid Rabb, Raquel Charles Greer, Deidra Crews, Bernard Jaar, Priscilla Auguste, Tanjala Purnell, Julio A. Lamprea-Monteleagre, Tope Olufade, Luis Gimenez, Courtney Cook, Tiffany Campbell, Ashley Woodall, Hema C Ramamurthi, Cleomontina A. Davenport, Kingshuk Roy Choudhury, Matthew R. WeirDonna S. Hanes, Nae Yuh Wang, Helene Vilme, Neil R. Powe

Research output: Contribution to journalArticle

Abstract

Background: African Americans have persistently poor access to living donor kidney transplants (LDKT). We conducted a small randomized trial to provide preliminary evidence of the effect of informational decision support and donor financial assistance interventions on African American hemodialysis patients' pursuit of LDKT. Methods: Study participants were randomly assigned to receive (1) Usual Care; (2) the Providing Resources to Enhance African American Patients' Readiness to Make Decisions about Kidney Disease (PREPARED); or (3) PREPARED plus a living kidney donor financial assistance program. Our primary outcome was patients' actions to pursue LDKT (discussions with family, friends, or doctor; initiation or completion of the recipient LDKT medical evaluation; or identification of a donor). We also measured participants' attitudes, concerns, and perceptions of interventions' usefulness. Results: Of 329 screened, 92 patients were eligible and randomized to Usual Care (n = 31), PREPARED (n = 30), or PREPARED plus financial assistance (n = 31). Most participants reported interventions helped their decision making about renal replacement treatments (62%). However there were no statistically significant improvements in LDKT actions among groups over 6 months. Further, no participants utilized the living donor financial assistance benefit. Conclusions: Findings suggest these interventions may need to be paired with personal support or navigation services to overcome key communication, logistical, and financial barriers to LDKT.

Original languageEnglish (US)
Article number107
JournalBMC Nephrology
Volume19
Issue number1
DOIs
StatePublished - May 3 2018

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Decision Support Techniques
Living Donors
African Americans
Renal Dialysis
Tissue Donors
Transplants
Kidney
Financial Support
Kidney Diseases
Decision Making
Communication

Keywords

  • Decision aid
  • End stage renal disease
  • Financial support
  • Live donor kidney transplant
  • Race disparities

ASJC Scopus subject areas

  • Nephrology

Cite this

Effectiveness of informational decision aids and a live donor financial assistance program on pursuit of live kidney transplants in African American hemodialysis patients. / Boulware, Leigh; Ephraim, Patti L; Ameling, Jessica; Lewis-Boyer, La Pricia; Rabb, Hamid; Greer, Raquel Charles; Crews, Deidra; Jaar, Bernard; Auguste, Priscilla; Purnell, Tanjala; Lamprea-Monteleagre, Julio A.; Olufade, Tope; Gimenez, Luis; Cook, Courtney; Campbell, Tiffany; Woodall, Ashley; Ramamurthi, Hema C; Davenport, Cleomontina A.; Choudhury, Kingshuk Roy; Weir, Matthew R.; Hanes, Donna S.; Wang, Nae Yuh; Vilme, Helene; Powe, Neil R.

In: BMC Nephrology, Vol. 19, No. 1, 107, 03.05.2018.

Research output: Contribution to journalArticle

Boulware, L, Ephraim, PL, Ameling, J, Lewis-Boyer, LP, Rabb, H, Greer, RC, Crews, D, Jaar, B, Auguste, P, Purnell, T, Lamprea-Monteleagre, JA, Olufade, T, Gimenez, L, Cook, C, Campbell, T, Woodall, A, Ramamurthi, HC, Davenport, CA, Choudhury, KR, Weir, MR, Hanes, DS, Wang, NY, Vilme, H & Powe, NR 2018, 'Effectiveness of informational decision aids and a live donor financial assistance program on pursuit of live kidney transplants in African American hemodialysis patients', BMC Nephrology, vol. 19, no. 1, 107. https://doi.org/10.1186/s12882-018-0901-x
Boulware, Leigh ; Ephraim, Patti L ; Ameling, Jessica ; Lewis-Boyer, La Pricia ; Rabb, Hamid ; Greer, Raquel Charles ; Crews, Deidra ; Jaar, Bernard ; Auguste, Priscilla ; Purnell, Tanjala ; Lamprea-Monteleagre, Julio A. ; Olufade, Tope ; Gimenez, Luis ; Cook, Courtney ; Campbell, Tiffany ; Woodall, Ashley ; Ramamurthi, Hema C ; Davenport, Cleomontina A. ; Choudhury, Kingshuk Roy ; Weir, Matthew R. ; Hanes, Donna S. ; Wang, Nae Yuh ; Vilme, Helene ; Powe, Neil R. / Effectiveness of informational decision aids and a live donor financial assistance program on pursuit of live kidney transplants in African American hemodialysis patients. In: BMC Nephrology. 2018 ; Vol. 19, No. 1.
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abstract = "Background: African Americans have persistently poor access to living donor kidney transplants (LDKT). We conducted a small randomized trial to provide preliminary evidence of the effect of informational decision support and donor financial assistance interventions on African American hemodialysis patients' pursuit of LDKT. Methods: Study participants were randomly assigned to receive (1) Usual Care; (2) the Providing Resources to Enhance African American Patients' Readiness to Make Decisions about Kidney Disease (PREPARED); or (3) PREPARED plus a living kidney donor financial assistance program. Our primary outcome was patients' actions to pursue LDKT (discussions with family, friends, or doctor; initiation or completion of the recipient LDKT medical evaluation; or identification of a donor). We also measured participants' attitudes, concerns, and perceptions of interventions' usefulness. Results: Of 329 screened, 92 patients were eligible and randomized to Usual Care (n = 31), PREPARED (n = 30), or PREPARED plus financial assistance (n = 31). Most participants reported interventions helped their decision making about renal replacement treatments (62{\%}). However there were no statistically significant improvements in LDKT actions among groups over 6 months. Further, no participants utilized the living donor financial assistance benefit. Conclusions: Findings suggest these interventions may need to be paired with personal support or navigation services to overcome key communication, logistical, and financial barriers to LDKT.",
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T1 - Effectiveness of informational decision aids and a live donor financial assistance program on pursuit of live kidney transplants in African American hemodialysis patients

AU - Boulware, Leigh

AU - Ephraim, Patti L

AU - Ameling, Jessica

AU - Lewis-Boyer, La Pricia

AU - Rabb, Hamid

AU - Greer, Raquel Charles

AU - Crews, Deidra

AU - Jaar, Bernard

AU - Auguste, Priscilla

AU - Purnell, Tanjala

AU - Lamprea-Monteleagre, Julio A.

AU - Olufade, Tope

AU - Gimenez, Luis

AU - Cook, Courtney

AU - Campbell, Tiffany

AU - Woodall, Ashley

AU - Ramamurthi, Hema C

AU - Davenport, Cleomontina A.

AU - Choudhury, Kingshuk Roy

AU - Weir, Matthew R.

AU - Hanes, Donna S.

AU - Wang, Nae Yuh

AU - Vilme, Helene

AU - Powe, Neil R.

PY - 2018/5/3

Y1 - 2018/5/3

N2 - Background: African Americans have persistently poor access to living donor kidney transplants (LDKT). We conducted a small randomized trial to provide preliminary evidence of the effect of informational decision support and donor financial assistance interventions on African American hemodialysis patients' pursuit of LDKT. Methods: Study participants were randomly assigned to receive (1) Usual Care; (2) the Providing Resources to Enhance African American Patients' Readiness to Make Decisions about Kidney Disease (PREPARED); or (3) PREPARED plus a living kidney donor financial assistance program. Our primary outcome was patients' actions to pursue LDKT (discussions with family, friends, or doctor; initiation or completion of the recipient LDKT medical evaluation; or identification of a donor). We also measured participants' attitudes, concerns, and perceptions of interventions' usefulness. Results: Of 329 screened, 92 patients were eligible and randomized to Usual Care (n = 31), PREPARED (n = 30), or PREPARED plus financial assistance (n = 31). Most participants reported interventions helped their decision making about renal replacement treatments (62%). However there were no statistically significant improvements in LDKT actions among groups over 6 months. Further, no participants utilized the living donor financial assistance benefit. Conclusions: Findings suggest these interventions may need to be paired with personal support or navigation services to overcome key communication, logistical, and financial barriers to LDKT.

AB - Background: African Americans have persistently poor access to living donor kidney transplants (LDKT). We conducted a small randomized trial to provide preliminary evidence of the effect of informational decision support and donor financial assistance interventions on African American hemodialysis patients' pursuit of LDKT. Methods: Study participants were randomly assigned to receive (1) Usual Care; (2) the Providing Resources to Enhance African American Patients' Readiness to Make Decisions about Kidney Disease (PREPARED); or (3) PREPARED plus a living kidney donor financial assistance program. Our primary outcome was patients' actions to pursue LDKT (discussions with family, friends, or doctor; initiation or completion of the recipient LDKT medical evaluation; or identification of a donor). We also measured participants' attitudes, concerns, and perceptions of interventions' usefulness. Results: Of 329 screened, 92 patients were eligible and randomized to Usual Care (n = 31), PREPARED (n = 30), or PREPARED plus financial assistance (n = 31). Most participants reported interventions helped their decision making about renal replacement treatments (62%). However there were no statistically significant improvements in LDKT actions among groups over 6 months. Further, no participants utilized the living donor financial assistance benefit. Conclusions: Findings suggest these interventions may need to be paired with personal support or navigation services to overcome key communication, logistical, and financial barriers to LDKT.

KW - Decision aid

KW - End stage renal disease

KW - Financial support

KW - Live donor kidney transplant

KW - Race disparities

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