Abstract: FR-OR89
Experiencing Discrimination Reduced the Effectiveness of the TALK Intervention on Kidney Failure Patients
Session Information
- Navigating a Path to Diversity and Equity in Kidney Health
November 03, 2023 | Location: Room 107, Pennsylvania Convention Center
Abstract Time: 05:42 PM - 05:51 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
Authors
- Myaskovsky, Larissa, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
- Loor, Jamie Marie, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
- Leyva, Yuridia, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
- Croswell, Emilee J., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Dew, Mary Amanda, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
- Boulware, L. Ebony, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
Background
Although kidney transplantation (KT) is the optimal treatment for patients with kidney failure, few patients receive it. Our study tested the effect of an empirically-developed culturally-concordant education intervention on increasing KT evaluation completion rates for patients starting the evaluation process. We also examined the impact of novel social determinants of health (e.g., experience of discrimination) on outcomes.
Methods
We recruited patients for a baseline interview before their first KT evaluation appointment. We randomly assigned patients to receive the Talking About Live Kidney Donation (TALK) intervention or no intervention at their evaluation appointment. The TALK group received an educational booklet and video encouraging shared decision making and informed consideration of kidney failure treatment options. We called patients after two weeks to address questions and encourage review of materials. We conducted a second interview to assess intervention engagement and other outcomes after patients completed or discontinued evaluation.
Results
Our study sample included 1028 participants (63% male; mean age=56.7 yrs; 45% ≤ high school graduates; 71% non-Hispanic White; 21% Black). Using a Fine-Gray proportional subdistribution hazards model for time to evaluation completion, and controlling for demographic, medical, cultural, psychosocial, and transplant knowledge covariates, we found no significant difference in the likelihood of evaluation completion between TALK and no-TALK (SHR = 1.13, 95% CI = 0.96-1.34, p=0.153). Interaction analyses showed that the TALK intervention increased the rate of evaluation completion among people who reported never experiencing discrimination in healthcare (SHR=1.26, 95%CI=1.04-1.52, p=0.019), but not among those who reported ever experiencing discrimination.
Conclusion
Our findings suggest that TALK education materials alone did not promote higher KT evaluation completion rates and that the impact of experiencing discrimination in healthcare may be particularly relevant. Patients, especially those who have experienced discrimination, may need additional or different support to encourage their completion of KT evaluation, such as a social worker, peer mentor, or community health worker.
Funding
- NIDDK Support