Abstract: TH-PO871
Unraveling the Hemodialysis Patient Network: Results from the Social Network and Renal Education (SNARE) Transplant Intervention
Session Information
- Transplantation: Donation and Access
November 02, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Gayner, Alec, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
- Gillespie, Avrum, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
- Reese, Peter P., Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, United States
- Gadegbeku, Crystal A., Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
- Calvelli, Hannah, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
- Gardiner, Heather Marie, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
- Fink, Edward L., Temple University, Philadelphia, Pennsylvania, United States
Background
In-center Hemodialysis (HD) is a unique therapy occurring in a group setting, facilitating patient social network formation. Social networks are a key social determinant of health, amenable to intervention if influential members are identifiable. The goal of our study is to determine whether patients who are more clustered (a network member whose alters are interconnected) vs. more central (a network member who has multiple alters who are not interconnected) within HD networks are more likely to disseminate the COmmunicating About Choices in Transplant (COACH) intervention. This intervention has been shown to improve knowledge, communication skills, and behaviors regarding living/deceased-donor kidney transplantation (KT).
Methods
For this pilot network intervention clinical trial (NCT03536858), in a North Philadelphia HD clinic, the Monday, Wednesday, Friday patients were stratified to centrality spread and Tuesday, Thursday, Saturday to clustering spread. Outcomes including number of transplant evaluation steps completed, change in KT knowledge, self-reported KT conversation self-efficacy, and living donation requests were assessed using repeated questionnaire data and chart review prior to the intervention, at 3-months, and 9-months post-intervention. Data analysis was performed using t-tests, repeated measures ANOVA, and Fisher’s exact test.
Results
Twenty-eight transplant-eligible patients completed the study. Groups (centrality N=11; clustering N=17) did not differ significantly in demographic or clinical variables. The clustering group completed more KT evaluation steps (+0.79 ± 1.72 vs -0.38 ± 1.3, p=0.02) and reported higher conversation self-efficacy scores than the centrality group (21± 2.6 vs.16 ± 1.4, p=0.03). The difference in living KT requests was not significant (3 vs 1, p=0.5). No differences were observed in knowledge outcomes.
Conclusion
Selection of patients with the highest clustering yielded more efficient dissemination of the COACH intervention. Notably, this network intervention improved transplant behaviors but not knowledge, indicating a peer-network imitation effect on behaviors without changing knowledge. Further research is indicated to assess these effects in a larger population and with expanded network targeting strategies.
Funding
- NIDDK Support