Abstract: SA-PO957
Perceived Patient Interest in Pursuing Kidney Transplantation: A Qualitative Study
Session Information
- Transplantation: Clinical - 3
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Wilk, Adam S., Emory University, Atlanta, Georgia, United States
- Mcdonnell, Jennifer Lenore, Emory University, Atlanta, Georgia, United States
- Urbanski, Megan, Emory University, Atlanta, Georgia, United States
- Pastan, Stephen O., Emory University, Atlanta, Georgia, United States
- Arriola, Kimberly, Emory University, Atlanta, Georgia, United States
- Escoffery, Cam, Emory University, Atlanta, Georgia, United States
- Patzer, Rachel E., Indiana University School of Medicine, Indianapolis, Indiana, United States
Background
Kidney transplantation improves patient survival and quality of life compared to dialysis for many patients, yet dialysis care teams do not refer all qualified candidates for transplant evaluation. Dialysis professionals often cite “Patient not interested” as a key reason for not providing comprehensive transplant education or completing referrals, yet little is known about how dialysis professionals assess patient interest or use these assessments to guide education and referral practices.
Methods
We conducted 39 in-depth telephone interviews during June-August 2022 with dialysis professionals in Georgia, North Carolina, and South Carolina about their processes leading up to referral decisions. We recruited dialysis social workers, nurse managers, nephrologists, and administrators using purposive sampling to capture diversity by participants’ role, years of experience, and county median household income. Interviews were recorded and transcribed and data were managed using MAXQDA software. We used thematic analysis to identify themes, with 3 coders developing the codebook, analyzing, and interpreting data.
Results
Dialysis professionals described assessing patients’ interest in transplant as part of transplant education, directly asking patients if they are interested during initial discussions or regularly “checking in” about care options across later care encounters. Most described concurrently assessing and influencing patients’ thinking, using distinct approaches. Some encourage nearly all patients to consider transplant given its benefits for most patients. Others are selective, choosing when to bring up transplant and how much transplant education to provide based on assumptions about the patient’s interest in transplant and transplant eligibility. These assumptions are based on perceived innate characteristics (e.g.,“really want it”) or social constraints (e.g.,“too far to the center,” “cannot afford…post-transplant medications”) of the patient.
Conclusion
Many dialysis professionals provide transplant education selectively based on how interested they perceive patients are, based on subjective perceptions of patient characteristics and circumstances. Future research should examine whether standardized transplant education practices minimize implicit biases and increase equity in transplant access.
Funding
- NIDDK Support