Assessment of an Educational Intervention to Increase Transplant Knowledge

There are approximately 637,000 patients in the United States with end-stage renal disease (ESRD) or kidney failure. The two options for patients with ESRD to sustain life are dialysis or kidney transplantation from a living or deceased donor. Kidney transplantation, particularly from a living donor, is associated with 6 to 16 additional years of life and improved quality-of life versus treatment with maintenance dialysis, yet the majority of patients with ESRD (450,000 as of 2013) remain on dialysis.

While dialysis is life saving, it replaces only 10% to 15% of normal kidney function and has been associated with cardiovascular disease, infection, and other comorbidities. Further, the chance of a dialysis patient being alive after 5 years without a transplant is only 40%. The Centers for Medicare & Medicaid Services requires all dialysis patients to receive education about transplantation and be informed of the option for transplantation within 45 days of dialysis initiation.

Patients with ESRD who are black and of lower socioeconomic status are significantly less likely to receive education about transplantation, pursue evaluation for transplant, and receive deceased donor kidney transplants and living donor kidney transplants. Low-income patients may be treated at facilities with systemic barriers to transplant education, including limited staff ability to provide transplant education or limited access to transplant education materials.

In 2014, the American Society of Transplantation Consensus Conference recommended ways to improve educational outreach for patients with ESRD who have not yet presented at a transplant center. The recommendations included repeating education multiple times and in settings prior to the transplant center, providing more culturally competent education at appropriate literacy levels, and using technology more effectively as an educational strategy.

In a report in BMC Nephrology [2015. doi:10.1186/s12882-015-0143-0], Amy D. Waterman, PhD, and colleagues describe the protocol of a randomized control trial with low socioeconomic, white, and black dialysis patients designed to compare the efficacy of two versions of the Explore Transplant at Home (ETH) educational program with standard education being provided within dialysis centers [clinicaltrials.gov, NCT02268682]. The three education conditions include: (1) standard-of-care education provided within dialysis centers; (2) a video-guided, four-part ETH program, delivered via mail, plus optional texts [ETH Patient-Guided]; and (3) a video-guided, four-part ETH program with discussion facilitated by a transplant educator via telephone [ETH Educator-Guided].

The study outcomes of interest are whether the three approaches improve black and white patients’ knowledge of transplantation, self-efficacy, and informed decision-making. The study will also explore which deceased donor kidney transplantation and living donor kidney transplantation action steps patients commonly take during an 8-month period. Changes in transplant knowledge, decisional balance, self-efficacy, and informed decision-making will be captured via surveys given prior to and 8 to 12 months following the ETH Education. The researchers will recruit 540 patients at the start of the 8-month educational intervention period, with 180 patients in each group, to complete the baseline survey. After attrition, 150 patients in each group are expected to complete the follow-up survey.

The sample will be drawn from the Missouri Kidney Program (MoKP), a program established in 1968 to serve and educate Missouri residents with chronic kidney disease. MoKP provides subsidies for the cost of dialysis and transplant medication for low-income patients with ESRD in Missouri. To be eligible for enrollment in the study, patients must be 18 to 74 years of age, self-identify as black or white race, currently be on dialysis, have a household income at or below 250% of the federal poverty level, and be able to speak and read in English.

Exclusion criteria are having a visual and/or hearing impairment that would preclude watching and reading educational study material, a previous kidney transplant, and/or previously having been told he/she was not a candidate for transplant.

The primary outcome of the level of deceased donor kidney transplant and living donor kidney transplant knowledge will be measured via a survey that includes 17 true/false questions and eight multiple choice questions about the basic facts, advantages, risks, and outcomes of kidney transplantation. The researchers will assess informed decision-making using the decisional conflict scale [49].

“At the conclusion of this randomized control trial, we will have determined whether an education program administered to socioeconomically disadvantaged dialysis patients, over several months directly in their homes, can help more individuals learn about the options of deceased donor kidney transplant and living donor kidney transplant, We will also be able to examine the efficacy of different educational delivery approaches to further understand whether the addition of a telephone educator is necessary for increasing transplant knowledge,” the researchers said.


Takeaway Points

  1. Researchers describe the protocol of a randomized control trial with low socioeconomic, white, and black dialysis patients designed to compare the efficacy of two versions of the Explore Transplant at Home educational program with standard education being provided within dialysis centers [clinicaltrials.gov, NCT02268682].
  2. The study outcomes of interest are whether the three approaches improve black and white patients’ knowledge of transplantation, self-efficacy, and informed decision-making. The study will also explore which deceased donor kidney transplantation and living donor kidney transplantation action steps patients commonly take during an 8-month period.
  3. The primary outcome of the level of deceased donor kidney transplant and living donor kidney transplant knowledge will be measured via a survey that includes 17 true/false question and eight multiple choice questions about the basic facts, advantages, risks, and outcomes of kidney transplantation.