Melania Calestani1, Sarah Tonkin-Crine1, Rishi Pruthi2, Geraldine Leydon1, Rommel Ravanan3, J Andrew Bradley4, Charles R Tomson3, John L Forsythe5, Gabriel C Oniscu5, Clare Bradley6, John Cairns7, Christopher Dudley3, Christopher Watson4, Heather Draper8, Rachel J Johnson9, Wendy Metcalfe10, Damian G Fogarty11, Paul Roderick1. 1. Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK. 2. UK Renal Registry, Southmead Hospital, Bristol, UK. 3. Richard Bright Renal Unit, Southmead Hospital, Bristol, UK. 4. Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK. 5. Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK. 6. Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK. 7. Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK. 8. Medicine Ethics Society and History, School of Health and Population Sciences, University of Birmingham, Birmingham, UK. 9. NHS Blood and Transplant, Bristol, UK. 10. Scottish Renal Registry, Paisley, UK. 11. Regional Nephrology Unit, Belfast Health and Social Care Trust, Belfast, UK.
Abstract
BACKGROUND: There is variation in time to listing and rates of listing for transplantation between renal units in the UK. While research has mainly focused on healthcare organization, little is known about patient perspectives of entry onto the transplant waiting list. This qualitative study aimed to explore patients' views and experiences of kidney transplant listing. METHODS: Semi-structured interviews were conducted with patients aged under 75, who were on dialysis and on the transplant waiting list, not on the waiting list, undergoing assessment for listing or who had received a transplant. Patients were recruited from a purposive sample of nine UK renal units, which included transplanting and non-transplanting units and units with high and low wait-listing patterns. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS: Fifty-three patients (5-7 per renal unit) were interviewed. Patients reported that they had received little information about the listing process. Some patients did not know if they were listed or had found they were not listed when they had thought they were on the list. Others expressed distress when they felt they had been excluded from potential listing based on age and/or comorbidity and felt the process was unfair. Many patients were not aware of pre-emptive transplantation and believed they had to be on dialysis before being able to be listed. There was some indication that pre-emptive transplantation was discussed more often in transplant than non-transplant units. Lastly, some patients were reluctant to consider family members as potential donors as they reported they would feel 'guilty' if the donor suffered subsequent negative effects. CONCLUSIONS: Findings suggest a need to review current practice to further understand individual and organizational reasons for the renal unit variation identified in patient understanding of transplant listing. The communication of information warrants attention to ensure patients are fully informed about the listing process and opportunity for pre-emptive transplantation in a way that is meaningful and understandable to them.
BACKGROUND: There is variation in time to listing and rates of listing for transplantation between renal units in the UK. While research has mainly focused on healthcare organization, little is known about patient perspectives of entry onto the transplant waiting list. This qualitative study aimed to explore patients' views and experiences of kidney transplant listing. METHODS: Semi-structured interviews were conducted with patients aged under 75, who were on dialysis and on the transplant waiting list, not on the waiting list, undergoing assessment for listing or who had received a transplant. Patients were recruited from a purposive sample of nine UK renal units, which included transplanting and non-transplanting units and units with high and low wait-listing patterns. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS: Fifty-three patients (5-7 per renal unit) were interviewed. Patients reported that they had received little information about the listing process. Some patients did not know if they were listed or had found they were not listed when they had thought they were on the list. Others expressed distress when they felt they had been excluded from potential listing based on age and/or comorbidity and felt the process was unfair. Many patients were not aware of pre-emptive transplantation and believed they had to be on dialysis before being able to be listed. There was some indication that pre-emptive transplantation was discussed more often in transplant than non-transplant units. Lastly, some patients were reluctant to consider family members as potential donors as they reported they would feel 'guilty' if the donor suffered subsequent negative effects. CONCLUSIONS: Findings suggest a need to review current practice to further understand individual and organizational reasons for the renal unit variation identified in patient understanding of transplant listing. The communication of information warrants attention to ensure patients are fully informed about the listing process and opportunity for pre-emptive transplantation in a way that is meaningful and understandable to them.
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Authors: Sarah Tonkin-Crine; Rishi Pruthi; Dominic M Taylor; Geraldine M Leydon; Melania Calestani; Gabriel C Oniscu; J Andrew Bradley; Charles R Tomson; Clare Bradley; Christopher Dudley; Christopher J E Watson; Heather Draper; Rachel J Johnson; Wendy Metcalfe; Damian G Fogarty; Rommel Ravanan; Paul Roderick Journal: Transplant Direct Date: 2018-04-18
Authors: Diana A Wu; Matthew L Robb; Christopher J E Watson; John L R Forsythe; Charles R V Tomson; John Cairns; Paul Roderick; Rachel J Johnson; Rommel Ravanan; Damian Fogarty; Clare Bradley; Andrea Gibbons; Wendy Metcalfe; Heather Draper; Andrew J Bradley; Gabriel C Oniscu Journal: Nephrol Dial Transplant Date: 2017-05-01 Impact factor: 5.992