Amy D Waterman1,2, John D Peipert1,2,3,4, Huiling Xiao4,5, Christina J Goalby1, Satoru Kawakita2, Yujie Cui2, Krista L Lentine5,6. 1. Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA. 2. Terasaki Research Institute, Los Angeles, CA. 3. Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL. 4. Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, IL. 5. Saint Louis University Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO. 6. Department of Medicine, Saint Louis University School of Medicine, St. Louis, MO.
Abstract
BACKGROUND: Transplant education in dialysis centers can increase access to kidney transplant; however, dialysis center transplant barriers are common, and limited research identifies the most effective transplant education approaches. METHODS: We surveyed transplant educators in 1694 US dialysis centers about their transplant knowledge, use of 12 education practices, and 8 identified education barriers. Transplant wait-listing rates were calculated using US Renal Data System data. RESULTS: Fifty-two percent of educators orally recommended transplant to patients, 31% had in-center transplant discussions with patients, 17% distributed print educational resources, and 3% used intensive education approaches. Distribution of print education (incident rate ratio: 1.021.151.30) and using >1 intensive education practice (1.001.111.23) within dialysis centers were associated with increased wait-listing rates. Several dialysis center characteristics were associated with reduced odds of using education strategies leading to increased wait-listing. Centers with greater percentages of uninsured patients (odds ratio [OR]: 0.960.970.99), in rural locations (OR: 0.660.790.95), with for-profit ownership (OR: 0.640.770.91), and with more patients older than 65 years (OR: 0.050.110.23) had lower odds of recommending transplant, while centers with a higher patient-to-staff ratio were more likely to do so (OR: 1.011.031.04). Language barriers (OR: 0.480.640.86) and having competing work priorities (OR: 0.400.530.70) reduced the odds of distributing print education. Providers with greater transplant knowledge were more likely to use >1 intensive educational strategy (OR: 1.011.271.60) while providers who reported competing work priorities (OR: 0.510.660.84) and poor communication with transplant centers (OR: 0.580.760.98) were less likely to do so. CONCLUSIONS: Educators should prioritize transplant education strategies shown to be associated with increasing wait-listing rates.
BACKGROUND: Transplant education in dialysis centers can increase access to kidney transplant; however, dialysis center transplant barriers are common, and limited research identifies the most effective transplant education approaches. METHODS: We surveyed transplant educators in 1694 US dialysis centers about their transplant knowledge, use of 12 education practices, and 8 identified education barriers. Transplant wait-listing rates were calculated using US Renal Data System data. RESULTS: Fifty-two percent of educators orally recommended transplant to patients, 31% had in-center transplant discussions with patients, 17% distributed print educational resources, and 3% used intensive education approaches. Distribution of print education (incident rate ratio: 1.021.151.30) and using >1 intensive education practice (1.001.111.23) within dialysis centers were associated with increased wait-listing rates. Several dialysis center characteristics were associated with reduced odds of using education strategies leading to increased wait-listing. Centers with greater percentages of uninsured patients (odds ratio [OR]: 0.960.970.99), in rural locations (OR: 0.660.790.95), with for-profit ownership (OR: 0.640.770.91), and with more patients older than 65 years (OR: 0.050.110.23) had lower odds of recommending transplant, while centers with a higher patient-to-staff ratio were more likely to do so (OR: 1.011.031.04). Language barriers (OR: 0.480.640.86) and having competing work priorities (OR: 0.400.530.70) reduced the odds of distributing print education. Providers with greater transplant knowledge were more likely to use >1 intensive educational strategy (OR: 1.011.271.60) while providers who reported competing work priorities (OR: 0.510.660.84) and poor communication with transplant centers (OR: 0.580.760.98) were less likely to do so. CONCLUSIONS: Educators should prioritize transplant education strategies shown to be associated with increasing wait-listing rates.
Authors: Jennifer Gander; Teri Browne; Laura Plantinga; Stephen O Pastan; Leighann Sauls; Jenna Krisher; Rachel E Patzer Journal: Am J Nephrol Date: 2015-08-06 Impact factor: 3.754
Authors: Elisa J Gordon; Joe Feinglass; Paula Carney; Karina Vera; Maria Olivero; Anne Black; Kate Grubbs O'Connor; Jessica MacLean Baumgart; Juan Carlos Caicedo Journal: Prog Transplant Date: 2016-03 Impact factor: 1.187
Authors: Elisa J Gordon; Jungwha Lee; Raymond Kang; Daniela P Ladner; Anton I Skaro; Jane L Holl; Dustin D French; Michael M Abecassis; Juan Carlos Caicedo Journal: Transplant Direct Date: 2015-09-22
Authors: James R Rodrigue; Matthew J Paek; Ogo Egbuna; Amy D Waterman; Jesse D Schold; Martha Pavlakis; Didier A Mandelbrot Journal: Transplantation Date: 2014-11-15 Impact factor: 4.939
Authors: L Ebony Boulware; Felicia Hill-Briggs; Edward S Kraus; J Keith Melancon; Brenda Falcone; Patti L Ephraim; Bernard G Jaar; Luis Gimenez; Michael Choi; Mikiko Senga; Maria Kolotos; LaPricia Lewis-Boyer; Courtney Cook; Laney Light; Nicole DePasquale; Todd Noletto; Neil R Powe Journal: Am J Kidney Dis Date: 2012-10-22 Impact factor: 8.860
Authors: David A Axelrod; Mary K Guidinger; Samuel Finlayson; Douglas E Schaubel; David C Goodman; Michael Chobanian; Robert M Merion Journal: JAMA Date: 2008-01-09 Impact factor: 56.272
Authors: Efrain Talamantes; Keith C Norris; Carol M Mangione; Gerardo Moreno; Amy D Waterman; John D Peipert; Suphamai Bunnapradist; Edmund Huang Journal: Clin J Am Soc Nephrol Date: 2017-02-09 Impact factor: 10.614
Authors: Amy D Waterman; John Devin Peipert; Anna-Michelle McSorley; Christina J Goalby; Jennifer L Beaumont; Leanne Peace Journal: Am J Kidney Dis Date: 2019-06-19 Impact factor: 8.860
Authors: Amy D Waterman; John D Peipert; Yujie Cui; Jennifer L Beaumont; Andrea Paiva; Amanda F Lipsey; Crystal S Anderson; Mark L Robbins Journal: Am J Transplant Date: 2020-09-15 Impact factor: 8.086
Authors: Teri Browne; Laura McPherson; Samantha Retzloff; Amandha Darius; Adam S Wilk; Alexandra Cruz; Shannon Wright; Stephen O Pastan; Jennifer C Gander; Alexander A Berlin; Rachel E Patzer Journal: Kidney Med Date: 2021-07-07
Authors: Karolina Schantz; Elisa J Gordon; Unsun Lee; Maria Rocha; John Friedewald; Daniela P Ladner; Yolanda Becker; Richard Formica; Peter P Reese; Dixon Kaufman; Masoud Barah; Marissa Walker; Om Mehrotra; Dania Viveros; Sanjay Mehrotra Journal: Transplant Direct Date: 2021-12-16
Authors: Christine Park; Mandisa-Maia Jones; Samantha Kaplan; Felicitas L Koller; Julius M Wilder; L Ebony Boulware; Lisa M McElroy Journal: Int J Equity Health Date: 2022-02-12