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Effectiveness of informational decision aids and a live donor financial assistance program on pursuit of live kidney transplants in African American hemodialysis patients.

  • Author(s): Boulware, L Ebony;
  • Ephraim, Patti L;
  • Ameling, Jessica;
  • Lewis-Boyer, LaPricia;
  • Rabb, Hamid;
  • Greer, Raquel C;
  • Crews, Deidra C;
  • Jaar, Bernard G;
  • Auguste, Priscilla;
  • Purnell, Tanjala S;
  • Lamprea-Monteleagre, Julio A;
  • Olufade, Tope;
  • Gimenez, Luis;
  • Cook, Courtney;
  • Campbell, Tiffany;
  • Woodall, Ashley;
  • Ramamurthi, Hema;
  • Davenport, Cleomontina A;
  • Choudhury, Kingshuk Roy;
  • Weir, Matthew R;
  • Hanes, Donna S;
  • Wang, Nae-Yuh;
  • Vilme, Helene;
  • Powe, Neil R
  • et al.
Abstract

BACKGROUND:African Americans have persistently poor access to living donor kidney transplants (LDKT). We conducted a small randomized trial to provide preliminary evidence of the effect of informational decision support and donor financial assistance interventions on African American hemodialysis patients' pursuit of LDKT. METHODS:Study participants were randomly assigned to receive (1) Usual Care; (2) the Providing Resources to Enhance African American Patients' Readiness to Make Decisions about Kidney Disease (PREPARED); or (3) PREPARED plus a living kidney donor financial assistance program. Our primary outcome was patients' actions to pursue LDKT (discussions with family, friends, or doctor; initiation or completion of the recipient LDKT medical evaluation; or identification of a donor). We also measured participants' attitudes, concerns, and perceptions of interventions' usefulness. RESULTS:Of 329 screened, 92 patients were eligible and randomized to Usual Care (n = 31), PREPARED (n = 30), or PREPARED plus financial assistance (n = 31). Most participants reported interventions helped their decision making about renal replacement treatments (62%). However there were no statistically significant improvements in LDKT actions among groups over 6 months. Further, no participants utilized the living donor financial assistance benefit. CONCLUSIONS:Findings suggest these interventions may need to be paired with personal support or navigation services to overcome key communication, logistical, and financial barriers to LDKT. TRIAL REGISTRATION:ClinicalTrials.gov [ NCT01439516 ] [August 31, 2011].

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