MedicalResearch.com Interview with:
Deborah Evans, MA, MSW, LCSW
Manager, Social Work Services
DaVita Kidney Care
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: For patients with end-stage renal disease (ESRD) receiving dialysis, receipt of a transplant offers the best possible long-term treatment option. However, the process of becoming qualified to receive a transplant involves many steps, beginning with the patient’s statement of interest.
In this study, we sought to characterize transplant interest among patients in a large dialysis organization in the U.S. and to explore reasons identified by the patients for lack of interest in transplant when applicable.
As of November 2016, of the 182,906 patients with available transplant status information in the LDO database, 58,057 (31.7%) expressed that they were not interested in transplant. Among patients not interested in transplant, the most frequently identified reasons for lack of interest were:
- Advanced age (25.7%)
- Perceived poor health (12.0%)
- Comfortable with current modality (12.0%)
- Uninterested in further surgeries (11.9%)
- 13.2% of patients not interested in transplant indicated that “other” factors were responsible for their lack of interest. At the time of the study, we didn’t have any further insight into what might account for these “other” factors.
Compared to patients with transplant status listed as active, those not interested in transplant were:
- Older (21.4% < 60 years vs 64.6%)
- More likely to be female (47.7% vs 36.6%)
- More likely to be white (43.9% vs 30.4%) and less likely to be Hispanic (14.7% vs 22.2%)
- More likely to be receiving in-center hemodialysis (92.0% vs 73.7%)
- More likely to have Medicare/Medicaid as primary insurance (91.3% vs. 77.3%)
MedicalResearch.com: What should readers take away from your report?
Response: The reasons reported by dialysis patients for lack of interest in transplant are diverse. Transplant education should respect the specific needs and choices of individual patients. It also may be that there are certain categories of reasons for lack of interest that are amenable to education, supportive counseling and others that are less modifiable. These insights could help to inform both dialysis centers and transplant centers as they prepare their educational material to help patients become even more patient-centered. Also, as long as there are no medical contra-indications, it may be helpful to refer patients for transplant evaluation and thorough pre-transplant education in order to address some of the more common concerns or even misconceptions about transplant surgeries and post-transplant quality of life.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Future research should:
-Evaluate whether better education and referral to a transplant center could provide patients with greater insight into transplant as an alternative to their current modality, especially for those patients indicating they are “comfortable with current modality” or “uninterested in further surgeries”
– Explore the reasons that make up the “other” category to further understand the factors associated with lack of interest
Spring NKF Meeting 2017 abstract:
FACTORS AFFECTING INTEREST IN TRANSPLANT AMONG END-STAGE RENAL DISEASE PATIENTS RECEIVING DIALYSIS
Please consult your health care provider regarding your specific medical condition and questions.
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