Understanding Patient Barriers to Kidney Transplant Evaluation

Abstract

Background Some patients referred for kidney transplant evaluation fail to attend the visit. Our goal was to compare demographic, socioeconomic, and psychological factors between evaluation visit attendees and absentees. Methods A convenience sample of patients referred and scheduled for kidney transplant evaluation at a single center from November 2012 to December 2013 participated in a phone survey reporting socioeconomic, demographic and clinical characteristics; health literacy; and perceived knowledge and concerns about transplantation. Absentees were matched by race with attendees. Analyses of differences between groups were performed with Chi-square, Fisher’s exact test, and t-tests. Multivariable logistic regression adjusted for relevant demographic characteristics. Results 104 adults participated (61% male, 46% Caucasian, 52±12 years). Financial concerns were the most prevalent (67.3% affording medication, 64.1% affording operation). Prior evaluation at a different transplant center (p=0.029) and being on dialysis (p=0.008) were significantly associated with absence. Attendance was associated with concerns about finding a living donor (p=0.038) and higher perceived general knowledge about transplantation (p ≤0.001). No differences were appreciated in demographic, socioeconomic or health literacy factors between groups. Conclusions Both attendee and absentee patients were most concerned with the financial burden of kidney transplantation. While concerns and perceived knowledge are important correlates of behavior, other considerations such as psychological factors and prior medical experiences may influence patients’ ability to complete the kidney transplant evaluation process. Although this pilot study was conducted in a small sample and has limited generalizability, our findings can guide future research.

Association of Health Literacy With Postoperative Outcomes in Patients Undergoing Major Abdominal Surgery

“…We found that lower HL levels were associated with an increased LOS during index hospitalization, such that patients with low HL levels (BHLS 3-8) spent an additional median of 1 day in the hospital compared with those with a high HL level (BHLS,15). Discharge from the hospital represents a complex transition in the lives of patients.…”

A Systematic Review of the Prevalence and Associations of Limited Health Literacy in CKD

“…All others recruited from clinical environments without efforts to obtain a sample representative of a target CKD population. Two studies surveyed patients with CKD at transplant assessment clinics (37,41), whereas one excluded patients listed for transplant (19). Three studies reported offering a monetary gift to participants (45)(46)(47).…”

“…Analyses were performed using the user-written commands metaprop and metareg in Stata 12 (StataCorp LP). Figure 1 shows the study selection process, which identified 433 unique studies, 15 of which met the inclusion criteria (23,24,(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) with full agreement between the two reviewers. Table 1 summarizes the 15 new studies in addition to five studies included in the 2012 review (18)(19)(20)(21)47).…”

Distance to Kidney Transplant Center and Access to Early Steps in the Kidney Transplantation Process in the Southeastern United States

“…Transportation cost and access are more important barriers to referral and evaluation initiation compared with distance. Populations of patients with ESKD report transportation concerns as barriers to transplant access (6)(7)(8), and other studies among general populations have shown that transportation barriers (including lack of transportation in the form of car or mass transit and transportation cost) are important impediments to health care access in the United States (26)(27)(28). Furthermore, studies have shown that, although transportation is often more expensive for people living farther from clinics compared with those living closer, transportation is often reported as a concern equally among both rural and urban residents (28,29), suggesting that transportation barriers affect patients regardless of distance.…”