Guiding more patients from the dialysis center to the transplant waitlist

Emily Wood New Publications, New Research from TREC, Transplant News

By Anne Osuji, Research Associate

InEducation Strategies in Dialysis Centers Associated With Increased Transplant Wait-listing Rates,” Dr. Waterman and coauthors explore the many challenges associated with delivering transplant education in dialysis centers and recommend education strategies that are shown to be associated with increasing waitlisting rates.

A Need for Effective Education for Dialysis Center Settings

There are many barriers to kidney transplant, with challenges reaching and educating prospective recipients being among the most prominent. Dialysis centers are an appropriate setting for many patients to receive education about their possible transplant options.3 However, to actually increase waitlisting among dialysis patients, centers must ensure that patients are receiving the information and support that they need to make informed choices about their treatment options.

Many dialysis patients first learn about their transplant options at the dialysis center where they are receiving treatment. Transplant as a treatment option is very complex and these patients require comprehensive education to make appropriate choices should they decide to pursue transplant care. Dialysis centers are currently required to provide education, however, not all dialysis centers currently have formal education programs woven into the care delivery process.4,5,6

Previous studies have found that patients who are not well-informed about transplant care options are less likely to pursue or receive transplant. Using multiple educational approaches is associated with increased access to transplant.3,5 However, few studies have explored the educational practices currently being used by dialysis centers and their effectiveness in guiding patients to the waitlist. This study sought to identify educational best practices and to examine which specific transplant education practices were most associated with increased transplant waitlisting rates for interested patients at dialysis centers.

What approaches are being used, and which ones are shown to be most effective?

In this study, transplant educators from 1694 US dialysis centers were surveyed about their transplant knowledge, current education practices, and barriers to education delivery. Four education delivery strategies were studied among the centers: (1) Oral Transplant Recommendations, (2) Distribution of Print Education, (3) In-Center Patient Discussions, and (4) Intensive Education. Centers reported that the most common specific educational strategies used were recommending that patients learn more about transplant (83%) and recommending that patients be evaluated for transplant (84%). Other common practices included: providing transplant handouts/brochures (61%), referring patients to an educational program at a transplant center/kidney organization (60%), and distributing transplant center phone numbers (57%). Oral recommendations were found to be the most effective single approach associated with increased wait-listing. Of the remaining strategies used, 31% of centers used In-Center Patient Discussions, 17% used Distribution of Print Education, and 3% used Intensive Education.

Only 3% of providers report that they were using all four Intensive Education practices (showing transplant videos, providing education to share with prospective living donors, offering an opportunity to talk to a kidney recipient, and displaying transplant information in center waiting rooms) which had the greatest efficacy for increasing wait-listing, and less than half were using one or more, making this a clear opportunity for improvement.

 

Barriers to Effective Approaches for Transplant Education in Dialysis Centers

In order to guide more patients to transplant waitlists, there are center-level barriers that must be overcome. The most common barriers reported included limited time to educate, competing work priorities, and poor provider experience and/or knowledge about transplant. Transplant educators with more knowledge about transplant were more likely to use intensive educational strategies. In addition, providers reported difficulty educating patients who were not native English speakers.

Importantly, providers reported that when competing work priorities were present, they were less likely to use the intensive multi-pronged educational strategies associated with increased wait-listing rates.

Future Recommendations

With access to transplant still restricted for many dialysis patients, it is critical for dialysis organizations and individual educators to design effective transplant education initiatives. Increasing access to comprehensive transplant education for dialysis patients translates to an increased pursuit of transplant education and receipt of a transplant.1,2 Without effective educational outreach at the dialysis center, some patients may never present to a transplant center for evaluation. It is recommended that transplant educators utilize the education strategies with greatest efficacy—intensive educational strategies—to increase waitlisting. To do this effectively, additional training about transplant for dialysis providers may be needed.

References

  1. Rodrigue JR, Paek MJ, Egbuna O, et al. Making house calls increases living donor inquiries and evaluations for blacks on the kidney transplant waiting list. Transplantation. 2014;98:979–986.
  2. Patzer RE, Paul S, Plantinga L, et al; Southeastern Kidney Transplant Coalition. A randomized trial to reduce disparities in referral for transplant evaluation. J Am Soc Nephrol. 2017;28:935–942.
  3. Kucirka LM, Grams ME, Balhara KS, et al. Disparities in provision of transplant information affect access to kidney transplantation. Am J Transplant. 2012;12:351–357.
  4. Balhara KS, Kucirka LM, Jaar BG, et al. Disparities in provision of transplant education by profit status of the dialysis center. Am J Transplant. 2012;12:3104–3110.
  5. Waterman AD, Peipert JD, Goalby CJ, et al. Assessing transplant education practices in dialysis centers: comparing educator reported and medicare data. Clin J Am Soc Nephrol. 2015;10:1617–1625.
  6. Browne T, Patzer RE, Gander J, et al. Kidney transplant referral practices in southeastern dialysis units. Clin Transplant. 2016;30:365–371.