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      The RaDIANT community study protocol: community-based participatory research for reducing disparities in access to kidney transplantation

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          Abstract

          Background

          The Southeastern United States has the lowest kidney transplant rates in the nation, and racial disparities in kidney transplant access are concentrated in this region. The Southeastern Kidney Transplant Coalition (SEKTC) of Georgia, North Carolina, and South Carolina is an academic and community partnership that was formed with the mission to improve access to kidney transplantation and reduce disparities among African American (AA) end stage renal disease (ESRD) patients in the Southeastern United States.

          Methods/Design

          We describe the community-based participatory research (CBPR) process utilized in planning the Reducing Disparities In Access to kid Ney Transplantation (RaDIANT) Community Study, a trial developed by the SEKTC to reduce health disparities in access to kidney transplantation among AA ESRD patients in Georgia, the state with the lowest kidney transplant rates in the nation. The SEKTC Coalition conducted a needs assessment of the ESRD population in the Southeast and used results to develop a multicomponent, dialysis facility-randomized, quality improvement intervention to improve transplant access among dialysis facilities in GA. A total of 134 dialysis facilities are randomized to receive either: (1) standard of care or “usual” transplant education, or (2) the multicomponent intervention consisting of transplant education and engagement activities targeting dialysis facility leadership, staff, and patients within dialysis facilities. The primary outcome is change in facility-level referral for kidney transplantation from baseline to 12 months; the secondary outcome is reduction in racial disparity in transplant referral.

          Discussion

          The RaDIANT Community Study aims to improve equity in access to kidney transplantation for ESRD patients in the Southeast.

          Trial registration

          Clinicaltrials.gov number NCT02092727.

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          Most cited references58

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          The effect of patient race and socio-economic status on physicians' perceptions of patients

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            The effect of patients' preferences on racial differences in access to renal transplantation.

            In the United States, black patients undergo renal transplantation less often than white patients, but few studies have directly assessed the association between race and patients' preferences with respect to transplantation. To assess preferences with respect to transplantation and experiences with medical care, we interviewed 1392 (82.9 percent) of 1679 eligible patients with end-stage renal disease (age range, 18 to 54 years) approximately 10 months after they had begun maintenance treatment with dialysis. Participants were selected from a stratified random sample of patients undergoing dialysis in four regions of the United States (Alabama, southern California, Michigan, and the mid-Atlantic region of Maryland, Virginia, and the District of Columbia) in 1996 and 1997. Patients were followed until March 1999. The interviews were conducted with 384 black women, 354 white women, 337 black men, and 317 white men. Black patients were less likely than white patients to want a transplant (76.3 percent of black women reported such a preference, vs. 79.3 percent of white women, and 80.7 percent of black men vs. 85.5 percent of white men), and they were less likely to be very certain about this preference (58.3 percent vs. 65.3 percent and 64.1 percent vs. 75.7 percent, respectively; P<0.01 for each comparison with both sexes combined). However, much larger differences were evident in rates of referral for evaluation at a transplantation center (50.4 percent for black women vs. 70.5 percent for white women, and 53.9 percent for black men vs. 76.2 percent for white men; P<0.001 for each comparison) and placement on a waiting list or transplantation within 18 months after the start of dialysis therapy (31.3 percent for black women vs. 56.5 percent for white women, and 35.3 percent for black men vs. 60.6 percent for white men; P<0.001). These racial differences remained significant after adjustment for patients' preferences and expectations about transplantation, sociodemographic characteristics, the type of dialysis facility, perceptions of care, health status, the cause of renal failure, and the presence or absence of coexisting illnesses. In the United States, the preferences and expectations with respect to renal transplantation among patients with end-stage renal disease differ according to race. These differences, however, explain only a small fraction of the substantial racial differences in access to transplantation. Physicians should ensure that black patients who desire renal transplantation are fully informed about it and are referred for evaluation.
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              Barriers to cadaveric renal transplantation among blacks, women, and the poor.

              Cadaveric renal transplantation rates differ greatly by race, sex, and income. Previous efforts to lessen these differences have focused on the transplant waiting list. However, the transplantation process involves a series of steps related to medical suitability, interest in transplantation, pretransplant workup, and movement up a waiting list to eventual transplantation. To determine the relative importance of each step in explaining differences in cadaveric renal transplantation rates. Prospective cohort study. A total of 7125 patients beginning long-term dialysis between January 1993 and December 1996 in Indiana, Kentucky, and Ohio. Completion of 4 separate steps during each patient-year of follow-up: (A) being medically suitable and possibly interested in transplantation; (B) being definitely interested in transplantation; (C) completing the pretransplant workup; and (D) moving up a waiting list and receiving a transplant. Compared with whites, blacks were less likely to complete steps B (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.61-0.76), C (OR, 0.56; 95% CI, 0.48-0.65), and D (OR, 0.50; 95% CI, 0.40-0.62) after adjustment for age, sex, cause of renal failure, years receiving dialysis, and median income of patient ZIP code. Compared with men, women were less likely to complete each of the 4 steps, with ORs of 0.90, 0.89, 0.80, and 0.82, respectively. Poor individuals were less likely than wealthy individuals to complete steps A, B, and C, with ORs of 0.67, 0.78, and 0.77, respectively. Barriers at several steps are responsible for sociodemographic differences in access to cadaveric renal transplantation. Efforts to allocate kidneys equitably must address each step of the transplant process.
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                Author and article information

                Contributors
                rpatzer@emory.edu
                jennifer.gander@emory.edu
                LSauls@nw6.esrd.net
                AAmamoo@nw6.esrd.net
                JKrisher@nw6.esrd.net
                LMULLOY@gru.edu
                eric.gibney@piedmont.org
                BROWNETM@mailbox.sc.edu
                laura.plantinga@emory.edu
                Stephen.Pastan@emoryhealthcare.org
                Journal
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central (London )
                1471-2369
                28 October 2014
                28 October 2014
                2014
                : 15
                : 1
                : 171
                Affiliations
                [ ]Department of Surgery, Division of Transplantation, Emory University School of Medicine, Atlanta, GA USA
                [ ]Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA USA
                [ ]Emory Transplant Center, Atlanta, GA USA
                [ ]Southeastern Kidney Council, Inc, Raleigh, NC USA
                [ ]Department of Medicine, Section of Nephrology, Hypertension, and Transplant Medicine, Georgia Regents University, Augusta, GA USA
                [ ]Piedmont Transplant Institute, Atlanta, GA USA
                [ ]College of Social Work, University of South Carolina, Columbia, SC USA
                [ ]Department of Medicine, Renal Division, Emory University School of Medicine, Atlanta, GA USA
                Article
                861
                10.1186/1471-2369-15-171
                4230631
                25348614
                71dcd2fb-1ea2-4da4-b641-5f2fd47acbe0
                © Patzer et al.; licensee BioMed Central Ltd. 2014

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 26 August 2014
                : 23 September 2014
                Categories
                Study Protocol
                Custom metadata
                © The Author(s) 2014

                Nephrology
                kidney transplantation,dialysis facility,randomized trial,education,staff,community-based participatory research

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