House Calls and Decision Support: Increasing Access to Live Donor Transplantation

Beth Israel Deaconess Medical Center, Boston MA

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): While kidney transplantation is the best treatment option for adults with end-stage renal disease (ESRD), profound racial and socioeconomic disparities persist. Minorities and low-income patients, for instance, are less likely to receive lve donor kidney transplantation (LDKT), which yields better survival, quality of life, and health care cost outcomes than chronic dialysis or deceased donor transplantation. Guided by a socio- ecological model of LDKT, the PI developed an innovative House Calls intervention that has shown to be effective at overcoming barriers and increasing LDKT rates in Black patients. We now seek to expand the reach and intensity of the House Calls intervention by including other minorities and socioeconomically disadvantaged patients and by adding a novel Patient-Centered Decision Support component. Also, little is known about those variables that mediate the intervention's impact on the occurrence of LDKT or whether the intervention can attenuate the growing gender disparity in living donation. In this study, we will pursue three specific aims: (1) evaluate the differential benefit of adding a patient-centered decision support component to the House Calls intervention; (2) identify mediators of the relationship between the interventions and the occurrence of LDKT; and (3) examine whether the House Calls intervention reduces the gender disparity in rates of living kidney donation. To accomplish these aims, we will conduct a single-site, randomized controlled trial with a planned enrollment of 100 minority and low income patients awaiting kidney transplantation. Patients will be randomized to receive the House Calls intervention alone (HC) or the House Calls intervention + a web-based Patient-Centered Decision Support intervention (HC+DS). The central hypothesis is that, compared to HC alone, the HC+DS group will have a higher proportion of enrolled patients with LDKT by the 2-yr study endpoint (primary outcome) and higher proportions of enrolled patients with at least one live donor inquiry, at least one live donor evaluation, and in LDKT action (vs. contemplation) stages (secondary outcomes). Also, we will evaluate whether the House Calls intervention (either HC alone or HC+DS) leads to more donor inquiries, evaluations, and actual donations from men, relative to a non-intervention control group, controlling for patient race/ethnicity, gender, age, and household income. By identifying effective interventions for patient populations with historically lower rates of LDKT, we can eliminate many barriers to access, reduce disease burden, and lower mortality rates by producing more donor organs for transplantation. We are especially well-prepared to conduct the proposed research due to the multidisciplinary nature of the research team, as well as the expertise and experience of the team in developing LDKT and living donation educational materials, implementing and evaluating the House Calls intervention, conducting LDKT research with minorities and socioeconomically disadvantaged patients, and producing meaningful scientific and clinical outcomes.