Protocol of a cluster randomized trial of an educational intervention to increase knowledge of living donor kidney transplant among potential transplant candidates

Francis L Weng, Diane R Brown, John D Peipert, Bart Holland, Amy D Waterman, Francis L Weng, Diane R Brown, John D Peipert, Bart Holland, Amy D Waterman

Abstract

Background: The best treatment option for end-stage renal disease is usually a transplant, preferably a live donor kidney transplant (LDKT). The most effective ways to educate kidney transplant candidates about the risks, benefits, and process of LDKT remain unknown.

Methods/design: We report the protocol of the Enhancing Living Donor Kidney Transplant Education (ELITE) Study, a cluster randomized trial of an educational intervention to be implemented during initial transplant evaluation at a large, suburban U.S. transplant center. Five hundred potential transplant candidates are cluster randomized (by date of visit) to receive either: (1) standard-of-care ("usual") transplant education, or (2) intensive education that is based upon the Explore Transplant series of educational materials. Intensive transplant education includes viewing an educational video about LDKT, receiving print education, and meeting with a transplant educator. The primary outcome consists of knowledge of the benefits, risks, and process of LDKT, assessed one week after the transplant evaluation. As a secondary outcome, knowledge and understanding of LDKT are assessed 3 months after the evaluation. Additional secondary outcomes, assessed one week and 3 months after the evaluation, include readiness, self-efficacy, and decisional balance regarding transplant and LDKT, with differences assessed by race. Although the unit of randomization is the date of the transplant evaluation visit, the unit of analysis will be the individual potential transplant candidate.

Discussion: The ELITE Study will help to determine how education in a transplant center can best be designed to help Black and non-Black patients learn about the option of LDKT.

Trial registration: Clinicaltrials.gov number NCT01261910.

Figures

Figure 1
Figure 1
Flow diagram of study activities.

References

    1. Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, Held PJ, Port FK. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341:1725–1730.
    1. Terasaki PI, Cecka JM, Gjertson DW, Takemoto S. High survival rates of kidney transplants from spousal and living unrelated donors. N Engl J Med. 1995;333:333–336.
    1. Oniscu GC, Brown H, Forsythe JL. Impact of cadaveric renal transplantation on survival in patients listed for transplantation. J Am Soc Nephrol. 2005;16:1859–1865.
    1. Dew MA, Switzer GE, Goycoolea JM, Allen AS, DiMartini A, Kormos RL, Griffith BP. Does transplantation produce quality of life benefits? A quantitative analysis of the literature. Transplantation. 1997;64:1261–1273.
    1. Meier-Kriesche HU, Port FK, Ojo AO, Rudich SM, Hanson JA, Cibrik DM, Leichtman AB, Kaplan B. Effect of waiting time on renal transplant outcome. Kidney Int. 2000;58:1311–1317.
    1. Leeser DB, Aull MJ, Afaneh C, Dadhania D, Charlton M, Walker JK, Hartono C, Serur D, Del Pizzo JJ, Kapur S. Living donor kidney paired donation transplantation: experience as a founding member center of the National Kidney Registry. Clin Transplant. 2012;26:E213–E222.
    1. Montgomery RA. Renal transplantation across HLA and ABO antibody barriers: integrating paired donation into desensitization protocols. Am J Transplant. 2010;10:449–457.
    1. Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) OPTN/SRTR 2010 Annual Data Report. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation; 2011.
    1. Schold J, Srinivas TR, Sehgal AR, Meier-Kriesche HU. Half of kidney transplant candidates who are older than 60 years now placed on the waiting list will die before receiving a deceased-donor transplant. Clin J Am Soc Nephrol. 2009;4:1239–1245.
    1. Tan JC, Chertow GM. Cautious optimism concerning long-term safety of kidney donation. N Engl J Med. 2009;360:522–523.
    1. Gore JL, Danovitch GM, Litwin MS, Pham PT, Singer JS. Disparities in the utilization of live donor renal transplantation. Am J Transplant. 2009;9:1124–1133.
    1. Weng FL, Reese PP, Mulgaonkar S, Patel AM. Barriers to living donor kidney transplantation among black or older transplant candidates. Clin J Am Soc Nephrol. 2010;5:2338–2347.
    1. Purnell TS, Xu P, Leca N, Hall YN. Racial differences in determinants of live donor kidney transplantation in the United States. Am J Transplant. 2013;13:1557–1565.
    1. Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) OPTN/SRTR 2011 Annual Data Report. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation; 2013.
    1. Purnell TS, Hall YN, Boulware LE. Understanding and overcoming barriers to living kidney donation among racial and ethnic minorities in the United States. Adv Chronic Kidney Dis. 2012;19:244–251.
    1. Waterman AD, Rodrigue JR, Purnell TS, Ladin K, Boulware LE. Addressing racial and ethnic disparities in live donor kidney transplantation: priorities for research and intervention. Semin Nephrol. 2010;30:90–98.
    1. Waterman AD, Stanley SL, Covelli T, Hazel E, Hong BA, Brennan DC. Living donation decision making: recipients’ concerns and educational needs. Prog Transplant. 2006;16:17–23.
    1. Barnieh L, McLaughlin K, Manns BJ, Klarenbach S, Yilmaz S, Hemmelgarn BR. Barriers to living kidney donation identified by eligible candidates with end-stage renal disease. Nephrol Dial Transplant. 2011;26:732–738.
    1. DePasquale N, Ephraim PL, Ameling J, Lewis-Boyer L, Crews DC, Greer RC, Rabb H, Powe NR, Jaar BG, Gimenez L, Auguste P, Jenckes M, Boulware LE. Selecting renal replacement therapies: what do African American and non-African American patients and their families think others should know? A mixed methods study. BMC Nephrol. 2013;14:9.
    1. Ommen ES, Winston JA, Murphy B. Medical risks in living kidney donors: absence of proof is not proof of absence. Clin J Am Soc Nephrol. 2006;1:885–895.
    1. Matas AJ, Bartlett ST, Leichtman AB, Delmonico FL. Morbidity and mortality after living kidney donation, 1999–2001: survey of United States transplant centers. Am J Transplant. 2003;3:830–834.
    1. Hadjianastassiou VG, Johnson RJ, Rudge CJ, Mamode N. 2509 living donor nephrectomies, morbidity and mortality, including the UK introduction of laparoscopic donor surgery. Am J Transplant. 2007;7:2532–2537.
    1. Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto SE, McBride MA, Montgomery RA. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303:959–966.
    1. Boudville N, Prasad GV, Knoll G, Muirhead N, Thiessen-Philbrook H, Yang RC, Rosas-Arellano MP, Housawi A, Garg AX. Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med. 2006;145:185–196.
    1. Garg AX, Muirhead N, Knoll G, Yang RC, Prasad GV, Thiessen-Philbrook H, Rosas-Arellano MP, Housawi A, Boudville N. Proteinuria and reduced kidney function in living kidney donors: A systematic review, meta-analysis, and meta-regression. Kidney Int. 2006;70:1801–1810.
    1. Gibney EM, King AL, Maluf DG, Garg AX, Parikh CR. Living kidney donors requiring transplantation: focus on African Americans. Transplantation. 2007;84:647–649.
    1. Gibney EM, Parikh CR, Garg AX. Age, gender, race, and associations with kidney failure following living kidney donation. Transplant Proc. 2008;40:1337–1340.
    1. Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, Gross CR, Matas AJ. Long-term consequences of kidney donation. N Engl J Med. 2009;360:459–469.
    1. Fehrman-Ekholm I, Elinder CG, Stenbeck M, Tyden G, Groth CG. Kidney donors live longer. Transplantation. 1997;64:976–978.
    1. Cherikh WS, Young CJ, Kramer BF, Taranto SE, Randall HB, Fan PY. Ethnic and gender related differences in the risk of end-stage renal disease after living kidney donation. Am J Transplant. 2011;11:1650–1655.
    1. Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, Hays R, Howard A, Jones E, Leichtman AB, Merion RM, Metzger RA, Pradel F, Schweitzer EJ, Velez RL, Gaston RS. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol. 2008;3:471–480.
    1. Centers for Medicare & Medicaid Services. Medicare-approved transplant programs- Updated 04/18/2013. .
    1. Department of Health and Human Services. Centers for Medicare & Medicaid Services: Hospital conditions of participation: Requirements for approval and re-approval of transplant centers to perform organ transplants. Fed Regist. 2007;72:15198–15280.
    1. Gordon EJ, Caicedo JC, Ladner DP, Reddy E, Abecassis MM. Transplant center provision of education and culturally and linguistically competent care: a national study. Am J Transplant. 2010;10:2701–2707.
    1. U.S. Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation: Social and Behavioral Interventions to Increase Organ and Tissue Donation. Announcement HRSA-09-189. and .
    1. Campbell MK, Piaggio G, Elbourne DR, Altman DG. CONSORT 2010 statement: extension to cluster randomised trials. BMJ. 2012;345:e5661.
    1. Campbell MK, Elbourne DR, Altman DG. CONSORT statement: extension to cluster randomised trials. BMJ. 2004;328:702–708.
    1. Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P. Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008;148:295–309.
    1. Torgerson DJ. Contamination in trials: is cluster randomisation the answer? BMJ. 2001;322:355–357.
    1. Waterman AD, Hyland SS, Stanley S, Barrett A, Millinger R. Improving Education Increases Dialysis Patients’ Pursuit of Transplant: Explore Transplant RCT Findings. Boston, MA: American Transplant Congress; 2009.
    1. Waterman AD, Hyland SS, Goalby C, Robbins M, Dinkel K. Improving transplant education in the dialysis setting: the “Explore Transplant” initiative. Dialysis & Transplantation. 2010;39:236–241.
    1. Washington University School of Medicine. Computer Education to Increase Living Kidney Donation in African-Americans. NLM Identifier: NCT01553864.
    1. Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot. 1997;12:38–48.
    1. Prochaska JO, Velicer WF, Rossi JS, Goldstein MG, Marcus BH, Rakowski W, Fiore C, Harlow LL, Redding CA, Rosenbloom D. et al.Stages of change and decisional balance for 12 problem behaviors. Health Psychol. 1994;13:39–46.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.
    1. Weiss BD, Mays MZ, Martz W, Castro KM, DeWalt DA, Pignone MP, Mockbee J, Hale FA. Quick assessment of literacy in primary care: the newest vital sign. Ann Fam Med. 2005;3:514–522.
    1. Chew LD, Griffin JM, Partin MR, Noorbaloochi S, Grill JP, Snyder A, Bradley KA, Nugent SM, Baines AD, Vanryn M. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med. 2008;23:561–566.
    1. Wallace LS, Rogers ES, Roskos SE, Holiday DB, Weiss BD. Brief report: screening items to identify patients with limited health literacy skills. J Gen Intern Med. 2006;21:874–877.
    1. Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information? JAMA. 2010;304:76–84.
    1. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–130.
    1. Localio AR, Berlin JA, Ten Have TR, Kimmel SE. Adjustments for center in multicenter studies: an overview. Ann Intern Med. 2001;135:112–123.
    1. Piantadosi S. Clinical Trials: A Methodologic Perspective. 2. Hoboken, NJ: John Wiley & Sons, Inc.; 2005.
    1. Sterne JA, White IR, Carlin JB, Spratt M, Royston P, Kenward MG, Wood AM, Carpenter JR. Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. BMJ. 2009;338:b2393.
    1. Hedeker D, Gibbons RD. Longitudinal data analysis. Hoboken, NJ: John Wiley & Sons; 2006.
    1. Maldonado G, Greenland S. Simulation study of confounder-selection strategies. Am J Epidemiol. 1993;138:923–936.
    1. Rodrigue JR, Pavlakis M, Egbuna O, Paek M, Waterman AD, Mandelbrot DA. The “house calls” trial: a randomized controlled trial to reduce racial disparities in live donor kidney transplantation: rationale and design. Contemp Clin Trials. 2012;33:811–818.
    1. Boulware LE, Hill-Briggs F, Kraus ES, Melancon JK, McGuire R, Bonhage B, Senga M, Ephraim P, Evans KE, Falcone B, Troll MU, Depasquale N, Powe NR. Protocol of a randomized controlled trial of culturally sensitive interventions to improve African Americans’ and non-African Americans’ early, shared, and informed consideration of live kidney transplantation: the Talking About Live Kidney Donation (TALK) Study. BMC Nephrol. 2011;12:34.
    1. Boulware LE, Hill-Briggs F, Kraus ES, Melancon JK, Falcone B, Ephraim PL, Jaar BG, Gimenez L, Choi M, Senga M, Kolotos M, Lewis-Boyer L, Cook C, Light L, DePasquale N, Noletto T, Powe NR. Effectiveness of educational and social worker interventions to activate patients’ discussion and pursuit of preemptive living donor kidney transplantation: a randomized controlled trial. Am J Kidney Dis. 2013;61:476–486.
    1. Pradel FG, Suwannaprom P, Mullins CD, Sadler J, Bartlett ST. Short-term impact of an educational program promoting live donor kidney transplantation in dialysis centers. Prog Transplant. 2008;18:263–272.
    1. Ephraim PL, Powe NR, Rabb H, Ameling J, Auguste P, Lewis-Boyer L, Greer RC, Crews DC, Purnell TS, Jaar BG, Depasquale N, Boulware LE. The providing resources to enhance African American patients’ readiness to make decisions about kidney disease (PREPARED) study: protocol of a randomized controlled trial. BMC Nephrol. 2012;13:135.
    1. Rodrigue JR, Cornell DL, Lin JK, Kaplan B, Howard RJ. Increasing live donor kidney transplantation: a randomized controlled trial of a home-based educational intervention. Am J Transplant. 2007;7:394–401.

Source: PubMed

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