Your Path to Transplant: A randomized controlled trial of a tailored expert system intervention to increase knowledge, attitudes, and pursuit of kidney transplant

Abstract

Individually tailoring education over time may help more patients, especially racial/ethnic minorities, get waitlisted and pursue deceased and living donor kidney transplant (DDKT and LDKT, respectively). We enrolled 802 patients pursuing transplant evaluation at the University of California, Los Angeles Transplant Program into a randomized education trial. We compared the effectiveness of Your Path to Transplant (YPT), an individually tailored coaching and education program delivered at 4 time points, with standard of care (SOC) education on improving readiness to pursue DDKT and LDKT, transplant knowledge, taking 15 small transplant-related actions, and pursuing transplant (waitlisting or LDKT rates) over 8 months. Survey outcomes were collected prior to evaluation and at 4 and 8 months. Time to waitlisting or LDKT was assessed with at least 18 months of follow-up. At 8 months, compared to SOC, the YPT group demonstrated increased LDKT readiness (47% vs 33%, P = .003) and transplant knowledge (effect size [ES] = 0.41, P < .001). Transplant pursuit was higher in the YPT group (hazard ratio: 1.44, 95% confidence interval: 1.15-1.79, P = .002). A focused, coordinated education effort can improve transplant-seeking behaviors and waitlisting rates. ClinicalTrials.gov registration: NCT02181114.

Keywords: donor nephrectomy; donors and donation: donor evaluation; education; health services and outcomes research; kidney disease; kidney transplantation/nephrology; kidney transplantation: living donor; organ transplantation in general; translational research/science.

Conflict of interest statement

Disclosure

Dr. Amy D. Waterman, PhD owns the intellectual property to the transplant education product Explore Transplant and has licensed it at no-cost to a nonprofit, Health Literacy Media (HLM), who retains all revenue as to their sales. She serves as an unpaid consultant to HLM to ensure the accuracy of educational content. All other authors declare that they have no competing interests.

© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1.

Study design

Figure 2.

Your Path to Transplant Trial CONSORT Flowchart

Figure 3.

Transplant knowledge and readiness over time (mixed effect model predicted means and 95% confidence intervals) Effect size and p-values are for comparison between YPT and SOC at month 8.

Figure 4.

Waitlisting rate by randomized group

Figure 5.

LDKT rate by randomized group