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• W2051201762 abstract "National kidney organizations and the transplant community recommend that potential kidney transplant recipients and donors be educated about the different transplant options, the surgical process and the medical risks involved with transplantation (1Kasiske BL Bia MJ The evaluation and selection of living kidney donors.Am J Kidney Dis. 1995; 26: 387-398Abstract Full Text PDF PubMed Scopus (63) Google Scholar). Education also can motivate patients to choose a recommended treatment option. Most education occurs at the transplant center. However, many family members and friends of kidney patients do not attend transplant educational sessions, and thus, remain unaware that they could be living donors. Could improved educational delivery help more patients consider the possibility of living donation? Little research is available on how to use education effectively to increase living donation rates (2Schweitzer EJ Yoon S Hart J et al.Increased living donor volunteer rates with a formal recipient family education program.Am J Kidney Dis. 1997; 29: 739-745Abstract Full Text PDF PubMed Scopus (70) Google Scholar,3Foster 3rd, CE Philosophe B Schweitzer EJ et al.A decade of experience with renal transplantation in African-Americans.Ann Surg. 2002; 236 (discussion 804–805.): 794-804Crossref PubMed Scopus (67) Google Scholar). In this issue of the American Journal of Transplantation, Rodrigue and colleagues present the first randomized, controlled trial comparing the effects of a conventional clinic-based educational intervention to a novel clinic-based plus home-based educational intervention on living donor transplantation (4Rodrigue JR Cornell DL Lin JK Kaplan B Howard RJ Increasing live donor kidney transplantation: A randomized evaluation of a home-based educational intervention.Am J Transplant. 2006; (In press)Google Scholar). From a pool of 237 willing, English-speaking medically acceptable potential recipients living less than 90 miles from the center, 169 patients (71%) were randomized: 77 to the clinic-based arm and 92 to the clinic-based plus home-based arm. Eight patients (10%) in the clinic-based arm dropped out and 29 patients (32%) dropped out from the clinic-based plus home-based arm. Using a ‘per protocol’ analysis of the data, significantly more patients in the clinic-based plus home-based arm (n = 63) compared to the clinic-based arm (n = 69) had living donor inquiries (83% vs 64%, p < 0.019), evaluations (60% vs 35%, p < 0.005) and living donor kidney transplants (52% vs 30%, p < 0.013), respectively. One way to test the robustness of a study’s findings is to review the results after including those who dropped out or failed to complete the protocol. This ‘intention to treat’ analytic strategy (ITT) is especially important when dropout rates differ between groups. Using an ITT analysis, however, there were no significant differences found in the number of living donor inquiries (58% vs 57%, p < NS), evaluations (41% vs 31%, p < NS) and living donor kidney transplants (36% vs 27%, p < NS) between the clinic-based plus home-based (n = 92) and the clinic-based educational conditions (n = 77), respectively. The differences between these two analytic strategies illustrate both the success possible and the potential problems inherent in educating patients about living donation. Compared to patients educated in the clinic, patients who participated in the home-based educational program had the opportunity for family decision making and discussion about living donation in an informal setting in the presence of knowledgeable health professionals. The program also educated family members and friends who might not have come to the clinic and provided the opportunity for interested living donors to volunteer to be evaluated. African Americans, particularly, were more likely to pursue living donation after this home-based education strategy compared to the clinic-based strategy. However, a third of patients randomized to the home-based condition never actually hosted a family educational session. African Americans were more likely than non-African Americans to drop out. Although the reasons for dropout were not presented, patients who dropped out might have been too uncomfortable having health-care professionals in their home or talking about living donation with their family. They also simply might not have had any potential living donors. Whether these dropouts can be minimized and whether this will result in increased living donation rates, especially among those groups most likely to benefit from living donation, remains to be determined. What do these findings mean for improving transplant education? First, the efforts by Rodrigue and colleagues are to be commended. As shown by this study, living donation educational programs that include the entire family and discuss the psychological issues affecting and practical advantages to living donation may result in greater number of living donor transplants—at least for those patients who stick with the program. Their data also provide important information for future educational studies regarding the sample size necessary to have adequate power and for estimating patient dropout rates. However, a living donation education program involving multiple educators, administrative coordination and travel costs may be cost prohibitive for some transplant centers. The next step should be to determine whether components of this program could transfer to a clinic-based setting or whether every transplant center should instigate home-based education programs to increase living donation rates. This work was funded by National Institute of Diabetes and Digestive and Kidney Diseases K01 DK066239-01 (ADW), K24 DK002886-02 (DCB) and HRSA/Division of Transplantation 5H39OT00115 (ADW)." @default.
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• W2051201762 date "2007-02-01" @default.
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• W2051201762 title "Improving Patient Education Delivery to Increase Living Donation Rates" @default.
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• W2051201762 doi "https://doi.org/10.1111/j.1600-6143.2006.01652.x" @default.
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