Impact of a Combined Educational and Communication Skills Training on Kidney Transplant Candidates' Discussions of Living Donation


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Abstract

IntroductionRenal patients’ reluctance to discuss transplantation or request consideration of living donation is well-documented. This study assessed the impact of a communication skills training program, Communicating About Choices in Transplantation (COACH), on kidney transplant candidates' confidence and ability to discuss living donor kidney transplantation (LDKT) with their social network.MethodsKidney transplant candidates were recruited from two mid-Atlantic transplant centers (132 of 277 invited; 49.8%) and enrolled in a 2-arm, randomized controlled trial testing the impact of the COACH program (intervention group; n=86) against the standard education provided by patient's respective transplant centers (control group; n=46). Semi-structured phone interviews at enrollment and 1-month post-enrollment measured participants’ transplant knowledge, communication self-efficacy; perceived conversational difficulties; and, intent to request and self-reported requests for consideration of living donation. Paired sample t-tests were used for comparisons across time; student's t-test were performed for between group comparisons. A power analysis indicated that a sample size of 116 would yeild 88% power to detect a 2-point difference in knowledge scores between intervention and control groups.ResultsParticipants were, on average, 51.7 years of age, primarily African-American (69.0%), female (53.8%), with incomes under $39,999 (62.7%). There were no statistically significant baseline differences in participant demographics between the intervention and control arms, aside from race (80.0% nonwhite vs. 62.7%, p=.03). At baseline, the majority (91.6%) of participants reported holding prior transplant conversations, and most participants (80.0%) intended to continue (Mean = 4.6; SD = 1.0). Nearly half (43.5%) had ever requested that another person consider living donation, but just one-third of participants (28.6%) intended to continue making requests for consideration of living donation (Mean = 2.8; SD = 1.7). A small, but nonsignificant increase was observed in transplant knoweldge for both the intervention and control groups over the two time points. Nor were statistically signficant differences found for communication self-efficacy or perceived conversational difficulties from pre- to post-assessment. However, COACH program participants were significantly more likely to report requesting consideration of living donation (21.7% vs. 5.7%; p=0.04) from a member of their social network, as compared to the control group.ConclusionThese finding suggest that the COACH program was efficacious in preparing patients awaiting transplant to request consideration of living donation from members of their social networks, thereby increasing the likelihood of identifying a prospective donor and progressing along the path to transplantation.This project was supported by Grant numbers K01HS018113 and R03HS21312 from the Agency for Healthcare Research and Quality (AHRQ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality (AHRQ).

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