Abstract: TH-PO1173
Contraindications to Transplant and Home Dialysis: Variation in Nephrologist Practices
Session Information
- Transplantation: Clinical - Pretransplant Management
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1901 Transplantation: Basic
Authors
- Wilk, Adam S., Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
- Patzer, Rachel E., Emory University, Atlanta, Georgia, United States
- Drewry, Kelsey M., Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
- Escoffery, Cam, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
- Lea, Janice P., Emory University, Atlanta, Georgia, United States
Background
There is notable variation in ESRD patients’ transplant waitlisting rates and home dialysis use across care providers. This variation persists after controlling for differences in patients’ clinical need and community factors. It is unclear how much variation there is in nephrologists’ decisions about whether a given patient is eligible for transplant or home dialysis.
Methods
We are administering a new and innovative survey—the Transplant and Home Dialysis Recommendations Survey of Nephrologists, or THRoNe—in a nationally representative sample of n=120 nephrologists (non-pediatric). The THRoNe, which we have pre-tested and validated rigorously using a modified Delphi approach with 12 nephrologists and subject experts, collects data on nephrologists’ decision processes and other practice and physician characteristics that may affect treatment choices. Nephrologists are asked to rate 35 clinical and psychosocial patient evaluation criteria (e.g., not hypotensive, adequate social support) individually—as a major or relative contraindication, a minor concern, or not a concern—in the contexts of determining whether to recommend transplant, peritoneal dialysis, or home hemodialysis for a given patient. We will construct indices—overall and by modality—to support classifying nephrologists as highly restrictive (i.e., more often interpreting criteria as major or relative contraindications vs. minor concerns), moderately restrictive, and unrestrictive. We will describe the distributions of nephrologists’ restrictiveness overall and by modality, and we will test for differences in these distributions across different nephrologist characteristics—by geographic region, sex, race/ethnicity, and years in practice—using Pearson’s χ2 tests and linear regression models adjusting for other physician and practice characteristics.
Results
Data collection is ongoing. We anticipate obtaining a response rate of ≥70%, in line with response rates achieved in other difficult-to-reach clinician samples using our evidence-based recruitment protocol.
Conclusion
We will determine how meaningfully U.S. nephrologists’ judgments differ about whether a given patient should be referred for transplant evaluation or home dialysis training. There are important implications for developing interventions to improve the evidence basis of ESRD treatment.
Funding
- Other NIH Support