ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on X

Kidney Week

Abstract: FR-OR89

Experiencing Discrimination Reduced the Effectiveness of the TALK Intervention on Kidney Failure Patients

Session Information

Category: Diversity and Equity in Kidney Health

  • 900 Diversity and Equity in Kidney Health

Authors

  • Myaskovsky, Larissa, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
  • Loor, Jamie Marie, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
  • Leyva, Yuridia, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, United States
  • Croswell, Emilee J., University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Dew, Mary Amanda, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States
  • Boulware, L. Ebony, Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
Background

Although kidney transplantation (KT) is the optimal treatment for patients with kidney failure, few patients receive it. Our study tested the effect of an empirically-developed culturally-concordant education intervention on increasing KT evaluation completion rates for patients starting the evaluation process. We also examined the impact of novel social determinants of health (e.g., experience of discrimination) on outcomes.

Methods

We recruited patients for a baseline interview before their first KT evaluation appointment. We randomly assigned patients to receive the Talking About Live Kidney Donation (TALK) intervention or no intervention at their evaluation appointment. The TALK group received an educational booklet and video encouraging shared decision making and informed consideration of kidney failure treatment options. We called patients after two weeks to address questions and encourage review of materials. We conducted a second interview to assess intervention engagement and other outcomes after patients completed or discontinued evaluation.

Results

Our study sample included 1028 participants (63% male; mean age=56.7 yrs; 45% ≤ high school graduates; 71% non-Hispanic White; 21% Black). Using a Fine-Gray proportional subdistribution hazards model for time to evaluation completion, and controlling for demographic, medical, cultural, psychosocial, and transplant knowledge covariates, we found no significant difference in the likelihood of evaluation completion between TALK and no-TALK (SHR = 1.13, 95% CI = 0.96-1.34, p=0.153). Interaction analyses showed that the TALK intervention increased the rate of evaluation completion among people who reported never experiencing discrimination in healthcare (SHR=1.26, 95%CI=1.04-1.52, p=0.019), but not among those who reported ever experiencing discrimination.

Conclusion

Our findings suggest that TALK education materials alone did not promote higher KT evaluation completion rates and that the impact of experiencing discrimination in healthcare may be particularly relevant. Patients, especially those who have experienced discrimination, may need additional or different support to encourage their completion of KT evaluation, such as a social worker, peer mentor, or community health worker.

Funding

  • NIDDK Support