Perceived Barriers to Transplantation in the Hispanic Community
- Diversity and Equity: Kidney Transplant Research
November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Diversity and Equity in Kidney Health
- 900 Diversity and Equity in Kidney Health
- Lopez, Arturo, University of Kansas Medical Center Department of Internal Medicine, Kansas City, Kansas, United States
Hispanics have a higher prevalence of kidney disease but a lower rate of kidney transplantation (KT). Multiple barriers have been proposed, but patient reported barriers have not been assessed. We interviewed Hispanic patients with kidney failure to assess first-hand reports of patient perceived barriers to KT.
We interviewed patients from dialysis units and clinics between June and October 2022. The inclusion criteria were age 18-65, eGFR of < 20 ml/min, and Spanish as the primary language. Interviews were conducted in Spanish, audio recorded, transcribed to English, and uploaded to a qualitative data analysis software DEDOOSE. The interviews were then analyzed and coded into a priori twenty-three communication-based categories created by a communications framework.
Most patients felt willing and able to undergo KT. Patients lacked knowledge about the KT process and could not make a well-informed decision. Living donation (LD) was discussed with very few; in general, patients lacked knowledge about LD. Some viewed LD as a significant health risk to the donor. Misconceptions were evident, with a few patients reporting discussions on emigration to their native countries increasing their chances of KT. Lack of insurance or cost of KT were common concerns.
Patients reported infrequent counseling, with most interactions with individuals other than a nephrologist. Often, the initial communication regarding KT occurred in the emergency room or when initiating dialysis. Use of translators and Spanish-speaking providers was common. Discussions were limited when a Spanish interpreter was absent. Occasionally, the translation was inadequate or difficult to understand.
Multiple patient perceived barriers to KT were noted during our interviews. These included access to nephrologists, barriers in communication despite interpreters, and infrequent counseling. Additional resources and efforts are needed to improve KT rates in the Hispanic population.