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Randomized Controlled Trial
. 2013 Mar;61(3):476-86.
doi: 10.1053/j.ajkd.2012.08.039. Epub 2012 Oct 22.

Effectiveness of educational and social worker interventions to activate patients' discussion and pursuit of preemptive living donor kidney transplantation: a randomized controlled trial

L Ebony Boulware  1 , Felicia Hill-Briggs, Edward S Kraus, J Keith Melancon, Brenda Falcone, Patti L Ephraim, Bernard G Jaar, Luis Gimenez, Michael Choi, Mikiko Senga, Maria Kolotos, LaPricia Lewis-Boyer, Courtney Cook, Laney Light, Nicole DePasquale, Todd Noletto, Neil R Powe
Affiliations
Randomized Controlled Trial

Effectiveness of educational and social worker interventions to activate patients' discussion and pursuit of preemptive living donor kidney transplantation: a randomized controlled trial

L Ebony Boulware et al. Am J Kidney Dis. 2013 Mar.

Abstract

Background: Many patients with chronic kidney disease (CKD) have difficulty becoming actively engaged in the pursuit of preemptive living donor kidney transplantation.

Study design: The Talking About Live Kidney Donation (TALK) Study was a randomized controlled trial of the effectiveness of educational and social worker interventions designed to encourage early discussions and active pursuit of preemptive living donor kidney transplantation in patients with progressive CKD.

Setting & participants: We recruited participants with progressive CKD from academically affiliated nephrology practices in Baltimore, MD.

Intervention: Participants randomly received: (1) usual care (routine care with their nephrologists), the (2) TALK education intervention (video and booklet), or the (3) TALK social worker intervention (video and booklet plus patient and family social worker visits).

Outcomes: We followed participants for 6 months to assess their self-reported achievement of behaviors reflecting their discussions about and/or pursuit of living donor kidney transplantation (discussions with family, discussions with physicians, initiating recipient evaluation, completing recipient evaluation, and identifying a potential living donor).

Measurements: We assessed outcomes through a questionnaire at 1-, 3-, and 6-months follow-up.

Results: Participants receiving usual care with their nephrologists (n = 44), TALK education (n = 43), and the TALK social worker (n = 43) were similar at baseline. TALK Study interventions improved participants' living donor kidney transplantation discussion and pursuit behaviors, with the social worker leading to greater patient activation (participants' predicted probability of achieving living donor kidney transplantation discussions, evaluations, or donor identification over 6 months): probabilities were 30% (95% CI, 20%-46%), 42% (95% CI, 33%-54%), and 58% (95% CI, 41%-83%), respectively, in the usual care, TALK education, and TALK social worker groups (P = 0.03).

Limitations: Our population was well educated and mostly insured, potentially limiting generalizability of our findings.

Conclusions: TALK interventions improved discussion and active pursuit of living donor kidney transplantation in patients with progressive CKD and may improve their use of preemptive living donor kidney transplantation.

Trial registration: ClinicalTrials.gov NCT00932334.

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Figures

Figure 1
Figure 1
Study flow diagram for eligibility, screening, consent, enrollment, randomization and follow-up. Estimated glomerular filtration rate (eGFR) expressed as mL/min/1.73 m2. TALK, Talking About Live Kidney Donation study.
Figure 2
Figure 2
(A) Participants in the Talking About Live Kidney Donation (TALK) who achieved at least one additional LKT discussion/pursuit behavior from baseline to 1, 3, or 6 months follow-up. (B) Predicted proportion of participants achieving one additional LKT discussion/pursuit behavior over 6 months. *Participants’ predicted probability of achieving one additional discussion/pursuit behavior at either 1, 3 or 6 months follow up in generalized estimating equation model accounting for missing values and repeated measurements; Missing Data: 5 (Usual Care), 5 (TALK Education), 3 (TALK Social Worker) observations missing at 1 month; 7 (Usual Care), 7 (TALK Education), 5 (TALK Social Worker) observations missing at 3 months; 11 (Usual Care), 8 (TALK Education), 8 (TALK Social Worker) observations missing at 6 months. TALK, Talking About Live Kidney Donation study.
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References

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