Understanding Patient Barriers to Kidney Transplant Evaluation

Abstract

Background: Some patients referred for kidney transplant evaluation fail to attend the visit. Our goal was to compare demographic, socioeconomic, and psychologic factors between evaluation visit attendees and absentees.

Methods: A convenience sample of patients referred and scheduled for kidney transplant evaluation at a single center from November 2012 to December 2013 participated in a phone survey reporting socioeconomic, demographic, and clinical characteristics; health literacy; and perceived knowledge and concerns about transplantation. Absentees were matched by race with attendees. Analyses of differences between groups were performed with chi-square test, Fisher exact test, and t tests. Multivariable logistic regression was adjusted for relevant demographic characteristics.

Results: One hundred four adults participated (61% men, 46% white, 52 ± 12 years). Financial concerns were the most prevalent (67.3% affording medication, 64.1% affording operation). Previous evaluation at a different transplant center (P = 0.029) and being on dialysis (P = 0.008) were significantly associated with absence. Attendance was associated with concerns about finding a living donor (P = 0.038) and higher perceived general knowledge about transplantation (P ≤ 0.001). No differences were appreciated in demographic, socioeconomic, or health literacy factors between groups.

Conclusion: Both attendee and absentee patients were most concerned with the financial burden of kidney transplantation. Although concerns and perceived knowledge are important correlates of behavior, other considerations such as psychologic factors and prior medical experiences may influence patients' ability to complete the kidney transplant evaluation process. Although this pilot study was conducted in a small sample and has limited generalizability, our findings can guide future research.

Figure 1

Flow chart of enrollment and participant visit status. Absentee and attendee participant groups were matched on race.

Figure 2

The proportion of participants reporting any agreement with statements on perceived knowledge about kidney transplantation. Percentages are displayed for the overall cohort and for each of the participant groups. Attendees at our center were more likely to report general knowledge about transplantation than participants in the absentee group.

Figure 3

Percentages of participants reporting concerns are displayed for each statement in the total cohort and in each participant group. Participants who attended the initial visit were more likely to report concern about finding a living donor than absentee participants.