Preferences, Knowledge, Communication and Patient-Physician Discussion of Living Kidney Transplantation in African American Families

Authors

  • L. Ebony Boulware,

    Corresponding author
    1. Department of Medicine, Johns Hopkins School of Medicine
    2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
    3. Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA
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  • Lucy A. Meoni,

    1. Department of Medicine, Johns Hopkins School of Medicine
    2. Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health
    3. Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA
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  • Nancy E. Fink,

    1. Department of Medicine, Johns Hopkins School of Medicine
    2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
    3. Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA
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  • Rulan S. Parekh,

    1. Department of Medicine, Johns Hopkins School of Medicine
    2. Department of Pediatrics, Johns Hopkins School of Medicine
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  • W. H. Linda Kao,

    1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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  • Michael J. Klag,

    1. Department of Medicine, Johns Hopkins School of Medicine
    2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
    3. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health
    4. Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA
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  • Neil R. Powe

    1. Department of Medicine, Johns Hopkins School of Medicine
    2. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
    3. Welch Center for Prevention, Epidemiology and Clinical Research, Baltimore, Maryland, USA
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*Corresponding author: L. Ebony Boulware, lboulwa@jhmi.edu

Abstract

It is unknown whether patient-physician discussion about live kidney transplantation (LT) among African Americans (AA) is affected by preferences, knowledge and family discussions regarding LT. We recruited 182 AA dialysis patients and their families and assessed the relation of preferences, knowledge and family discussions regarding LT to the occurrence of patient-physician discussion using multivariable logistic regression. Most patients (76%) desired a transplant, and most patients (93%), spouses (91%) and children (88%) had knowledge of LT. Nearly half of the families discussed transplantation. Only 68% of patients and less than half of their spouses (41%) and children (31%) had discussed transplantation with physicians. Patient-physician discussion was more common among patients: whose spouses acknowledged their interest in transplantation (adjusted odds ratio (AOR) (95% CI):3.5 (1.61–7.8)); who discussed transplantation with spouses (AOR(95% CI):5.25 (2.22–12.41)); whose spouses agreed that they discussed transplantation with patients (AOR (95%CI):5.20 (1.76–15.37)) and whose children discussed transplantation with patients' physicians (AOR (95%CI):7.4 (1.3–40.0)). Universal patient-physician discussion of LT does not occur despite patient preferences. Rates of family-physician discussions are low, and rates of family discussions vary. Early family-physician discussion of LT, use of allied health professionals to promote family discussion of LT and the institution of culturally appropriate programs to enhance discussion of LT in AA families could improve rates of discussion and enhance patients' access to LT.

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