scholarly journals 4101 Creating a Culturally Sensitive Report Card for African American (AA) Kidney Transplant Candidates

2020 ◽  
Vol 4 (s1) ◽  
pp. 54-54
Author(s):  
Warren McKinney ◽  
Marilyn J. Bruin ◽  
Sauman Chu ◽  
Bertram L. Kasiske ◽  
Ajay K. Israni
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Kidney Transplant ◽  
Culturally Sensitive ◽  
Report Card ◽  
Medical Decision ◽  
Transplant Recipients ◽  
Transplant Program ◽  
Study Population ◽  
Transplant Candidates

OBJECTIVES/GOALS: AA are over-represented on the waitlist for kidney transplant and are often unaware of how waitlist acceptance practices differ across transplant programs and influence access to transplant. We will develop a culturally sensitive transplant program report card to communicate these variations. METHODS/STUDY POPULATION: Scientific Registry of Transplant Recipients (SRTR) data will be used to identity clinical factors strongly associated with AA access to transplant. Interviews and focus groups with AA kidney transplant candidates and their families will collect feedback on the SRTR report card and inform the development of the culturally sensitive report card. Additional focus groups will evaluate its effect on knowledge and medical decision making. We will collaborate with the stakeholders, including AA transplant candidates and their families, transplant programs, SRTR, and providers, to identify strategies to disseminate the report card in the AA community RESULTS/ANTICIPATED RESULTS: To date, no investigation has systematically collected feedback on the SRTR transplant program report card from AA candidates to ensure that the tool is accessible and effective in the AA community. We hypothesize that a culturally sensitive report card will improve AA candidates’ knowledge of program factors that impact access to transplant and enable informed decisions about where they pursue a transplant evaluation. The results of this study have the potential to change how AA patients are counselled while seeking transplantation. DISCUSSION/SIGNIFICANCE OF IMPACT: A culturally sensitive report card can reach more AA patients and enable more informed decision making by providing education about differences in transplant programs that may impact their access to transplant. In the future, we will design a trial to evaluate the prototype.

scholarly journals The Gray Zone: Adolescent and Young Adult Decision Support Needs for Ulcerative Colitis

2020 ◽  
Vol 5 (2) ◽  
pp. 238146832094070
Author(s):  
Andrea Meisman ◽  
Nancy M. Daraiseh ◽  
Phil Minar ◽  
Marlee Saxe ◽  
Ellen A. Lipstein
Keyword(s):  
Ulcerative Colitis ◽  
Decision Making ◽  
Decision Support ◽  
Focus Groups ◽  
Medical Decision Making ◽  
Medical Decision ◽  
Support Needs ◽  
Final Decision ◽  
Care Providers ◽  
Medical Decisions

Purpose. To understand the medical decision support needs specific to adolescents and young adults (AYAs) with ulcerative colitis (UC) and inform development of a decision support tool addressing AYAs’ preferences. Methods. We conducted focus groups with AYAs with UC and mentors from a pediatric inflammatory bowel disease clinic’s peer mentoring program. Focus groups were led by a single trained facilitator using a semistructured guide aimed at eliciting AYAs’ roles in medical decision making and perceived decision support needs. All focus groups were audio recorded, transcribed, and coded by the research team. Data were analyzed using content analysis and the immersion crystallization method. Results. The facilitator led six focus groups: one group with peer mentors aged 18 to 24 years, three groups with patients aged 14 to 17 years, and two groups with patients aged 18 to 24 years. Decision timing and those involved in decision making were identified as interacting components of treatment decision making. Treatment decisions by AYAs were further based on timing, location (inpatient v. outpatient), and family preference for making decisions during or outside of clinic. AYAs involved parents and health care providers in medical decisions, with older participants describing themselves as “final decision makers.” Knowledge and experience were facilitators identified to participating in medical decision making. Conclusions. AYAs with UC experience changes to their roles in medical decisions over time. The support needs identified will inform the development of strategies, such as decision support tools, to help AYAs with chronic conditions develop and use skills needed for participating in medical decision making.

scholarly journals Gamble on the Uncertain. Negotiating Medical Decision-Making

2016 ◽  
Vol 12 (4) ◽  
pp. 44-59
Author(s):  
Helena Serra
Keyword(s):  
Decision Making ◽  
Strategic Alliances ◽  
Medical Decision Making ◽  
Participant Observation ◽  
Medical Decision ◽  
Structured Interviews ◽  
Complex Processes ◽  
Transplant Program ◽  
The Social ◽  
Constructivist Approaches

The aim of this paper is to analyze the medical decision-making process in the admission of patients into a Liver Transplant Program in a hospital in Lisbon, Portugal. The relationships and main strategies established among the medical specializations involved in this process will be investigated. The theoretical basis was drawn from medical sociology, in particular, from the social constructivist approaches, which highlight the relation between medical power and knowledge in the construction of medical decision-making. I attempt to elucidate the processes of negotiation through which a medical decision is constructed. The research methodology included non-participant observation and semi-structured interviews with participants from the two medical specializations of interest: liver surgeons and hepatologists. The management of risk and uncertainty in relation to patients’ access to liver transplantation is discussed and the strategic alliances that are formed during medical decision-making in search of consensus are investigated. The research findings show that medical practices and knowledge do not converge linearly to produce a coherent network of actions with a view to decision-making. Instead, medical decision-making is constructed through complex processes of negotiation. The different natures and levels of uncertainty and indetermination that are inherent in the social world of medicine have a fundamental influence on medical decision-making.

scholarly journals Value Assessment in Healthcare Decision-Making of Ethnically and Cognitively Diverse Older Adults

2019 ◽  
Vol 34 (7) ◽  
pp. 1260-1260
Author(s):  
A Mejia ◽  
G D Smith ◽  
R E Curiel ◽  
W Barker ◽  
R Behar ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Focus Groups ◽  
Family Involvement ◽  
Medical Decision ◽  
Value Assessment ◽  
Healthcare Decision ◽  
Medical Decisions ◽  
Healthcare Decision Making ◽  
Normal Cognition

Abstract Objective Little is known regarding the values that patients with mild cognitive impairment (MCI) incorporate into healthcare decision-making or how culture may affect such values. Even if values overlap across cultures, cultural groups may emphasize the importance of specific values differently since values emanate, at least in part, from cultural and life-long learning. The aim of this study was to explore and compare values that older adults of different ethnicities and cognitive statuses incorporate in their medical decisions. Participants and Method Four focus groups were established by identifying older adults as, a) Hispanic or non-Hispanic, and with b) normal cognition or MCI. Participants were recruited from the 1Florida Alzheimer’s Disease Research Center. Focus groups were audio-recorded and transcribed using a professional transcription service. Results There were a total of 23 participants (Age: M = 70.9, SD = 6.4). MCI groups had briefer discussions (Time M = 44 minutes) than the normal cognition groups (Time M = 62 minutes). Qualitative analysis of discussions was used to explore the values identified across the focus groups. The MCI groups valued spirituality, doctor recommendations, and family involvement when facing medical decisions. Normal cognition groups valued the necessity of proactive involvement as healthcare consumers and the relationship between the quality of patient-clinician interaction and their health care related decisions. Cultural themes involving perceptions of gender and generational differences emerged from the Hispanic normal cognition group. Conclusions This study identified many determinants influencing the medical decision-making process of diverse older adults: including past experiences, family involvement, healthcare barriers, and cultural background. These results have the potential to impact patient-clinician discussions, decisions made by surrogates, and the development of decision aids with a broader range of relevant patient values.

scholarly journals Real-world Effectiveness of 2-dose SARS-CoV-2 Vaccination in Kidney Transplant Recipients

2021 ◽  
Author(s):  
Caitriona M. McEvoy ◽  
Anna Lee ◽  
Paraish S. Misra ◽  
Gerald Lebovic ◽  
Ron Wald ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kidney Transplant ◽  
Real World ◽  
Humoral Response ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
The Real ◽  
Transplant Program ◽  
The Impact

The humoral response to two doses of SARS-CoV-2 (Covid-19) vaccine among transplant recipients is inferior to immunocompetent individuals. Data on the real-world effectiveness of vaccination in kidney transplant recipients [KTRs] are lacking. We performed a cohort study to investigate the impact of vaccination on Covid-19 infection and outcomes in our kidney transplant program.

MO924GROWTH DIFFERENTIATION FACTOR 15 PREDICTOR VALUE IS SUPERIOR TO TROPONIN I IN THE EVALUATION OF KIDNEY TRANSPLANT CANDIDATES

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Marina De Cos Gomez ◽  
Maria Teresa Garcia Unzueta ◽  
Adalberto Benito Hernandez ◽  
Mario Perez Arnedo ◽  
Alejandro Aguilera Fernandez ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Kidney Transplant ◽  
Cardiac Troponin ◽  
Cardiovascular Events ◽  
Troponin I ◽  
Transplant Recipients ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
Transplant Candidates ◽  
Overall Mortality

Abstract Background and Aims Elevation of cardiac troponin has been shown to be a marker of myocardial ischemia and other cardiovascular pathologies frequently present in patients with CKD. Pretransplant cardiac troponin I (cTNI) has demonstrated its predictor value of survival after kidney transplant in previous studies. Growth differentiation factor 15 (GDF-15) is a biomarker induced by oxidative stress currently studied as a predictor of mortality and cardiovascular events (CVE) in multiple scenarios, including patients with chronic kidney disease. The aim of this study is to compare the utility of cTNI and GDF-15 to predict posttransplant mortality and CVE in a cohort of kidney transplant recipients. Method We included 359 kidney transplants performed between 2005 and 2015. cTNI and GDF-15 were measured on stored serum samples obtained pretransplant. Information about patients was extracted from the prospectively maintained database of renal transplant recipients at our center. Results Receptors had a median age of 54.1 and were 67.4% male. 22% were diabetic before the transplant, whereas 9.5% and 8.1% had prior history of coronary and peripheral artery disease. 16.5% transplants were performed preemptively. Median GDF-15 was 5346.4 (IQR= 4071.83-6786.32) pg/ml and median cTNI was 5.6 (IQR= 3.11-10.67) ng/l. After follow up, 77 (21.45%) patients died. During this period, incidence of cerebrovascular accident, acute coronary syndrome and mayor adverse cardiovascular events (MACE) was 6.38%, 12.68% and 20.56% respectively. Patients were stratified in tertiles according to GDF-15 and cTNT levels. In the univariate analysis, higher levels of GDF-15 significantly related to overall mortality, cardiovascular mortality, cerebrovascular accident, acute coronary syndrome and major adverse cardiovascular events. Higher cTNI related to cardiovascular mortality, acute coronary syndrome and MACE, but not overall mortality (Log Rank p=0.4). (Fig 1). By multivariate cox regression analysis, including both biomarkers and clinical characteristics (age, diabetes, prior coronary and peripheral artery disease and pretransplant renal replacement therapy), the relation between overall survival and GDF-15 remained significant for the highest tertile (HR 2.2 CI95% (1.2-4.1), p = 0.01). Similarly, GDF-15 relation with cerebrovascular accidents and MACE remained significant after the adjustment by these characteristics [HR 9.7 CI95% (2.2-43.1), p = 0.003 and HR 2.7 CI95% (1.4-5.1), p = 0.002] for the highest risk tertile. On the contrary, posttransplant acute coronary syndrome was only related to cTNI tertiles and previous coronary artery disease in the multivariate model [HR 3.2 CI95% (1.5-7.3), p = 0.003 for the highest cTNI tertile]. Conclusion Our study highlights the potential utility of GDF-15 as a predictor of mortality and cardiovascular events after kidney transplant and its superiority compared to cTNI. In our study, cardiac troponin showed a stronger relation with acute coronary events, probably due to its specific production in myocardial tissue. Altogether, these two molecules could be used in conjunction with clinical characteristics to create prognostic models to better stratify patient’s risk prior organ allocation, predict mortality and cardiovascular adverse events after transplant and ideally find strategies to minimize them. Large-scale, multicenter validation using these biomarkers would be the next step to prove its utility among kidney transplant candidates.

Pre-transplant assessment of the recipient

2015 ◽  
Author(s):  
Christophe Legendre
Keyword(s):  
Kidney Transplantation ◽  
Kidney Transplant ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Critical Step ◽  
Risks And Benefits ◽  
Local Experience ◽  
Candidate Assessment ◽  
Transplant Candidate ◽  
Transplant Candidates

Recipient assessment pre transplant is a critical step in the overall process of transplantation. It is required to define the surgical and medical strategies, evaluate the prognosis based on the knowledge of global kidney transplantation results, and hopefully improve the individual’s outcome. Each transplant centre will have developed its own experience and its own way of assessing transplant candidates. This chapter describes the transplant candidate assessment according to recognized recommendations as well as the author’s local experience at Necker Hospital, Paris, France. The goals of pre-transplant candidate assessment are to discuss the indications, to fully inform the patient, to determine which tests are useful to help balance risks and benefits, and finally to prepare as many potential kidney transplant recipients as possible to be wait-listed successfully.

scholarly journals Patient-reported outcomes in RA care improve patient communication, decision-making, satisfaction and confidence: qualitative results

Rheumatology ◽  
2019 ◽  
Vol 59 (7) ◽  
pp. 1662-1670 ◽  
Author(s):  
Susan J Bartlett ◽  
Elaine De Leon ◽  
Ana-Maria Orbai ◽  
Uzma J Haque ◽  
Rebecca L Manno ◽  
...  
Keyword(s):  
Decision Making ◽  
Focus Groups ◽  
Shared Decision Making ◽  
Patient Reported Outcomes ◽  
Medical Decision ◽  
Measurement Information ◽  
Shared Decision ◽  
Clinic Staff ◽  
Patient Reported ◽  
The Impact

Abstract Objective To evaluate the impact of integrating patient-reported outcomes (PROs) into routine clinics, from the perspective of patients with RA, clinicians and other staff. Methods We conducted a prospective cohort study using a mixed methods sequential explanatory design at an academic arthritis clinic. RA patients completed selected Patient-Reported Outcomes Measurement Information System measures on tablets in the waiting room. Results were immediately available to discuss during the visit. Post-visit surveys with patients and physicians evaluated topics discussed and their impact on decision making; patients rated confidence in treatment. Focus groups or interviews with patients, treating rheumatologists and clinic staff were conducted to understand perspectives and experiences. Results Some 196 patients and 20 rheumatologists completed post-visit surveys at 816 and 806 visits, respectively. Focus groups were conducted with 24 patients, 10 rheumatologists and 4 research/clinic staff. PROs influenced medical decision-making and RA treatment changes (38 and 18% of visits, respectively). Patients reported very high satisfaction and treatment confidence. Impact on clinical workflow was minimal after a period of initial adjustment. PROs were valued by patients and physicians, and provided new insight into how patients felt and functioned over time. Reviewing results together improved communication, and facilitated patient-centred care, shared decision making, and the identification of new symptoms and contributing psychosocial/behavioural factors. Conclusion PRO use at RA visits was feasible, increased understanding of how disease affects how patients feel and function, facilitated shared decision-making, and was associated with high patient satisfaction and treatment confidence.

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