RESUMO
BACKGROUND: Kidney transplant candidates (KTCs) must provide informed consent to accept kidneys from increased risk donors (IRD), but poorly understand them. We conducted a multisite, randomized controlled trial to evaluate the efficacy of a mobile Web application, Inform Me, for increasing knowledge about IRDs. METHODS: Kidney transplant candidates undergoing transplant evaluation at 2 transplant centers were randomized to use Inform Me after routine transplant education (intervention) or routine transplant education alone (control). Computer adaptive learning method reinforced learning by embedding educational material, and initial (test 1) and additional test questions (test 2) into each chapter. Knowledge (primary outcome) was assessed in person after education (tests 1 and 2), and 1 week later by telephone (test 3). Controls did not receive test 2. Willingness to accept an IRD kidney (secondary outcome) was assessed after tests 1 and 3. Linear regression test 1 knowledge scores were used to test the significance of Inform Me exposure after controlling for covariates. Multiple imputation was used for intention-to-treat analysis. RESULTS: Two hundred eighty-eight KTCs participated. Intervention participants had higher test 1 knowledge scores (mean difference, 6.61; 95% confidence interval [95% CI], 5.37-7.86) than control participants, representing a 44% higher score than control participants' scores. Intervention participants' knowledge scores increased with educational reinforcement (test 2) compared with control arm test 1 scores (mean difference, 9.50; 95% CI, 8.27-10.73). After 1 week, intervention participants' knowledge remained greater than controls' knowledge (mean difference, 3.63; 95% CI, 2.49-4.78) (test 3). Willingness to accept an IRD kidney did not differ between study arms at tests 1 and 3. CONCLUSIONS: Inform Me use was associated with greater KTC knowledge about IRD kidneys above routine transplant education alone.
Assuntos
Seleção do Doador , Conhecimentos, Atitudes e Prática em Saúde , Transplante de Rim/métodos , Aplicativos Móveis , Educação de Pacientes como Assunto/métodos , Doadores de Tecidos/provisão & distribuição , Adulto , Alabama , Chicago , Feminino , Letramento em Saúde , Humanos , Transplante de Rim/efeitos adversos , Modelos Lineares , Modelos Logísticos , Masculino , Cadeias de Markov , Pessoa de Meia-Idade , Método de Monte Carlo , Análise Multivariada , Aceitação pelo Paciente de Cuidados de Saúde , Reforço Psicológico , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
Northwestern Memorial Hospital (NMH) has developed a single-center kidney paired donation (KPD) program that has resulted in 74 living donor kidney transplants in the 22 months since its inception. The NMH KPD program has increased access to transplantation among patients who are highly sensitized and has limited the amount of desensitization therapy used for incompatible recipients. Additionally, the incorporation of compatible pairs and non-directed donors into the KPD has allowed hard to match patients on the deceased donor waiting list the opportunity to receive living donor transplants. The number of donor-recipient pairs in the KPD pool has never exceeded forty and average time to transplant from entry into the KPD database until transplantation is less than four months. This demonstrates the capability of KPD to benefit challenging recipients and increase access to living donor transplantation in a timely manner. A multi-disciplinary approach is used to manage, review, and maintain the KPD database and resulting transplants.