Feasibility of providing web-based education to patients prior to kidney transplant evaluation.

BACKGROUND: We previously developed web-based education to be used by patients prior to kidney transplant (KTX) evaluation. The current feasibility study evaluated patients' intervention uptake and barriers, and staff experiences of the clinic-wide implementation in preparation for a definitive comparative effectiveness trial. METHODS: Web links and login instructions to view 17 educational videos designed to promote KTX access were delivered via email or text to adults referred to a single transplant center between 10/2020 and 3/2021. Patient barriers were recorded. Non-completers were allowed to view the resources in the clinic. N = 7 clinic staff were interviewed about their experiences of in-clinic delivery of the web-education. Interviews were recorded with field notes and coded using simple content analysis. Patient characteristics and 30-month KTX access were examined with Chi-square, t-tests, and log-rank tests. RESULTS: Of 210 patients, 71% completed the self-education remotely (completers), 16% attempted but did not complete remotely (attempters), and 13% declined the web link invitation (decliners). Implementation barriers included technology access and use difficulties, unstable internet connectivity, limited staff time in clinic to facilitate technology use by patients, and limited technology attentiveness by patients in clinic. In 3-group comparisons, remote decliners were older with worse estimated posttransplant survival scores, and attempters were younger, more often Medicaid insured, and lived in higher area deprivation; both were more often deemed ineligible for KTX than completers. Between-group time-to-transplantation was non-significant (p = .571). CONCLUSION: The majority of patients accessed the web-education remotely; however, more vulnerable demographic populations reported greater problems accessing web-education. In-clinic delivery was burdensome to staff and patients. Future adaptive implementation strategies are needed to allow for adequate patient education.

Preliminary feasibility of animated video education designed to empower patients' referral to kidney transplantation.

BACKGROUND: Referral for kidney transplantation is influenced by patient education; digital technologies can enhance broad information accessibility. This single-group study tested the feasibility and acceptability of patient-centered self-directed educational animated videos to improve mediators of kidney transplant referral. METHODS: Community-based adults with chronic kidney disease stage ≥4 invited from a clinical registry or self-responding to flyers viewed eight sequential videos (19:36 min total duration) remotely on their own device. Change in kidney transplant knowledge, concerns, and confidence talking about kidney transplantation to doctors was assessed with self-report surveys before and immediately after viewing. Program feedback was assessed by survey and self-selected exit interview. RESULTS: Viewers of the video set (n = 50) demonstrated increases in mean kidney transplantation knowledge by +22%, confidence discussing with their doctor by +6%, and reductions in concerns by -2%. Knowledge results were consistent across age, race, and literacy level. Over 90% indicated positive ratings on understanding, engaging, and helpfulness. In post-study interviews viewers indicated the videos promoted confidence in obtaining a kidney transplant and none reported that the 19-min duration of the home education was too long. CONCLUSION: The animated video education is promising to improve diverse individuals' knowledge, concerns, and communication confidence about kidney transplantation and is highly acceptable.

Ceiling effects indicate a possible threshold structure for working alliance.

This review investigated whether ceiling effects on client-reported working alliance measures represent measurement artifacts or valid information related to the formation of the working alliance. Using data from two previously published meta-analyses, a total of 92 estimates of ceiling effects were calculated based on 37 studies with 6,439 participants. Analyses examined the size of ceiling effects, relation with demographic variables, type of alliance measure, and ceiling effect stability across sessions. Moderate to large ceiling effects appeared across score distributions of multiple measures of client-rated alliance, across time administered, and across different sample characteristics such as gender, age, and ethnicity. When examined with the Session Rating Scale (SRS), analyses indicated ceiling effects had a moderate correlation with session number. When SRS ceiling effects were examined in a single study with a large sample of complete cases (N = 2,990) across seven sessions, large initial ceiling effects continued to increase slightly in size across sessions. Higher ceiling effects were also observed with the Working Alliance Inventory. Given the prevalence and relative stability of ceiling effects on score distributions, working alliance scores do not exhibit the characteristics of a normally distributed continuous variable. While the working alliance has typically been defined in terms of theoretical content such as tasks, goals, and bond, study findings suggest another key element may be a threshold structure where clients shift to an experience of the therapeutic relationship as established. Discussion focuses on directions for alliance research and clinical practice as well as study limitations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Opinions of African American adults about the use of apolipoprotein L1 (ApoL1) genetic testing in living kidney donation and transplantation.

Apolipoprotein L1 (ApoL1) predictive genetic testing for kidney disease, and its emerging role in transplantation, remains controversial as it may exacerbate underlying disparities among African Americans (AAs) at increased risk. We conducted an online simulation among AAs (N = 585) about interest in ApoL1 testing and its cofactors, under 2 scenarios: as a potential living donor (PLD), and as a patient awaiting transplantation. Most respondents (61%) expressed high interest in genetic testing as a PLD: age ≥35 years (adjusted odds ratio [aOR], 1.75; 95% confidence interval [CI], 1.18, 2.60, P = .01), AA identity (aOR, 1.67; 95% CI, 1.02, 2.72, P = .04), perceived kidney disease risk following donation (aOR, 1.68; 95% CI, 1.03, 2.73, P = .03), interest in genetics (aOR, 2.89; 95% CI, 1.95, 4.29, P = .001), and genetics self-efficacy (aOR, 2.38; 95% CI, 1.54, 3.67, P = .001) were positively associated with ApoL1 test interest. If awaiting transplantation, most (89%) believed that ApoL1 testing should be done on AA deceased donors, and older age (aOR, 1.85; 95% CI, 1.03, 3.32, P = .04) and greater interest in genetics (aOR, 2.61; 95% CI, 1.41, 4.81, P = .002) were associated with interest in testing deceased donors. Findings highlight strong support for ApoL1 testing in AAs and the need to examine such opinions among PLDs and transplant patients to enhance patient education efforts.

Video education to facilitate patient outreach about living kidney donation: A proof of concept.

BACKGROUND: Increasing living-donor kidney transplantation (LDKT) requires education of transplant candidates and their social network. This pre-post study tested the feasibility and acceptability of KidneyTIME, an intervention which leverages LDKT video-based educational content designed for sharing. METHODS: Adult kidney candidates undergoing transplant evaluation/re-evaluation and their caregivers at a single transplant center viewed different sets of KidneyTIME videos prior to evaluation. Change in LDKT knowledge, self-efficacy, and concerns was assessed before and immediately after exposure and 3 weeks later. Also assessed were post-exposure program feedback, online use, and living donor (LD) inquiry. RESULTS: A total of 82 candidates and 79 caregivers participated. Viewers of KidneyTIME demonstrated increases in mean LDKT knowledge by +71% and communication self-efficacy by +48%, and reductions in concerns by -21%. The intervention was received positively, with over 95% of participants agreeing that the videos were understandable, credible, and engaging. By 3 weeks follow-up, 58% had viewed it again, 63% of family clusters had shared it, and 100% would recommend the program to a friend. Time to LD inquiry was similar to historic controls. CONCLUSION: KidneyTime improved facilitators of LDKT, was rated as highly acceptable, and was highly shared, but did not impact LD inquiry during the COVID-19 pandemic.

Development of the living donation and kidney transplantation information made easy (KidneyTIME) educational animations.

BACKGROUND: Current web-based educational approaches about living kidney donation (LKD) are complex, lengthy, and/or text-laden, which may impair accurate interpretation of information, thereby limiting kidney transplant access. PURPOSE: This paper describes the process of developing animation-based LKD education designed to be suitable for and acceptable to kidney transplant candidates and their support networks. METHODS: Based on formative work, early animation prototypes were designed by a transplant surgeon and a health communication expert. In qualitative focus groups and individual interviews, animation prototypes were shown to 46 kidney transplant recipients, 28 kidney transplant candidates, 32 previous or potential kidney donors, 10 caregivers, 32 transplant providers, 24 dialysis providers, and 4 cultural and community advisors for their input regarding animation suitability, acceptability, and potential usability/feasibility. Viewer feedback was used to iteratively refine the animations. Animation design to facilitate adult learning was guided by elaboration theory, Bandura's self-efficacy theory, and Mayer's cognitive theory of multimedia learning. RESULTS: KidneyTIME currently consists of 12 animations about LKD process, benefits, and risks. CONCLUSIONS: Patients/friends/family members, experts, and stakeholders provided valuable feedback to the research team that was integrated into the development of KidneyTIME with the goal of enhancing suitability, acceptability, engagement, usability, and feasibility of dissemination.

Development and preliminary evaluation of an animation (simplifyKDPI) to improve kidney transplant candidate understanding of the Kidney Donor Profile Index.

BACKGROUND: Transplant candidates are reluctant to accept kidneys from high Kidney Donor Profile Index (KDPI) donors. Incomplete understanding can lead to transplant delays for older transplant candidates. Patients need access to understandable information to make more informed decisions about KDPI. METHODS: We developed a KDPI-specific animation with input from six stakeholder groups and conducted a one-group pre-post study with 60 kidney transplant candidates for feasibility and acceptability to improve participant KDPI knowledge, understanding, decisional self-efficacy, and willingness to accept a KDPI > 85% kidney. Data were compared using McNemar's test and Wilcoxon signed-rank test. RESULTS: Compared with pre-animation scores, post-animation scores were significantly higher for KDPI knowledge for the entire cohort (4.6 vs 6.1, P < .001) and across different levels of age, educational attainment, health literacy, vintage, and technology access. The frequency of positive responses increased pre-post animation for KDPI understanding (55% vs 83%, P < .001) and decisional self-efficacy (47% vs 75%, P < .001). However, willingness to accept KDPI > 85% kidneys (32% vs 36%, P = .83) increased by 2%. After viewing simplifyKDPI, >90% indicated positive ratings on ease of watching, understanding, and engaging. CONCLUSION: In collaboration with stakeholders, an educational animation about KDPI was developed that was well-received and is promising to impact knowledge.

Development and preliminary evaluation of ilearnKAS: An animated video about kidney allocation to support transplant decision-making.

BACKGROUND: We aimed to develop and feasibility test an educational video culturally targeted to African American (AA) patients regarding kidney allocation. METHODS: We iteratively refined an animated video for AAs with multiple stakeholder input and conducted a one-group, pre-post study with 50 kidney transplant candidates to assess video feasibility and acceptability. A mixed population was chosen to obtain race-specific acceptability data and efficacy estimates for a larger study. RESULTS: Median participant age was 56 years, and 50% were AA. Comparing pre-post video scores, large knowledge effect sizes were found for the cohort (r = 0.7) and in the context of AA race (r = 0.8), low health literacy (r = 0.6), low educational achievement (r = 0.7), age >55 years (r = 0.6), dialysis vintage ≥1 year (r = 0.8), low income (r = 0.7) and low technology access (r = 0.8). Over 87% of participants provided positive ratings on each of the seven acceptability items. The frequency of positive responses increased pre-post video for kidney allocation understanding (78% vs 94%, P = 0.008), decisional self-efficacy (64% vs 88%, P < 0.001) and belief in fairness (76% vs 90%, P = 0.02). CONCLUSIONS: In collaboration with key stakeholders, a culturally targeted educational video was developed that was well received. Results are promising to impact kidney allocation knowledge among AA and non-AA kidney transplant candidates.

Using direct mail to promote organ donor registration: Two campaigns and a meta-analysis.

BACKGROUND: Two direct mail campaigns were undertaken in Rochester and Buffalo, New York, with the goal of enrolling adults aged 50-64 years into the state organ and tissue donation electronic registry. Meta-analytic methods were used to summarize the body of research on the effects of direct mail marketing to promote organ donation registration. METHODS: In the first study, 40 000 mailers were sent to targeted adults in Rochester, New York, and varied by brochure-only, letter-only, and letter plus brochure mailing conditions. A follow-up mailer using letter-only was sent to 20 000 individuals in Buffalo, New York area. In a second study, campaign results were combined with previously published direct mail campaigns in a random-effects meta-analysis. RESULTS: The overall registration rates were 1.6% and 4.6% for the Rochester and Buffalo campaigns, and the letter-only condition outperformed the brochure-only and letter plus brochure conditions in the Rochester area campaigns. Meta-analysis indicated a 3.3% registration rates across 15 campaigns and 329 137 targeted individuals. Registration rates were higher when targeting 18-year-olds and when direct mail letters were authored by officials affiliated with state departments. CONCLUSION: Use of direct mail to promote organ donor registration is an inexpensive method to increase enrollments in state registries.

Preliminary Evaluation of 2 Patient-Centered Educational Animations About Kidney Transplant Complications.

BACKGROUND Fear of kidney transplant complications and incomplete information can lower transplant acceptance and preparedness. Our group developed 2 patient-centered educational animated videos on common kidney transplant complications to complement a previously developed video-based curriculum intended to promote kidney transplant access. MATERIAL AND METHODS We preliminarily evaluated the 2 animated educational videos at a single center using mixed methods. We conducted a before-and-after single group study with 22 patients after kidney transplantation to measure the videos' acceptability and feasibility to improve patient knowledge, understanding, and concerns of kidney transplant complications. Concurrently, we individually interviewed 12 patients before kidney transplantation about their perceptions of the 2 videos and analyzed the data thematically. RESULTS Knowledge of kidney transplant complications increased 10% (7.82 to 8.59, P=0.002) from before to after video viewing. Large effect size increases for knowledge were found for different strata of age, race, and health literacy. The mean total score for perceived understanding of kidney transplant complications increased after video exposure by 7% (mean 2.48 to 2.66, P=0.184). There was no change in kidney transplant concern scores from before to after video viewing (mean 1.70 to 1.70, P=1.00). After video viewing, all patients reported positive ratings on comfort watching, understanding, and engaging. Three themes of patient perceptions emerged: (1) messages received as intended, (2) felt informed, and (3) scared but not deterred. CONCLUSIONS Two animated educational videos about kidney transplant complications were well received and promise to positively impact individuals' knowledge and understanding, without raising excessive concerns.

Using Community-Based Participatory Research to Create Animated Videos to Attenuate Disparities in Access to Kidney Transplant Information.

Introduction: Community-based participatory research and animated video offer promising approaches to attenuate disparities in access to kidney transplant information. Project Aims: We refined an evidence-based animated video curriculum (Kidney Transplant and Donation Information Made Easy) designed for diverse individuals, that is currently being trialed to advance kidney transplant access among referred patients at a single transplant center, to further accommodate information needs in earlier stages of the path to transplant (pre-referral) and to enhance fit for Black and Hispanic people. Design: We describe formation of an academic-community partnership and the application of qualitative research methods and partnership discussions to refine the Kidney Transplant and Donation Information Made Easy videos. A simple content analysis was undertaken of intervention refinement transcriptions, minutes, and meeting notes. Results: We formed a community steering committee and advisory board of local members predominantly of minoritized race or ethnicity. Full engagement with community members is evident in the program's adaptation process. Essential refinement elements were adaptation of 17 original videos and iterative development of 8 new videos with the community, conducting parallel cognitive interviews of an expanded sample of stakeholders, maintaining the theoretical grounding of Elaboration Theory, communication/multimedia learning best practices, and self-efficacy framework, and doing Spanish-language translation. Conclusions: Applying community-based participatory research principles and qualitative methods, we produced a culturally grounded adaptation of the Kidney Transplant and Donation Information Made Easy videos that provides information about kidney transplantation from primary care to transplantation. This approach is likely to strengthen our community partnership and eventual community acceptance of the intervention during the implementation phase. Challenges were achieving consensus and adding Spanish-language translation.

Estimating the risks of acquiring a kidney abroad: a meta-analysis of complications following participation in transplant tourism.

A meta-analysis of odds ratios comparing the risks of participating in transplant tourism by acquiring a kidney abroad to the risks associated with domestic kidney transplant was undertaken. Comparison across 12 medical outcomes indicates transplant tourists are significantly more likely to contract cytomegalovirus, hepatitis B, HIV, post-transplantation diabetes mellitus, and wound infection than those receiving domestic kidney transplant. Results also indicate that domestic kidney transplant recipients experience significantly higher one-yr patient- and graft-survival rates. Analyses are supplemented by independent comparisons of outcomes and provide practitioners with weighted estimates of the proportion of transplant recipients experiencing 15 medical outcomes. Practitioners are encouraged to caution patients of the medical risks associated with transplant tourism. Despite the illegal and unethical nature of transplant tourism, additional efforts are indicated to eliminate the organ trade and to educate wait-listed patients about the risks of transplant tourism.

The role of personal and perceived peer norms in bullying and sexual harassment perpetration.

Bullying, cyberbullying, and sexual harassment can be impacted by both personal attitudes and perceived social norms, although few empirical studies on this topic have been conducted with high school students. In this cross-sectional study, 233 high school students completed measures about personal normative attitudes, perceptions of peer norms, and perpetration of bullying, cyberbullying, and sexual harassment. Consistent with social norms theory, students perceived themselves to hold more prosocial (i.e., antibullying/antisexual harassment) personal normative attitudes than they perceived the typical student in their school to hold (i.e., peer norms). Path analyses revealed that students' personal normative attitudes (e.g., antibullying/antiharassment) were negatively related to their bullying, cyberbullying, and sexual harassment perpetration, although perceived peer norms were negatively related to sexual harassment perpetration only. Multiple-group path analysis revealed significant gender differences. Personal normative attitudes related to females' behavior for all forms of perpetration and only sexual harassment and cyberbullying for males (with more antibullying/antiharassment attitudes relating to less perpetration), although associations for males were stronger. Perceived peer norms related to bullying perpetration for males only. Results are discussed with regard to social-cognitive and peer contextual factors and implications for social norms interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Formative Usability of the Kidneytime Online Live Donor Kidney Transplant Education Tool Among Transplant Candidates.

BACKGROUND: Web-based education may be a powerful tool to support transplant candidates' learning and communication about live donor kidney transplantation. Few educational interventions are web-based and have education sharing for living donor transplant as a primary goal. METHODS: Through user-centered design and iterative usability testing, we developed a web platform, called KidneyTIME, to support an educational intervention for adult transplant candidates. KidneyTIME delivers animated videos to improve candidate knowledge, motivation, and self-efficacy to pursue living donor transplantation and to promote outreach through video sharing. The animated-video educational content was previously produced by the researchers. We conducted a formative usability evaluation of the KidneyTIME web platform to enable users to find, view, and share the previously produced videos. A total of 30 kidney transplant candidates were involved in 4 rounds of testing at one transplant center, with amendments made after each round. RESULTS: Transplant candidates were predominantly White non-Hispanic; 47% had incomes <$30 000 and >43% had vision or motor impairment. Readability, navigation, and failure to find videos were the main usability issues identified. Substantial improvements were found in the usability of most functions after implementing certain features, such as enlarging text and buttons, enhancing contrast, and simplifying presentation. Participants reported that the intervention was user friendly and easy to navigate. CONCLUSION: Considering feedback from a wide spectrum of users has improved the usability of KidneyTIME. A salient concern for End stage kidney disease populations is ensuring online accessibility despite vision and motor impairments.

Development and Preliminary Evaluation of a Patient-facing Educational Video About Live Kidney Donor Surgical Complications.

BACKGROUND: Living kidney donation (LKD) improves transplant access; however, its use is compromised, in part, by individuals' unaddressed concerns about perioperative complications. METHODS: We developed an animated, patient-centered educational video about LKD surgical complications, with input from experts in transplantation, communication, and anthropology, 35 patients/care partners (5 LKD candidates, 5 prior LKDs, 10 kidney transplant recipients, 10 kidney transplant candidates, 5 care partners), and 1 community advocate. We then conducted an online pre-post study with 24 potential kidney donors and recipients to measure the video's acceptability and feasibility to improve donation complication knowledge and concerns. RESULTS: Knowledge of LKD surgical complications increased 23% (mean 5.7 to 7.0, P < 0.01) from pre- to post- animation viewing. Large knowledge effect size increases were observed for different levels of age, race, health literacy, and technology access. The frequency of positive responses about donation safety increased from 88% preanimation to 96% postanimation. Concerns about surgical complications remained at 17% before and after exposure. After viewing the animation, over 90% indicated positive ratings on ease of watching, understanding, and engaging. CONCLUSIONS: An animated educational video about LKD surgical complications was developed in collaboration with multiple stakeholders. The video was well received and promised to positively impact individuals' knowledge and concerns.

Kidney Transplant Evaluation and Listing: Development and Preliminary Evaluation of Multimedia Education for Patients.

BACKGROUND Patient knowledge gaps about the evaluation and waitlisting process for kidney transplantation lead to delayed and incomplete testing, which compromise transplant access. We aimed to develop and evaluate a novel video education approach to empower patients to proceed with the transplant evaluation and listing process and to increase their knowledge and motivation. MATERIAL AND METHODS We developed 2 theory-informed educational animations about the kidney transplantation evaluation and listing process with input from experts in transplantation and communication, 20 candidates/recipients, 5 caregivers, 1 anthropologist, 3 community advocates, and 36 dialysis or transplant providers. We then conducted an online pre-post study with 28 kidney transplantation candidates to measure the acceptability and feasibility of the 2 videos to improve patients' evaluation and listing knowledge, understanding, and concerns. RESULTS Compared with before intervention, the mean knowledge score increased after intervention by 38% (5.7 to 7.9; P<0.001). Increases in knowledge effect size were large across age group, health literacy, education, technology access, and duration of pretransplant dialysis. The proportion of positive responses increased from before to after animation viewing for understanding the evaluation process (25% to 61%; P=0.002) and waitlist placement (32% to 86%; P<0.001). Concerns about list placement decreased (32% to 7%; P=0.039). After viewing the animations, >90% of responses indicated positive ratings on trusting the information, comfort level with learning, and engagement. CONCLUSIONS In partnership with stakeholders, we developed 2 educational animations about kidney transplant evaluation and listing that were positively received by patients and have the potential to improve patient knowledge and understanding and reduce patient concerns.

Educational Animations to Inform Transplant Candidates About Deceased Donor Kidney Options: An Efficacy Randomized Trial.

BACKGROUND: Transplant candidates struggle making decisions about accepting kidneys with variable kidney donor profile index (KDPI) and increased risk donor (IRD) status. METHODS: This single site, pilot randomized controlled trial evaluated the efficacy of 2 animations to improve KDPI/IRD knowledge, decisional self-efficacy, and willingness. Kidney candidates were randomly assigned to animation viewing plus standard nurse discussion (intervention) or standard nurse discussion alone (control). Linear regression was used to test the significance of animation exposure after controlling for covariates (α < 0.1). RESULTS: Mean age was 60 years, and 27% were African American. Both intervention (n = 42) and control (n = 38) groups received similar education at similar duration (12.8 versus 11.8 min, respectively), usually by the same dedicated nurse educator (85% versus 75%, respectively). On multivariate analysis, the intervention group (versus control) exhibited significantly increased knowledge (ß = 0.23; 95% confidence interval, 0.66-1.77) and IRD willingness (ß = 0.22; 95% confidence interval, 0.05-0.86). There were no between-group differences in KDPI >85% willingness or distribution of KDPI/IRD decisional self-efficacy. Over 90% of participants provided positive ratings on each of 11 acceptability items. CONCLUSIONS: Supporting conventional IRD and KDPI education with educational animations can improve knowledge and IRD willingness compared with standard methods.

Development and Preliminary Evaluation of IRD-1-2-3: An Animated Video to Inform Transplant Candidates About Increased Risk Donor Kidneys.

BACKGROUND: Current educational interventions about increased risk donors (IRDs) are less effective in improving knowledge among African American (AA) kidney transplant candidates compared to other races. We aimed to develop an IRD educational animated video culturally responsive to AAs and conduct feasibility testing. METHODS: Between May 1, 2018, and June 25, 2018, we iteratively refined a culturally targeted video for AAs with input from multiple stakeholders. We then conducted a one group pre-post study between June 28, 2018, and October 29, 2018, with 40 kidney transplant candidates to assess the feasibility and acceptability of the video to improve participant knowledge and obtain feedback about IRD understanding, self-efficacy, and willingness. A mixed population was chosen to obtain race-specific acceptability data and efficacy estimates to inform a larger study. RESULTS: Three themes emerged and informed video development; misattribution of IRD to kidney quality, IRD terminology as a barrier to meaningful understanding, and variable reactions to a 1:1000 risk estimate. The study cohort was 50% AA. Median IRD knowledge increased from 5 to 7.5 (P = 0.001) overall and from 5 to 7 (P < 0.001) among AAs. The frequency of positive responses increased pre-post video for understanding of (23% vs 83%, P < 0.001), self-efficacy to decide about (38% vs 70%, P < 0.001), and willingness to accept IRD kidneys (25% vs 72%, P < 0.001). Over 90% of participants provided positive ratings on each of the 6 acceptability items. CONCLUSIONS: A culturally responsive IRD educational video was developed in collaboration with key stakeholders. Quantitative results indicate the video was acceptable and promising to impact IRD knowledge among AA and non-AA kidney transplant candidates.

Survey on addictions: toward curricular change for family nurse practitioners.

The purpose of this paper is to describe the results of a survey of advanced practice nurses (APNs) to determine the activities they perform related to caring for patients with addictions and or co-occurring mental health disorders, the amount of addictions education in their graduate programs, and their perceptions of the value of addictions education for their role. Data were obtained from 233 APNs in New York State using a tool adapted from a previous job analysis survey. APNs reported the greatest amount of experience in history taking for various types of addictions and co-occurring mental health disorders and least amount of experience in performing objective exams, using standardized screening tools, ordering related diagnostic tests, prescribing pharmacological treatments, and making referrals for addiction treatment. Respondents reported a mean of less than three hours addictions education in their graduate programs in contrast to their high perceived importance of this clinical area.

Kidney Transplant Evaluation: Inferences from Qualitative Interviews with African American Patients and their Providers.

BACKGROUND: Completing pre-transplant evaluation is often a barrier to kidney waiting list placement among African American (AA) patients. Interventions are needed to provide AAs with culturally sensitive, understandable information that increases their capacity to achieve placement on the kidney transplant waiting list. Research about enabling and constraining factors for patients to complete the waitlisting process is necessary to inform such interventions; however, few such studies have been conducted specific to AA patient needs. METHODS: Semistructured qualitative focus groups and interviews were conducted with 24 AA listed or transplanted patients (along with their caregivers when available) and 14 transplant providers to explore thoughts, feelings, and assumptions about transplant evaluation. Questions also probed participants' perceptions of enabling and constraining factors to wait-listing. Interviews were recorded and transcribed and inductive thematic analysis was performed to inform message content for a future educational video intervention. RESULTS: Three themes emerged from thematic content analysis: (1) transplant center support in navigating steps to wait-listing, (2) provider attitude and messaging, and (3) education about evaluation and the waiting list. Enabling factors for evaluation completion included staff assistance with completing testing, frequent communication, and positive staff messaging. Constraining factors were staff inaccessibility, patient scheduling difficulties, and misunderstanding/misinformation regarding the role of the transplant coordinator, process of and requirements for listing, and understanding allocation. CONCLUSIONS: We identified information based on patients' expressed needs and experiences managing evaluation completion. These findings are valuable in efforts going forward to empower AAs to achieve placement on the waiting list.