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

ABSTRACT

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.