Academic journal article Health and Social Work

Feasibility and Acceptability of the TALK Social Worker Intervention to Improve Live Kidney Transplantation

Academic journal article Health and Social Work

Feasibility and Acceptability of the TALK Social Worker Intervention to Improve Live Kidney Transplantation

Article excerpt

Live kidney transplantation (LKT) is an optimal therapy for patients with end-stage renal disease; it offers substantially improved length and quality of life compared with dialysis (Abecassis et al., 2008; Terasaki, Cecka, Gjertson, & Takemoto, 1995). Preemptive LKT (pLKT), initiated before potential recipients need renal replacement therapy, typically yields superior clinical outcomes (Mange, Joffe, & Feldman, 2001; Terasaki et al., 1995). However, this type of transplant is largely underused, particularly among African Americans, who have up to 50 percent less odds of becoming preemptive transplant recipients when compared with their white counterparts (Gore, Danovitch, Litwin, Pham, & Singer, 2005; Grams, Massie, Coresh, & Segev, 2011; Kasiske et al., 2002). Reasons for inadequate use of pLKT are poorly understood. However, some studies have attributed underuse to several factors, including potential recipients' difficulties identifying willing, eligible, or compatible donors (Schweitzer et al., 1997; Tankersley et al., 1997; Young & Gatson, 2000); insufficient access to health care (Ayanian, Cleary, Weissman, & Epstein, 1999; Kasiske et al., 2002); and a lack of knowledge about transplantation (Waterman et al., 2006). Many of these factors (for example, poor access to health care) disproportionately affect ethnic and racial minorities and may contribute to disparities in their receipt of pLKT. Interventions that address common barriers to potential recipients' access to and receipt of pLKT are greatly needed to improve rates of pLKT overall and to narrow ethnic and racial pLKT disparities.

For potential recipients to have access to pLKT, they must first have discussions about pLKT with their health care providers (HCPs) as well as their families, who represent key sources of support for decision making and for kidney donation. Nonetheless, prior studies have demonstrated that patients with chronic kidney disease (CKD) often fail to engage in LKT discussions (Smith, Nazione, LaPlante, Clark-Hitt, & Park, 2011). In our qualitative study, minority and nonminority patients with CKD reported a variety of reasons for not engaging in LKT discussions, including their concerns that their family members would feel coerced to donate or feel guilty, concerns that discussions could be misconstrued as donation requests, and difficulties initiating conversations about LKT (Boulware, Hill-Briggs, Kraus, Melancon, Senga, et al., 2011).

The Talking About Live Kidney Donation (TALK) social worker intervention (SWI) was designed to directly address patients' with CKD and their family members' self-identified barriers to discussing pLKT (Boulware, Hill-Briggs, Kraus, Melancon, McGuire, et al., 2011; Boulware, Hill-Briggs, Kraus, Melancon, Senga, et al., 2011). In a previously described randomized controlled trial (Boulware et al., in press), the TALK SWI was effective in improving patients' consideration and pursuit of pLKT compared with patients not receiving the TALK SWI. Although the success of the TALK SWI during the clinical trial is encouraging, the effectiveness of the TALK SWI in clinical practice will be determined, in part, by the degree to which it can be easily delivered and is acceptable to patients and families. To better understand the ease with which the TALK SWI can be used in real-world settings, we examined the extent to which the TALK study social worker (SW) was able to adhere to the TALK SWI protocol, assessed the acceptability of the intervention to patients and their families, and described the content of discussions occurring during TALK SW visits.


Description of the TALK SWI

Overview. The TALK SWI consisted of both educational and behavioral interventions to ameliorate consideration and pursuit of LKT among patients with advanced, progressive CKD. The educational video featured CKD patients and their family members discussing their experiences with considering LKT as a treatment option, as well as HCPs and SWs citing key factors that patients and families should consider when contemplating LKT. …

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