Patient provider communication and disparities in access to home dialysis and kidney transplantation

About This Grant

PROJECT ABSTRACT Black and Hispanic patients are less than half as likely to be preemptively waitlisted or receive preemptive kidney transplantation compared to their non-Hispanic White (NHW) or Asian counterparts. Black and Hispanic patients are also less than half as likely to receive peritoneal or home hemodialysis compared to their non-Hispanic White (NHW) or Asian counterparts. To date, a few trials have tested interventions aimed at reducing the known racial and ethnic inequities in access to preferred kidney replacement therapy (KRT) modalities such as kidney transplantation and home dialysis, but these interventions have had minimal impact and even when efficacious, are often difficult to adopt in real-world practice due to the resource investment needed and the absence of insurer support for these interventions (e.g., patient navigation or home education). In addition, prior studies have focused primarily on patient-related barriers to accessing home dialysis and preemptive waitlisting or kidney transplantation. Less attention has been paid to provider-related factors that may be contributory, such as how and which providers discuss kidney replacement therapy (KRT) options with patients, and when such discussions begin. The lack of granular data collection on how provider interactions with patients may mediate racial or ethnic disparities in access to preferred KRT modalities represents a significant and critical gap in the literature and likely stems from the fact that such granular data are not typically available in large national registries. Our objective is to leverage unstructured data in provider documentation embedded within electronic health record systems to understand how provider communication about KRT options may vary across different racial and ethnic groups (Aim 1), and whether such variations in patient-provider communication about KRT associates with or mediates the differential access of patients to preemptive waitlisting, transplantation, or home dialysis (Aim 2). To accomplish Aims 1-2, we will use harmonized data from diverse healthcare systems that have been centralized at UCSF to complete our analyses. To complement the data available within provider documentation, in Aim 3, we propose to innovatively review transcripts of clinic encounters focused on discussions of KRT options. We will apply qualitative inductive analyses and review these transcripts to identify factors and themes in patient-provider communication that may vary by patient race/ethnicity. We will then compare these themes to quantitative data on patient knowledge about KRT, satisfaction with the KRT education they received, and preferences as it relates to KRT after their clinic encounter. If successful, our study will identify best practices in patient- provider communication about KRT options that are amenable to simple interventions that could address the known long-standing inequities in access of racial and ethnic minorities to preferred KRT modalities.