Virtual coaching for potential kidney transplant candidates and their social support networks

PROJECT SUMMARY / ABSTRACT Kidney transplant compared to dialysis dramatically improves survival and quality of life for patients with end stage kidney disease (ESKD), but of the ~500,000 patients with ESKD in the US on dialysis, less than 1/5 are listed for transplant. Despite widespread recognition of the need to improve access to transplant, rates of waitlisting and transplant are substantially lower in patients in underserved communities, including individuals with low socioeconomic status and those in underrepresented racial/ethnic groups. The current system for educating patients is overwhelming and is designed to optimize clinical efficiency. Potential transplant candidates must complete a lengthy evaluation process, often with additional appointments and requirements depending on comorbidities, while also managing a severe chronic illness with high treatment burden. Thus, it is not surprising that a high proportion of patients never access the waitlist or living donor transplant, and that the system inadvertently favors patients with high health literacy and socioeconomic status. While the barriers to transplant are complex, modifiable individual-level barriers contribute significantly to low transplant access. Prior research supports an intervention provided to both patients and their social support networks (SN) but many efficacious interventions are too resource intensive to implement in practice. There is a critical need to identify feasible, efficacious interventions supporting underserved patients and SNs to improve access to kidney transplant. This proposal seeks to conduct a pilot randomized controlled trial (RCT) of Journey to Transplant (JtT), a virtual counseling session with the potential candidate along with their SN versus usual pre- transplant education in a safety net hospital setting (Aim 1). The study will evaluate the effect of JtT on intention to pursue transplant and on the determinants of behavioral change that are impacted by the intervention. In addition, the proposal will assess multisite RCT implementation outcomes, including enrollment rates and survey completion rates, as well as qualitative interviews with patients and providers on the barriers to implementing the protocol in other safety net hospital settings (Aim 2). This proposal is in response to PAS- 20-160: Small R01s for clinical trials targeting diseases within the mission of NIDDK, that does not require preliminary efficacy data, and will facilitate a future multisite, fully powered RCT to evaluate the effect of JtT on improving transplant access in underserved populations. This research agenda is aimed at transforming the paradigm of pre-transplant counseling, empowering underserved patients and their support networks to improve critical life-altering decisions surrounding kidney transplantation.