Direct Delivery of Kidney Transplant Education to Black and Low-Income Patients Receiving Dialysis: A Randomized Controlled Trial

Rationale & Objective: Compared with others, black and low-income patients receiving dialysis are less likely to receive kidney transplantation (KT) education within dialysis centers. We examined the efficacy of 2 supplementary KT education approaches delivered directly to patients. Study Design: Prospective, 3-arm parallel-group, randomized, controlled trial. Settings & Participants: Adult, black, and white low-income patients receiving dialysis in Missouri. Intervention: Patients were randomly assigned to 1 of 3 educational conditions: (1) standard of care, usual KT education provided in dialysis centers (control); (2) Explore Transplant @ Home patient-guided, 4 modules of KT education sent directly to patients using print, video, and text messages; and (3) Explore Transplant @ Home educator-guided, the patient-guided intervention plus 4 telephonic discussions with an educator. Outcomes: Primary: patient knowledge of living (LDKT) and deceased donor KT (DDKT). Secondary: informed decision making, change in attitudes in favor of LDKT and DDKT, and change in the number of new steps taken toward KT. Results: In intent-to-treat analyses, patients randomly assigned to educator- and patient-guided interventions had greater knowledge gains (1.4 point increase) than control patients (0.8 point increase; P = 0.02 and P = 0.01, respectively). Compared with control patients, more patients randomly assigned to educator- and patient-guided interventions were able to make informed decisions about starting KT evaluation (82% vs 91% and 95%; P = 0.003), pursuing DDKT (70% vs 84% and 84%; P = 0.003), and pursuing LDKT (73% vs 91% and 92%; P < 0.001). Limitations: Potential contamination because of patient-level randomization; no assessment of clinical end points. Conclusions: Education presented directly to dialysis patients, with or without coaching by telephone, increased dialysis patients’ KT knowledge and informed decision making without increasing educational burden on providers. Funding Source: This project was funded by the National Institutes of Health and Health Resources and Services Administration. Trial Registration: Registered at ClinicalTrials.gov with study number NCT02268682.