Understanding the relationship between trust in health care and attitudes toward living donor transplant among African Americans with end-stage renal disease.
McDonald EL, Powell CL, Perryman JP, et al.Clin Transplant. 2013; 27(4):619-26.
Aims
This study is part of a larger study to test the effectiveness of a culturally sensitive living donation education intervention for African American patients with end stage renal disease (ESRD). Attitudes towards dialysis and the relationship between trust in healthcare and living donor therapy were investigated in this study.
Interventions
In this study trust in healthcare was reviewed on data collected from August 2011 – April 2012. The measures used to obtain this data included the use of a ‘benefits of living donor transplant scale’ for patients to consider the impact of having a living donor transplant (LDT), a ‘trust in doctors scale’ which referred to the level of trust the participant had on his or her primary healthcare provider. A ‘trust in non-discrimination scale’ measured responses from one (strongly disagree) to five (strongly agree),’ trust in hospitals’ related directly to the treatment at hospit
Participants
Up to 259 adult participants.
Outcomes
The outcomes included the level of trust in doctors, trust in racial equity of treatment and trust in hospitals.
Follow-up
8 months.
CET Conclusions
This is a particularly interesting study looking at the influence of equity of healthcare in the African American population to attitudes to living kidney donation in that same population. The study was carried out in Georgia, presumably at the Emory University Medical School. It is noted that 35% of the nation’s kidney transplant waiting list candidates are African Americans even though they make up only 13% of the national population. In Georgia itself where this research was conducted, African Americans represent 31% of the population, and 64% are awaiting a kidney transplant. The study attempts to dissect the relationship between trust in healthcare, including both trust in doctors and trust in the hospitals as well as their attitudes to dialysis in determining attitudes toward living donor transplantation. The patients were selected from the baseline data of a large randomised controlled trial which is in progress, but the findings of this study suggest a strong relationship between trust in healthcare and attitudes towards living donor transplantation. It also suggests that a favourable dialysis experience would be related to a positive attitude to living donor transplantation. As the authors point out this study is limited to Georgia where there is a very high percentage of African American patients awaiting a transplant and it is not necessarily generalizable to the total population. It would be interesting to know if the same results would be found in a waiting list population where African Americans were, for example, 10% of the waiting list.
Data analysis
Per protocol analysis
Quality notes
Previously assessed in Arriola K, Robinson DH, et al. Project ACTS: an intervention to increase organ and tissue donation intentions among African Americans. Health Education & Behavior 2010; 37(2): 264-274.
Trial registration
Not reported.