Home-based family intervention increases knowledge, communication and living donation rates: a randomized controlled trial.
Ismail SY, Luchtenburg AE, et al.American Journal of Transplantation. 2014; 14(8): 1862-1869.
Aims
To develop and assess an educational program to support the decision making of renal transplantation and to promote access to living donor kidney transplantation (LDKT).
Interventions
Participants received standard care or standard care plus a home-based intervention. The standard care consisted of consultation with a transplant nephrologist, transplant co-ordinator and a social worker, and a yearly check-up with a nephrologist in addition to a variety of educational materials. The experimental group received the same standard care as well as sessions at home with an ‘educator’, in order to stimulate open communication between the patient and the patient’s family.
Participants
179 patients with end stage renal disease who were unable to find a living donor.
Outcomes
The primary outcomes included measures from the Attitude-Social Influence Efficacy model: knowledge, risk perception, self-efficacy, attitudes toward communication, communication on renal replacement therapies, subjective norm and willingness to accept a LDKT. Knowledge was assessed with the Rotterdam Renal Replacement Knowledge Test. The secondary outcome measures included access to LDKT.
Follow-up
6 months.
CET Conclusions
The report describes a comparison between standard care and standard care plus home-based education for 163 patients who were referred for transplant preparation or on the transplantation waiting list but unable to find a kidney donor. The home-based educational programme consisted of two sessions at the patient’s home. The aim was to provide information and support communication and the educators also explored the option of living donation within the patients’ own social network. Sample size calculations showed that at least 78 patients were required per group. The report described that there was a significantly greater increase in knowledge in the experimental group compared to the standard care group (although this was not supported with data) and communication, but no differences for self-efficacy, attitude toward communication about LDKT, subjective norm and willingness to accept LDKT. The invitees from the patients’ social network who attended the educational sessions improved on knowledge, risk perception, self-efficacy and attitudes towards communication. The number of patients who received a living donation donor was not significantly different between groups however, for active patients on the waiting list there were significantly more inquiries, evaluations and subsequent actual LDKTs. The authors correctly conclude that the home-based educational programme improves access to LDKT.
Data analysis
Modified intention-to-treat analysis
Trial registration
The Netherlands Trial Register: NTR2730