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Use of Patient Navigators to Reduce Barriers in Living Donation and Living Donor Transplantation

  • Live Kidney Donation (K Lentine and R Schaffer, Section Editors)
  • Published:
Current Transplantation Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

The transplant community is facing an important and growing crisis in healthcare disparities, which limits the access of vulnerable populations to successful transplant and its most ideal form, living donor transplantation [1,2,3,4,5,6]. The time is now to implement strategies that facilitate access to timely living donor transplant and relieve the pressure on a burdened deceased donor waiting list.

Recent Findings

Patient navigation programs have arisen as distinctive model of patient-centered healthcare delivery to overcome existing disparities in access to healthcare. Originally used in oncology [7,8,9] and gaining momentum across other specialties, navigators function as educators, sponsors, and allies to patients and their potential donors. Similarly, they provide unique insight, context, and valuable feedback to transplant providers who may be insufficiently aware of the challenges faced by the transplant candidates and the potential donors they care for. Ultimately, patient navigators can help decrease the risk of premature transplant process withdrawal, increase the likelihood of work-up completion, demystify living donor misconceptions and misunderstandings, and help maintain engagement of transplant candidates and their donors.

Summary

While data are still emerging, the future of patient navigation seems promising, particularly as an intervention to help equalize the access to living donor transplantation to the most vulnerable and under-resourced transplant candidates. In this review, we explore the role of patient navigation programs in solid organ transplantation and how they could help reduce the inequities in living donation and living donor transplantation.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gore JL, Danovitch GM, Litwin MS, Pham P-TT, Singer JS. Disparities in the utilization of live donor renal transplantation. Am J Transplant. 2009;9(5):1124–33.

    Article  CAS  Google Scholar 

  2. Rodrigue JR, Kazley AS, Mandelbrot DA, Hays R, Rudow DL, Baliga P. Living donor kidney transplantation: overcoming disparities in live kidney donation in the US—recommendations from a consensus conference. Clin J Am Soc Nephrol. 2015;10(9):1687–95.

    Article  Google Scholar 

  3. •• Purnell TS, Hall YN, Boulware LE. Understanding and overcoming barriers to living kidney donation among racial and ethnic minorities in the United States. Adv Chronic Kidney Dis. 2012;19(4):244–51. In depth review of existing barriers to living kidney donor transplantation.

  4. • Purnell TS, Luo X, Cooper LA, Massie AB, Kucirka LM, Henderson ML, et al. Association of race and ethnicity with live donor kidney transplantation in the united states from 1995 to 2014. JAMA. 2018;319(1):49–61.

  5. Nobel YR, Forde KA, Wood L, Cartiera K, Munoz-Abraham AS, Yoo PS, et al. Racial and ethnic disparities in access to and utilization of living donor liver transplants. Liver Transpl. 2015;21(7):904–13.

  6. Mogul DB, Luo X, Chow EK, Massie AB, Purnell TS, Schwarz KB, et al. Impact of race and ethnicity on outcomes for children waitlisted for pediatric liver transplantation. J Pediatr Gastroenterol Nutr. 2018;66(3):436–41.

    Article  Google Scholar 

  7. Freeman HP, Muth BJ, Kerner JF. Expanding access to cancer screening and clinical follow-up among the medically underserved. Cancer Pract. 1995;3(1):19–30.

    CAS  PubMed  Google Scholar 

  8. Freeman HP. The origin, evolution, and principles of patient navigation. Cancer Epidemiol Prev Biomarkers Prev. 2012;21(10):1614–7.

    Article  Google Scholar 

  9. Steinberg ML, Fremont A, Khan DC, Huang D, Knapp H, Karaman D, et al. Lay patient navigator program implementation for equal access to cancer care and clinical trials. Cancer. 2006;107(11):2669–77.

    Article  Google Scholar 

  10. Dageforde LA, Petersen AW, Feurer ID, Cavanaugh KL, Harms KA, Ehrenfeld JM, et al. Health literacy of living kidney donors and kidney transplant recipients. Transplantation. 2014;98(1):88.

    Article  Google Scholar 

  11. • Warsame F, Haugen CE, Ying H, Garonzik-Wang JM, Desai NM, Hall RK, et al. Limited health literacy and adverse outcomes among kidney transplant candidates. Am J Transplant. 2019;19(2):457–65.

  12. •• Garg AX. Helping more patients receive a living donor kidney transplant. Clin J Am Soc Nephrol. 2018;13(12):1918–23.

  13. Sullivan C, Leon JB, Sayre SS, Marbury M, Ivers M, Pencak JA, et al. Impact of navigators on completion of steps in the kidney transplant process: a randomized, controlled trial. Clin J Am Soc Nephrol. 2012;7(10):1639–45.

    Article  Google Scholar 

  14. Saran R, Robinson B, Abbott KC, Agodoa LYC, Bragg-Gresham J, Balkrishnan R, et al. US renal data system 2018 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2019;73(3S1):A7–8.

    Article  Google Scholar 

  15. Armstrong K, Ravenell KL, McMurphy S, Putt M. Racial/ethnic differences in physician distrust in the United States. Am J Public Health. 2007;97(7):1283–9.

    Article  Google Scholar 

  16. Armstrong K, Putt M, Halbert CH, Grande D, Schwartz JS, Liao K, et al. Prior experiences of racial discrimination and racial differences in health care system distrust. Med Care. 2013;51(2):144–50.

    Article  Google Scholar 

  17. Jennette C, Derebail V, Baldwin J, Cameron S. Renal replacement therapy and barriers to choice: using a mixed methods approach to explore the patient’s perspective. J Nephrol Soc Work. 2009;32:15–26.

    PubMed  PubMed Central  Google Scholar 

  18. Myaskovsky L, Almario Doebler D, Posluszny DM, Dew MA, Unruh M, Fried LF, et al. Perceived discrimination predicts longer time to be accepted for kidney transplant. Transplantation. 2012;93(4):423–9.

    Article  Google Scholar 

  19. Wachterman MW, McCarthy EP, Marcantonio ER, Ersek M. Mistrust, misperceptions, and miscommunication: a qualitative study of preferences about kidney transplantation among African Americans. Transplant Proc. 2015;47(2):240–6.

    Article  CAS  Google Scholar 

  20. Wilder JM, Oloruntoba OO, Muir AJ, Moylan CA. Role of patient factors, preferences, and distrust in health care and access to liver transplantation and organ donation. Liver Transpl. 2016;22(7):895–905.

    Article  Google Scholar 

  21. Olthoff KM, Smith AR, Abecassis M, Baker T, Emond JC, Berg CL, et al. Defining long-term outcomes with living donor liver transplantation in North America. Ann Surg. 2015;262(3):465–75.

    Article  Google Scholar 

  22. Humar A, Ganesh S, Jorgensen D, Tevar A, Ganoza A, Molinari M, et al. Adult living donor versus deceased donor liver transplant (LDLT Versus DDLT) at a single center: time to change our paradigm for liver transplant. Ann Surg. 2019;270(3):444–51.

    Article  Google Scholar 

  23. National Data - OPTN: Currrent U.S. waiting list by organ [Internet]. [cited 2019 Dec 15]. Available from: https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#

  24. • Hunt HF, Rodrigue JR, Dew MA, Schaffer RL, Henderson ML, Bloom R, et al. Strategies for increasing knowledge, communication, and access to living donor transplantation: an evidence review to inform patient education. Curr Transplant Rep. 2018;5(1):27–44.

    Article  Google Scholar 

  25. Garonzik-Wang JM, Berger JC, Ros RL, Kucirka LM, Deshpande NA, Boyarsky BJ, et al. Live donor champion: finding live kidney donors by separating the advocate from the patient. Transplantation. 2012;93(11):1147–50.

    Article  Google Scholar 

  26. Rodrigue JR, Paek MJ, Egbuna O, Waterman AD, Schold JD, Pavlakis M, et al. Making house calls increases living donor inquiries and evaluations for blacks on the kidney transplant waiting list. Transplantation. 2014;98(9):979–86.

    Article  Google Scholar 

  27. Gordon EJ, Reddy E, Gil S, Feinglass J, Rodde J, Abecassis MM, et al. Culturally competent transplant program improves hispanics’ knowledge and attitudes about live kidney donation and transplant. Prog Transplant. 2014;24(1):56–68.

    Article  Google Scholar 

  28. Gordon EJ, Feinglass J, Carney P, Vera K, Olivero M, Black A, et al. A Website intervention to increase knowledge about living kidney donation and transplantation among hispanic/latino dialysis patients. Prog Transplant. 2016;26(1):82–91.

    Article  Google Scholar 

  29. Arriola KRJ, Powell CL, Thompson NJ, Perryman JP, Basu M. Living donor transplant education for African American patients with end-stage renal disease. Prog Transplant. 2014;24(4):362–70.

    Article  Google Scholar 

  30. Patzer RE, McPherson L, Redmond N, DuBay D, Zayas C, Hartmann E, et al. A Culturally sensitive web-based intervention to improve living donor kidney transplant among African Americans. Kidney Int Rep. 2019;4(9):1285–95.

    Article  Google Scholar 

  31. U.S. Department of Health and Human Services Health Resources and Services Administration Healthcare Systems Bureau, Division of Transplantation. 2012 National Survey of Organ Donation Attitudes and Behaviors. [cited 2019 Dec 13].;124.

  32. Division N. HHS launches President Trump’s ‘Advancing American Kidney Health’ Initiative [Internet]. HHS.gov. 2019 Jul DOI: https://www.hhs.gov/about/news/2019/07/10/hhs-launches-president-trump-advancing-american-kidney-health-initiative.html

  33. Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, et al. KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Transplantation. 2017;101(8S):S7.

    Article  Google Scholar 

  34. NCI dictionary of cancer terms [Internet]. Natl Cancer Inst. 2011 Feb [cited 2019 Nov 29]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms

  35. Natale-Pereira A, Enard KR, Nevarez L, Jones LA. The role of patient navigators in eliminating health disparities. Cancer. 2011;117(S15):3541–50.

    Article  Google Scholar 

  36. •• Locke J, Reed R, Kumar V, Berry B, Hendricks D, Carter A, et al. Enhanced advocacy and health systems training through patient navigation increases access to living donor kidney transplantation. Transplantation. 2020;104(1):122–9. First-of-its-kind living donor navigation program that focused educational efforts on both patient advocates and potential living donors, through advocacy and health system training.

  37. Horne HN, Phelan-Emrick DF, Pollack CE, Markakis D, Wenzel J, Ahmed S, et al. Effect of patient navigation on colorectal cancer screening in a community-based randomized controlled trial of urban African American adults. Cancer Causes Control. 2015;26(2):239–46.

    Article  Google Scholar 

  38. Enard K, Nevarez L, Hernandez M, Hovick S, Moguel M, Hajek R, et al. Patient navigation to increase colorectal cancer screening among Latino Medicare enrollees: a randomized controlled trial. Cancer Causes Control CCC. 2015;26(9):1351–9.

    Article  CAS  Google Scholar 

  39. Percac-Lima S, Ashburner JM, Bond B, Oo SA, Atlas SJ. Decreasing disparities in breast cancer screening in refugee women using culturally tailored patient navigation. J Gen Intern Med. 2013;28(11):1463–8.

    Article  Google Scholar 

  40. Freund KM, Battaglia TA, Calhoun E, Darnell JS, Dudley DJ, Fiscella K, et al. Impact of patient navigation on timely cancer care: the Patient Navigation Research Program. J Natl Cancer Inst. 2014;106(6):dju115.

    Article  Google Scholar 

  41. Fouad MN, Johnson RE, Nagy MC, Person SD, Partridge EE. Adherence and retention in clinical trials: a community-based approach. Cancer. 2014;120(Suppl 7):1106–12.

    Article  Google Scholar 

  42. Hryniuk W, Simpson R, McGowan A, Carter P. Patient perceptions of a comprehensive cancer navigation service. Curr Oncol. 2014;21(2):69–76.

    Article  CAS  Google Scholar 

  43. • Sullivan CM, Barnswell KV, Greenway K, Kamps CM, Wilson D, Albert JM, et al. Impact of navigators on first visit to a transplant center, waitlisting, and kidney transplantation: a randomized, controlled trial. Clin J Am Soc Nephrol. 2018;13(10):1550–5.

  44. • Basu M, Petgrave-Nelson L, Smith KD, Perryman JP, Clark K, Pastan SO, et al. Transplant center patient navigator and access to transplantation among high-risk population: a randomized, controlled trial. Clin J Am Soc Nephrol. 2018;13(4):620–7.

  45. Basu M, Clark K, Perryman JP, Fletcher D, Allison W, et al. Development and Application of a Risk Assessment Tool for Patients Referred for Kidney Transplantation. Poster Sessions: Kidney. Am J Transplant. 2014;14(S3):434–658.

  46. Waterman AD, Beaumont JL. What Else Can We Do to Ensure Transplant Equity for High-Risk Patients? Clin J Am Soc Nephrol. 2018 Apr;13(4):529–30.

    Article  Google Scholar 

  47. •• Marlow NM, Kazley AS, Chavin KD, Simpson KN, Balliet W, Baliga PK. A patient navigator and education program for increasing potential living donors: a comparative observational study. Clin Transpl. 2016;30(5):619–27. Use of patient navigators in community nephrology practices, usually before dialysis, resulting in more living donor inquiries and screenings per patient participating in the navigation program.

  48. U.S. Census Bureau QuickFacts: United States [Internet]. [cited 2019 Dec 15]. Available from: https://www.census.gov/quickfacts/fact/table/US/PST045218

  49. Hall EC, James NT, Garonzik Wang JM, Berger JC, Montgomery RA, Dagher NN, et al. Center-level factors and racial disparities in living donor kidney transplantation. Am J Kidney Dis. 2012;59(6):849–57.

    Article  Google Scholar 

  50. Hanson CS, Chadban SJ, Chapman JR, Craig JC, Wong G, Ralph AF, et al. The expectations and attitudes of patients with chronic kidney disease toward living kidney donor transplantation: a thematic synthesis of qualitative studies. Transplantation. 2015;99(3):540–54.

    Article  CAS  Google Scholar 

  51. Barnieh L, McLaughlin K, Manns BJ, Klarenbach S, Yilmaz S, Hemmelgarn BR, et al. Barriers to living kidney donation identified by eligible candidates with end-stage renal disease. Nephrol Dial Transplant. 2011;26(2):732–8.

    Article  Google Scholar 

  52. Salter ML, Gupta N, King E, Bandeen-Roche K, Law AH, McAdams-DeMarco MA, et al. Health-related and psychosocial concerns about transplantation among patients initiating dialysis. Clin J Am Soc Nephrol. 2014;9(11):1940–8.

    Article  Google Scholar 

  53. Purnell TS, Xu P, Leca N, Hall YN. Racial differences in determinants of live donor kidney transplantation in the United States. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2013;13(6):1557–65.

    Article  CAS  Google Scholar 

  54. Axelrod DA, Schnitzler MA, Xiao H, Irish W, Tuttle-Newhall E, Chang S-H, et al. An economic assessment of contemporary kidney transplant practice. Am J Transplant. 2018;18(5):1168–76.

    Article  Google Scholar 

  55. Patient Navigation Pilot Program Findings Revealed at CMSA Conference [Internet]. PRWeb. [cited 2019 Dec 16]. Available from: https://www.prweb.com/releases/Pilot/Program/prweb11982982.htm

  56. Rocque GB, Pisu M, Jackson BE, Kvale EA, Demark-Wahnefried W, Martin MY, et al. Resource use and medicare costs during lay navigation for geriatric patients with cancer. JAMA Oncol. 2017;3(6):817–25.

    Article  Google Scholar 

  57. Gervès-Pinquié C, Girault A, Phillips S, Raskin S, Pratt-Chapman M. Economic evaluation of patient navigation programs in colorectal cancer care, a systematic review. Heal Econ Rev. 2018;8. https://doi.org/10.1186/s13561-018-0196-4.

  58. •• Reed RD, Hites L, Mustian MN, Shelton BA, Hendricks D, Berry B, et al. A qualitative assessment of the living donor navigator program to identify core competencies and promising practices for implementation. Prog Transplant. 2019; 1526924819892919. Recent study exploring core competencies and promising practices to deploy a living donor navigator program.

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Correspondence to Angie G. Nishio-Lucar.

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Nishio-Lucar, A.G., Locke, J. & Kumar, V. Use of Patient Navigators to Reduce Barriers in Living Donation and Living Donor Transplantation. Curr Transpl Rep 7, 72–80 (2020). https://doi.org/10.1007/s40472-020-00280-4

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