Skip to main content
SpringerLink
Log in

Promoting Access to Renal Transplantation: The Role of Social Support Networks in Completing Pre-transplant Evaluations

  • Original Article
  • Published:
Journal of General Internal Medicine Aims and scope Submit manuscript

Abstract

Background

Completing pre-transplant evaluations may be a greater barrier to renal transplantation for blacks with end-stage renal disease (ESRD) than for whites.

Objective

To determine whether social support networks facilitate completing the pre-transplant evaluation and reduce racial disparities in this aspect of care.

Design, Setting, and Participants

We surveyed 742 black and white ESRD patients in four regional networks 9 months after they initiated dialysis in 1996 and 1997. Patients reported instrumental support networks (number of friends or family to help with daily activities), emotional support networks (number of friends or family available for counsel on personal problems) and dialysis center support (support from dialysis center staff and patients). The completion of pre-transplant evaluations, including preoperative risk stratification and testing, was determined by medical record reviews.

Outcome Measurement

Complete renal pre-transplant evaluations.

Results

Compared to patients with low levels of instrumental support, those with high levels were more likely to have complete evaluations (25% versus 46%, respectively, p < .001). In adjusted analyses, high levels of instrumental support were associated with higher rates of complete evaluations among black women (p < .05), white women (p < .05), and white men (p < .05), but not black men. Among black men, but not other groups, private insurance was a significant predictor of complete evaluations.

Conclusions

Instrumental support networks may facilitate completing renal pre-transplant evaluations. Clinical interventions that supplement instrumental support should be evaluated to improve access to renal transplantation. Access to supplemental insurance may also promote complete evaluations for black patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Smedley B, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington DC: The National Academies Press, 2003.

  2. Epstein AM, Ayanian JZ, Keogh JH, et al. Racial disparities in access to renal transplantation—clinically appropriate or due to underuse or overuse? N Engl J Med. 2000;343(21):1537–44.

    Article  PubMed  CAS  Google Scholar 

  3. Peterson ED, Shaw LK, DeLong ER, Pryor DB, Califf RM, Mark DB. Racial variation in the use of coronary-revascularization procedures. Are the differences real? Do they matter? N Engl J Med. 1997;336(7):480–6.

    Article  PubMed  CAS  Google Scholar 

  4. Cameron JI, Whiteside C, Katz J, Devins GM. Differences in quality of life across renal replacement therapies: a meta-analytic comparison. Am J Kidney Dis. 2000;35(4):629–37.

    Article  PubMed  CAS  Google Scholar 

  5. Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725–30.

    Article  PubMed  CAS  Google Scholar 

  6. Eggers PW. Racial differences in access to kidney transplantation. Health Care Financ Rev. 1995;17(2):89–103.

    PubMed  CAS  Google Scholar 

  7. Alexander GC, Sehgal AR. Barriers to cadaveric renal transplantation among blacks, women, and the poor. JAMA. 1998;280(13):1148–52.

    Article  PubMed  CAS  Google Scholar 

  8. Gaylin DS, Held PJ, Port FK, Hunsicker LG, Wolfe RA, Kahan BD, et al. The impact of comorbid and sociodemographic factors on access to renal transplantation. JAMA. 1993;269(5):603–8.

    Article  PubMed  CAS  Google Scholar 

  9. Weng FL, Joffe MM, Feldman HI, Mange KC. Rates of completion of the medical evaluation for renal transplantation. Am J Kidney Dis. 2005;46(4):734–45.

    Article  PubMed  Google Scholar 

  10. Ayanian JZ, Cleary PD, Weissman JS, Epstein AM. The effect of patients’ preferences on racial differences in access to renal transplantation. N Engl J Med. 1999;341(22):1661–9.

    Article  PubMed  CAS  Google Scholar 

  11. Alexander GC, Sehgal AR. Why hemodialysis patients fail to complete the transplantation process. Am J Kidney Dis. 2001;37(2)321–8.

    Article  PubMed  CAS  Google Scholar 

  12. Kasiske BL, Cangro CB, Hariharan S, et al. The evaluation of renal transplantation candidates: clinical practice guidelines. Am J Transplant. 2001;1(Suppl 2):3–95.

    PubMed  Google Scholar 

  13. Steinman TI, Becker BN, Frost AE, Olthoff KM, Smart FW, Suki WN, et al. Guidelines for the referral and management of patients eligible for solid organ transplantation. Transplantation. 2001;71(9):1189–204.

    Article  PubMed  CAS  Google Scholar 

  14. Ayanian JZ, Cleary PD, Keogh JH, Noonan SJ, David-Kasdan JA, Epstein AM. Physicians’ beliefs about racial differences in referral for renal transplantation. Am J Kidney Dis. 2004;43(2):350–7.

    Article  PubMed  Google Scholar 

  15. Arthur T. The role of social networks: a novel hypothesis to explain the phenomenon of racial disparity in kidney transplantation. Am J Kidney Dis. 2002;40(4):678–81.

    Article  PubMed  Google Scholar 

  16. Hicks LS, Cleary PD, Epstein AM, Ayanian JZ. Differences in health-related quality of life and treatment preferences among black and white patients with end-stage renal disease. Qual Life Res. 2004;13(6):1129–37.

    Article  PubMed  Google Scholar 

  17. Hays RD, Kallich JD, Mapes DL, Coons SJ, Carter WB. Development of the kidney disease quality of life (KDQOL) instrument. Qual Life Res. 1994;3(5):329–38.

    Article  PubMed  CAS  Google Scholar 

  18. Donders AR, van der Heijden GJ, Stijnen T, Moons KG. Review: a gentle introduction to imputation of missing values. J Clin Epidemiol. 2006;59(10):1087–91.

    Article  PubMed  Google Scholar 

  19. Woloshin S, Schwartz LM, Tosteson AN, et al. Perceived adequacy of tangible social support and health outcomes in patients with coronary artery disease. J Gen Intern Med. 1997;12(10):613–8.

    Article  PubMed  CAS  Google Scholar 

  20. Becker G, Gates RJ, Newsom E. Self-care among chronically ill African Americans: culture, health disparities, and health insurance status. Am J Public Health. 2004;94(12):2066–73.

    PubMed  Google Scholar 

  21. Centers for Disease Control and Prevention. Kidney disease mortality—Michigan, 1989–2005. Morb Mort Wkly Rep. 2007;56(10):225–27.

    Google Scholar 

  22. Grubbs V. Good for harvest, bad for planting. Health Aff. (Millwood). 2007;26(1):232–7.

    Article  Google Scholar 

  23. Holley JL, McCauley C, Doherty B, Stackiewicz L, Johnson JP. Patients’ views in the choice of renal transplant. Kidney Int. 1996;49(2):494–8.

    Article  PubMed  CAS  Google Scholar 

  24. Klassen AC, Hall AG, Saksvig B, Curbow B, Klassen DK. Relationship between patients’ perceptions of disadvantage and discrimination and listing for kidney transplantation. Am J Public Health. 2002;92(5):811–7.

    Article  PubMed  Google Scholar 

  25. Dohan D, Schrag D. Using navigators to improve care of underserved patients: current practices and approaches. Cancer. 2005;104(4):848–55.

    Article  PubMed  Google Scholar 

  26. Patel SS, Peterson RA, Kimmel PL. The impact of social support on end-stage renal disease. Semin Dial. 2005;18(2):98–102.

    Article  PubMed  Google Scholar 

  27. Magee CC, Pascual M. Update in renal transplantation. Arch Intern Med. 2004;164(13):1373–88.

    Article  PubMed  Google Scholar 

  28. Young CJ, Gaston RS. Renal transplantation in black Americans. N Engl J Med. 2000;343(21):1545–52.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We are grateful to the Directors of the ESRD Networks and their staffs for collecting data from medical records and to Gordon Research Services for conducting interviews with patients. We are also grateful to Paul D. Cleary, PhD, Joel Weissman, PhD, and Susan Noonan, MD for advice on the design of our original study and to Garrett Fitzmaurice, PhD for advice on the statistical analysis in the current study. The study was supported by a grant from the Robert Wood Johnson Foundation. Dr. Clark was supported by the Center for Community Health and Health Equity, and an Eleanor and Miles Shore Minority Faculty Career Development Award from the Brigham and Women’s Hospital. The Project Export Center Grant (P20MD00537) supported Dr. Hicks. The financial sponsors of the research have not contributed to the design, interpretation, or manuscript preparation for this study. This paper was presented to the annual meeting of the Society for General Internal Medicine in Toronto, Canada on April 26, 2007.

Conflict of Interest Statement

None disclosed.

Author information

Authors and Affiliations

  1. Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA

    Cheryl R. Clark MD, SD, Leroi S. Hicks MD, MPH, Arnold M. Epstein MD & John Z. Ayanian MD, MPP

  2. Center for Community Health and Health Equity, Brigham and Women’s Hospital, Boston, MA, USA

    Cheryl R. Clark MD, SD & Leroi S. Hicks MD, MPH

  3. Brigham and Women’s—Faulkner Hospitalist Program, Brigham and Women’s Hospital, Boston, MA, USA

    Cheryl R. Clark MD, SD & Leroi S. Hicks MD, MPH

  4. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Leroi S. Hicks MD, MPH & John Z. Ayanian MD, MPP

  5. CliGnosis, Boston, MA, USA

    Joseph H. Keogh MD, JD

  6. Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA

    Arnold M. Epstein MD & John Z. Ayanian MD, MPP

Authors
  1. Cheryl R. Clark MD, SD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Leroi S. Hicks MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joseph H. Keogh MD, JD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Arnold M. Epstein MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John Z. Ayanian MD, MPP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Cheryl R. Clark MD, SD.

Appendix. Social Support Networks Survey Questions

Appendix. Social Support Networks Survey Questions

Social Support Network

Survey Question

Instrumental

“How many close friends or family members could help you on a regular basis with daily activities in your home, such as cooking, cleaning, shopping, or child care?”

Emotional

“How many close friends or family members could you talk to about your personal problems?”

Dialysis Center Staff and Patients

“How important to you are the patients and staff at your dialysis center as a source of emotional support?”

Rights and permissions

Reprints and permissions

About this article

Cite this article

Clark, C.R., Hicks, L.S., Keogh, J.H. et al. Promoting Access to Renal Transplantation: The Role of Social Support Networks in Completing Pre-transplant Evaluations. J GEN INTERN MED 23, 1187–1193 (2008). https://doi.org/10.1007/s11606-008-0628-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11606-008-0628-7

KEY WORDS

Search

Navigation