Cross-sectional study |
Escobedo and Weismuller (2013)1616 Escobedo W, Weismuller P. Assessing health literacy in renal failure and kidney transplant patients. Prog Transplant 2013;23(1):47-54. https://doi.org/10.7182/pit2013473 https://doi.org/10.7182/pit2013473...
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To identify the level of health literacy in patients seen at a suburban transplant center. |
Of the 44 participants, 18 (41%) had scores indicating a high likelihood of limited health literacy. An association was also found between limited health literacy and lower education levels. However, the assessment of educational level alone was not predictive of health literacy; eight participants (18%) had a high school education or higher but scored as having limited health literacy. |
Lambert et al. (2015)1717 Lambert K, Mullan J, Mansfield K, Lonergan M. A cross-sectional comparison of health literacy deficits among patients with chronic kidney disease. J Health Commun 2015;20(Suppl 2):16-23. https://doi.org/10.1080/10810730.2015.1080329 https://doi.org/10.1080/10810730.2015.10...
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To investigate the types and extent of health literacy deficits in patients with chronic kidney disease and to identify associations between patient characteristics and health literacy domains. |
Inadequate health literacy was high among groups with chronic kidney disease – especially in domains related to meeting health needs, understanding health information, social support and socioeconomic factors. Male gender and lower education were significantly associated with inadequate health literacy. The type and extent of health literacy deficits varied among groups with chronic kidney disease; transplant patients had more deficits than other groups. |
Grubbs et al. (2009)2121 Grubbs V, Gregorich SE, Perez-Stable EJ, Hsu C-Y. Health literacy and access to kidney transplantation. Clin J Am Soc Nephrol 2009;4(1):195-200. https://doi.org/10.2215/CJN.03290708 https://doi.org/10.2215/CJN.03290708...
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To examine health literacy in patients with end-stage kidney disease and the association with kidney transplant waiting list access. |
Inadequate health literacy occurred in 32.3% of participants, and 75.8% were referred for transplant evaluation. Among those referred, 85.1% were on the waiting list. Participants with inadequate health literacy had a 78% lower risk of being referred for transplant evaluation than those with adequate health literacy. |
Kazley et al. (2012)2222 Kazley AS, Simpson KN, Chavin KD, Baliga P. Barriers facing patients referred for kidney transplant cause loss to follow-up. Kidney Int 2012;82(9):1018-23. https://doi.org/10.1038/ki.2012.255 https://doi.org/10.1038/ki.2012.255...
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Identify barriers to kidney transplantation in patients who have not completed the necessary investigation to be added to the national transplant waiting list. |
These were the main reasons patients gave for not seeking a transplant: they thought they would not pass the medical exams, were afraid of having the transplant, and could not afford the medicine or the procedure. These impediments may have resulted from unclear communication with the provider, incorrect information received from colleagues or other sources, misperceptions related to transplant surgery, or limited health literacy. |
Rocha and Figueiredo (2019)2424 Rocha KT, Figueiredo AE. Letramento em saúde: avaliação de pacientes em terapia renal substitutiva. Enferm Nefrológica 2019;22(4):388-97. https://doi.org/10.4321/S2254-28842019000400005 https://doi.org/10.4321/S2254-2884201900...
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To study the impact of the health literacy level of patients undergoing hemodialysis, peritoneal dialysis and kidney transplantation associated with cognitive aspects, medication adherence and quality of life. |
Individuals with inadequate literacy had lower levels of schooling and monthly income. Those with adequate literacy had a higher score in the emotional aspects of quality of life. |
Vilme et al. (2018)3131 Vilme H, Davenport CA, Pendergast J, Boulware LE. Trends in African Americans' attitudes and behaviors about living donor kidney transplantation. Prog Transplant 2018;28(4):354-60. https://doi.org/10.1177/1526924818800036 https://doi.org/10.1177/1526924818800036...
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To characterize the interest and search for living donor transplantation among African Americans with varying levels of exposure to dialysis or transplantation treatments. Evaluate facilitators or barriers associated with the interest in and search for living donor transplantation among these populations. |
Interest in transplantation among the three strata of the study was high (pre-dialysis, 62.9%; dialysis, 67.4%; and transplant waiting list, 74.2%). The dialysis and transplant waiting list strata sought living donations more readily than those not on dialysis. Interest and seeking were not associated with knowledge, health literacy, or confidence in medical care. |
Vilme et al. (2018)3131 Vilme H, Davenport CA, Pendergast J, Boulware LE. Trends in African Americans' attitudes and behaviors about living donor kidney transplantation. Prog Transplant 2018;28(4):354-60. https://doi.org/10.1177/1526924818800036 https://doi.org/10.1177/1526924818800036...
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To investigate the prevalence and associations of limited health literacy using UK transplant outcome measurement program data. |
The prevalence of limited health literacy was higher in dialysis patients, followed by those on the waiting list and transplant recipients. Limited health literacy was independently associated with low socioeconomic status, low English fluency, and comorbidity. |
Qualitative study |
Devitt et al. (2017)2727 Devitt J, Anderson K, Cunningham J, Preece C, Snelling P, Cass A. Difficult conversations: Australian Indigenous patients' views on kidney transplantation. BMC Nephrol 2017;18(1):310. https://doi.org/10.1186/s12882-017-0726-z https://doi.org/10.1186/s12882-017-0726-...
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To explore the views of indigenous patients with chronic kidney disease on transplantation as a treatment option. |
Four interrelated thematic contents were apprehended: a very high level (90% of respondents) of positive interest in transplantation; patients experienced a range of communication difficulties and felt uninformed about the transplant; family involvement in decision-making was restricted by inadequate information; and patients needed to negotiate cultural and social sensitivities around transplantation. |
Senghor (2019)2828 Senghor AS. Reasons for dialysis patients choosing or refusing kidney transplantation as renal replacement therapy: A qualitative study. Nephrol Ther 2019;15(7):511-16. https://doi.org/10.1016/j.nephro.2019.07.327 https://doi.org/10.1016/j.nephro.2019.07...
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To identify the reasons for choosing or refusing kidney transplantation as renal replacement therapy in patients with Chronic Kidney Disease. |
The high level of health literacy predominated among patients who opted for kidney transplantation. Others saw kidney transplantation as a cure or a normal process. The patient’s ability to understand the information received influences the decision-making process for transplantation. |
King et al. (2020)2929 King A, Lopez FY, Lissanu L, Robinson E, Almazan E, Metoyer G, et al. Renal Replacement Knowledge and Preferences for African Americans With Chronic Kidney Disease. J Ren Care 2020;46(3):151-60. https://doi.org/10.1111/jorc.12312 https://doi.org/10.1111/jorc.12312...
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To understand African American patients’ knowledge of renal replacement therapy options and how patient, provider, and system factors contribute to knowledge and preferences. |
Four themes were identified: (1) limited knowledge of home modalities and deceased donor options, (2) patients with chronic kidney disease paid little attention to choosing renal replacement therapy options, (3) patients with chronic kidney disease depended on physicians for treatment decisions and (4) while patients reported knowledge of live kidney donation transplants, it did not translate into receiving that type of transplant. |
Prospective cohort |
Warsame et al. (2019)1919 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. https://doi.org/10.1111/ajt.14994 https://doi.org/10.1111/ajt.14994...
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To assess the prevalence of limited health literacy among 1,578 kidney transplant candidates. |
Among kidney transplant candidates, 8.9% had limited health knowledge; risk factors included education less than higher education, frailty, comorbidity, and cognitive impairment. Candidates with limited health literacy had a 30% reduced probability of waiting list participation and a more than twofold increased risk of waiting list mortality. |
Dageforde et al. (2015)2020 Dageforde LA, Box A, Feurer ID, Cavanaugh KL. Understanding patient barriers to kidney transplant evaluation. Transplantation 2015;99(7):1463-9. https://doi.org/10.1097/TP.0000000000000543 https://doi.org/10.1097/TP.0000000000000...
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To compare demographic, socioeconomic, and psychological factors among participants and those absent from the renal transplant evaluation visit. |
Participants were 104 adults (61% male, 46% Caucasian, 52 ± 12 years old). Most participants (77%) had adequate health literacy. Financial concerns were the most prevalent. Previous evaluation at another transplant center and being on dialysis was significantly associated with absence. Frequency was associated with concerns about finding a living donor and a greater general perception of knowledge about transplantation. No differences in demographic, socioeconomic, or health literacy factors were found between groups. |
Taylor et al. (2019)2323 Taylor DM, Bradley JA, Bradley C, Draper H, Dudley C, Fogarty D, et al. Limited health literacy is associated with reduced access to kidney transplantation. Kidney Int 2019;95(5):1244-52. https://doi.org/10.1016/j.kint.2018.12.021 https://doi.org/10.1016/j.kint.2018.12.0...
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To investigate the relationship between limited health literacy and clinical outcomes, including access to kidney transplantation. |
Limited health literacy was not associated with mortality, late presentation to nephrology, dialysis modality, vascular access for hemodialysis, or preventive kidney transplant list. Still, it was associated with a reduced probability of waiting for a deceased donor transplant, receiving a kidney transplant from a living donor or receiving a transplant from any donor. |
Randomized clinical trial |
Waterman et al. (2019)2525 Waterman AD, Peipert JD, McSorley A-M, Goalby CJ, Beaumont JL, Peace L. Direct delivery of kidney transplant education to black and low-income patients receiving dialysis: a randomized controlled trial. Am J Kidney Dis. 2019;74(5):640-9. https://doi.org/10.1053/j.ajkd.2019.03.430 https://doi.org/10.1053/j.ajkd.2019.03.4...
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To examine the effectiveness of two supplemental kidney transplant education approaches provided directly to patients. |
In intention-to-treat analyses, patients randomly assigned to educator- and patient-guided interventions had more significant knowledge gains than standard-of-care patients who received transplant education provided by dialysis centers (control). Patients with educator- and patient-guided interventions could make informed decisions about initiating transplant evaluation, followed by deceased-donor and living-donor transplantation. |
Interventional, non-randomized study |
Waterman et al. (2020)2626 Waterman AD, Peipert JD, Xiao H, Goalby CJ, Kawakita S, Cui Y, et al. Education strategies in dialysis centers associated with increased transplant wait-listing rates. Transplantation 2020;104(2):335-42. https://doi.org/10.1097/TP.0000000000002781 https://doi.org/10.1097/TP.0000000000002...
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To identify the most common transplant education practices and barriers to education among dialysis units and examine the association of practices with increased transplant waiting list rates. |
Of the educators, 52% orally recommended transplantation to patients, 31% had in-center discussions about transplantation with patients, 17% distributed printed educational resources, and 3% used intensive education approaches. The distribution of print education and the practice of intensive education were associated with increased waitlist rates. Educators with greater knowledge about transplantation were more likely to use intensive educational strategies, while those with poor communication with transplant centers were less likely to do so. |
Retrospective, cross-sectional study |
Jesse et al. (2019)3030 Jesse MT, Eshelman A, Christian T, Abouljoud M, Denny J, Patel A, et al. Psychiatric profile of patients currently listed for kidney transplantation: evidence of the need for more thorough pretransplant psychiatric evaluations. Transplant Proc 2019;51(10):3227-33. https://doi.org/10.1016/j.transproceed.2019.08.035 https://doi.org/10.1016/j.transproceed.2...
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To report the frequency of psychiatric and cognitive pathologies and the corresponding psychiatric recommendations in a sample of patients actively listed for kidney transplantation. |
Among the analyzed charts, 52.4% of the patients showed cognitive impairment, and 28.9% indicated limited health literacy. |
Methodological study |
Peipert et al. (2019)3232 Peipert JD, Hays RD, Kawakita S, Beaumont JL, Waterman AD. Measurement characteristics of the knowledge assessment of renal transplantation. Transplantation 2019;103(3):565-72. https://doi.org/10.1097/TP.0000000000002349 https://doi.org/10.1097/TP.0000000000002...
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To describe the development and psychometric performance of the Knowledge Assessment of Renal Transplantation (KART) scale. |
Construct validity was supported by the ability of the KART psychometric test to distinguish between patients who spent less than 1 and 1 hour or more receiving different types of education about kidney transplantation, including conversations with physicians/medical staff, reading brochures, surfing the internet, and watching videos. |