Living donor kidney transplantation among ethnic minorities in the Netherlands: A model for breaking the hurdles

• Published in: Patient education and counseling 2013-01, Vol.90 (1), p.118-124
• Main Authors: Ismail, Sohal Y, Claassens, Lily, Luchtenburg, Annemarie E, Roodnat, Joke I, Zuidema, Willij C, Weimar, Willem, Busschbach, Jan J.V, Massey, Emma K
• Format: Article
• Language: English
• Subjects: Adult; Aged; Attitude to Health; Attitudes; Communication; Cultural aspects; Culture; Decision Making; Emotions; Ethnic Groups - psychology; Ethnicity; Female; Focus Groups; Grounded theory; Home based; Humans; Internal Medicine; Interviews as Topic; Kidney; Kidney Failure, Chronic - ethnology; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - surgery; Kidney transplantation; Kidney Transplantation - ethnology; Kidney Transplantation - psychology; Kidneys; Living Donors; Male; Middle Aged; Netherlands; Nursing; Patient education; Patient Education as Topic; Socioeconomic Factors; Tissue and Organ Procurement; Young Adult
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2012.08.004

Abstract Objective Despite living donor kidney transplantation (LDKT) being the optimal treatment option for patients with end-stage renal disease, we observed a significant inequality in the number of LDKT performed between patients of Dutch versus non-Dutch descent. We conducted a focus group study to explore modifiable hurdles to LDKT. Methods Focus group discussions and in-depth interviews were conducted among 50 end-stage renal patients. Analyses were conducted according to ‘grounded theory’ using Atlas.ti. Results We found nearly all patients to be in favor of LDKT (96%). However, multiple factors played a role in considering LDKT. Four potentially modifiable hurdles were derived: (1) inadequate patient education, (2) impeding cognitions and emotions, (3) restrictive social influences, and (4) suboptimal communication. With regard to solutions, we found that our patients were open to home-based group education on renal replacement therapy options (88% in favor). Conclusion The study highlights the need for sensitivity and awareness of the influence of cultural factors on decision-making when discussing living donation with culturally diverse populations. Practice implications Since the majority of our patients were open to a tailored group education in their own homes, we see this as an opportunity to address factors that influence equality in access to LDKT.