Does this patient still want a kidney transplant? Changing treatment preferences among African Americans on the kidney transplant waiting list

Abstract

Poster: TH-PO1147 African Americans spend substantial time on the kidney transplant waiting list. However, it is not known if their desires to receive transplants change while waiting for a kidney. Background: African Americans spend substantial time on the kidney transplant waiting list. However, it is not known if their desires to receive transplants change while waiting for a kidney. Methods: We studied self-reported treatment preferences among 300 African Americans on the deceased donor kidney transplant waiting list. Using a standard questionnaire, we listed each treatment option and asked, “As of today, which treatment option for kidney failure do you prefer?” We considered participants preferences as concordant (preference for kidney transplant) or discordant (preference for non-transplant treatment). We also measured participants’ decisional conflict using the validated Decisional Conflict Scale (DCS), including subscales assessing the role of information, value clarity, support, uncertainty, and perceived decision effectiveness in decisional conflict. In multivariable analyses adjusting for participant demographics and history of nephrology care, we quantified associations between decisional conflict and discordant treatment preferences. Results: Participants’ mean (SD) age was 52 (11) years, 56% were male, 18% were in or near poverty, 39% had a high school education or less, and their median (IQR) waitlist time was 0.8 (0.2-1.9) years. Most were undergoing dialysis (82%). Fewer than half (44%) had concordant treatment preferences, while 30% preferred in-center hemodialysis, 4% home hemodialysis, 11% peritoneal dialysis, 9% conservative management, and 1% were unsure. Most (63%) had at least some decisional conflict (score >0 on the DCS [range 0-100]). After adjustment, participants with conflict about the clarity of their values (OR [95% CI]: 1.72 [1.0-2.94], p<0.05) and about their ability to make an effective decision (OR [95% CI]: 2.06 [1.06-4.01], p<0.05) had statistically significant greater odds of discordant treatment preferences. Conclusions: When provided with a range of potential treatment options, many African Americans on the kidney transplant waiting list stated that a kidney transplant was not their preferred therapy. Screening for decisional conflict among patients on the waiting list may help identify those who need further decision support.