Laura McPherson|Reem E. Hamoda|Rachel E. Patzer
Measuring Patient Knowledge of Kidney Transplantation: An Initial Step to Close the Knowledge Gap
Emory University|Emory University|Emory University|Emory Healthcare
kidney transplantation preferred treatment modality majority patients endstage renal disease esrd nevertheless widely recognized disparities access required steps preceding receipt kidney transplant including provision patient transplant education1 limited transplant knowledge2 variability administration patient transplant education found contribute disparities access transplantation3 furthermore research demonstrated greater emphasis development transplant education interventions improve patient knowledge informed decision making esrd treatment options45 however literature lacking appropriate measures examine efficacy interventions improving esrd patient transplant knowledge early transplant process although validated scale exists assess knowledge kidney transplantation among waitlisted candidates recipients6 tool yet validated among esrd patients waitlist population likely lower transplant knowledge challenging know whether current researcherdeveloped metrics appropriately measuring transplant knowledge patients across transplant care continuum scales assessed validity reliability using transplant candidate recipient populations may generalizable measuring intended constructs ie transplant knowledge among esrd patients yet reach kidney transplant waitlist example administering kinds transplant knowledge scales may result overestimates patient knowledge early transplant process resulting missed opportunities prompt targeted patient education furthermore examining efficacy education interventions improving patient transplant knowledge many target patients waitlisting would beneficial researchers use validated scale also used patients early steps ultimately would reduce bias interpreting results allow researchers compare results across study sites kidney disease populations improve researchers ability identify interventions greatest effect improving patient transplant knowledge turn access kidney transplantation study peipert et al months transplantation aimed investigate validity reliability newly developed knowledge assessment renal transplantation kart scale measuring transplant knowledge among adult esrd patients early steps transplant process dialysis patients yet evaluated kidney transplantation esrd patients presenting evaluation transplant center7 scale items developed assessed clinical relevance validity comprehension multidisciplinary team kidney disease experts including panel dialysis patients transplant recipients using extensive psychometric analyses survey data collected 2 prior studies 15item kart scale administered authors found evidence acceptable scale reliability marginal reliability 075 furthermore statistically significant differences kart tscores patients received various lengths transplant education multiple interventions provided evidence validity supporting karts use among dialysis patients patients presenting transplant evaluation valid reliable scales kart could vital tools assessing transplant knowledge earlier steps transplant process allowing timely targeted education dialysis facility level kart scores could give providers early indication patients would benefit targeted transplant education enrollment peer mentoring program access transplant education videos dialyzing extend beyond facility requirements mandated centers medicare medicaid services knowledge assessment renal transplantation could also administered esrd patients presenting evaluation transplant center intervene patients undecided regarding available treatment options ensure patients appropriately educated transplant providers could risk stratify patients based kart scores provide targeted interventions including shared decision aids access webbased tools additional educational resources low knowledge several limitations kart addressed first unknown whether high kart scores associated increased access transplantation absence examining efficacy educational intervention future studies needed examine correlations kart scores quantifiable transplant access outcomes justify use educational interventions aimed increase transplant knowledge second educational level required patients complete kart unknown despite documented low health literacy among esrd patients8 third unclear well scale performs testing patients repeatedly testretest reliability data used psychometric analyses include patients completed kart longitudinally evidence needed confirm meaningful changes knowledge measured kart attributable random error given tools intended use measuring efficacy transplant education interventions9 fourth appropriate kidney patient population target administration kart fully known although dialysis patients transplant evaluation patients included analysis cohort populations likely differ considerably underlying transplant knowledge additionally kart tested patients latestage ckd among transplant candidates recipients finally study assess karts performance administered dialysis facility staff despite evidence suggesting low transplant knowledge among providers10 overall kart relevant tool kidney disease community help identify gaps patient transplant knowledge make informed decisions implementation interventions patients low transplant knowledge early stages transplant process dialysis transplant facilities consider using kart respective institutions increase provider awareness range transplant knowledge among patient population identify step transplant process patients need additional educational resources knowledge assessment renal transplantation could help inform use targeted educational interventions supplement routine patient care may improve access kidney transplant