Article Text
Abstract
Background National guidelines require programmes use subjective assessments of social support when determining transplant suitability, despite limited evidence linking it to outcomes. We examined how transplant providers weigh the importance of social support for kidney transplantation compared with other factors, and variation by clinical role and personal beliefs.
Methods The National survey of the American Society of Transplant Surgeons and the Society of Transplant Social Work in 2016. Using a discrete choice approach, respondents compared two hypothetical patient profiles and selected one for transplantation. Conditional logistic regression estimated the relative importance of each factor; results were stratified by clinical role (psychosocial vs medical/surgical providers) and beliefs (outcomes vs equity).
Results Five hundred and eighy-four transplant providers completed the survey. Social support was the second most influential factor among transplant providers. Providers were most likely to choose a candidate who had social support (OR=1.68, 95% CI 1.50 to 1.86), always adhered to a medical regimen (OR=1.64, 95% CI 1.46 to 1.88), and had a 15 years life expectancy with transplant (OR=1.61, 95% CI 1.42 to 1.85). Psychosocial providers were more influenced by adherence and quality of life compared with medical/surgical providers, who were more influenced by candidates' life expectancy with transplant (p<0.05). For providers concerned with avoiding organ waste, social support was the most influential factor, while it was the least influential for clinicians concerned with fairness (p<0.05).
Conclusions Social support is highly influential in listing decisions and may exacerbate transplant disparities. Providers’ beliefs and reliance on social support in determining suitability vary considerably, raising concerns about transparency and justice.
- allocation of organs/tissues
- decision-making
- surgery
- social work
- social aspects
Statistics from Altmetric.com
Request Permissions
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Copyright information:
Read the full text or download the PDF:
Other content recommended for you
- A protocol for a discrete choice experiment: understanding preferences of patients with cancer towards their cancer care across metropolitan and rural regions in Australia
- Pancreas transplantation
- What factors are critical to attracting NHS foundation doctors into specialty or core training? A discrete choice experiment
- Eliciting patient preferences, priorities and trade - offs for outcomes following kidney transplantation: a pilot best – worst scaling survey
- A health economic model for the development and evaluation of innovations in aged care: an application to consumer - directed care — study protocol
- Patients ’ with obstructive sleep apnoea syndrome (OSAS) preferences and demand for treatment: a discrete choice experiment
- PROSpER: PReferences for the Organisation of acute health Services for oldER people: protocol for a mixed methods study
- Weekend versus weekday transplant surgery and outcomes after kidney transplantation in the USA: a retrospective national database analysis
- Impact of transplant pharmacists on length of stay and 30 - day hospital readmission rate: a single - centre retrospective cohort study
- Consumer preferences for electronic cigarettes: results from a discrete choice experiment