title: Physicians' beliefs about racial differences in referral for renal transplantation.
abstract: BACKGROUND
  Black patients with end-stage renal disease are much less likely than white patients to undergo renal transplantation, but previous research has shown that black patients are only slightly less likely to desire this procedure. A better understanding of physicians' views about racial differences in access to transplantation may help reduce disparities in care.
  
  
  METHODS
  We surveyed 278 nephrologists in 4 US regions about quality of life and survival for black and white patients undergoing renal transplantation and reasons for racial differences in access to transplantation. We also surveyed 606 of their patients about their care.
  
  
  RESULTS
  Physicians were less likely to believe transplantation improves survival for blacks than whites (69% versus 81%; P = 0.001), but similarly likely to believe it improves quality of life (84% versus 86%). Factors commonly cited by physicians as important reasons why blacks are less likely than whites to be evaluated for transplantation included patients' preferences (66%), availability of living donors (66%), failure to complete evaluations (53%), and comorbid illnesses (52%). Fewer physicians perceived patient-physician communication and trust (38%) or physician bias (12%) as important reasons. Black patients were less likely than white patients to report receiving some or a lot of information about transplantation (55% versus 74%; P = 0.006) when their physicians did not view patient-physician communication and trust as an important reason for racial differences in care.
  
  
  CONCLUSIONS
  Nephrologists' views about the benefits of renal transplantation and reasons for racial differences in access to this procedure may affect how they present this treatment option to black and white patients.
authors.affiliation: Department of Medicine, Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA. ayanian@hcp.med.harvard.edu
authors.forename: John Z
authors.initials: JZ
authors.lastname: Ayanian
authors.forename: Paul D
authors.initials: PD
authors.lastname: Cleary
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Keogh
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Noonan
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: David-Kasdan
authors.forename: Arnold M
authors.initials: AM
authors.lastname: Epstein
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001213:Asian / Q000706:statistics & numerical data; D001291:Attitude of Health Personnel; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000208:ethnology* / Q000706:statistics & numerical data*; D008875:Middle Aged; D009398:Nephrology; D010342:Patient Acceptance of Health Care; D010817:Physician-Patient Relations; D011788:Quality of Life; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data