title: Identifying and addressing barriers to African American and non-African American families' discussions about preemptive living related kidney transplantation.
abstract: BACKGROUND
  Ethnic/racial minority and nonminority families' perceived barriers to discussing preemptive living related kidney transplantation (LRKT) and their views on the potential value of health care professionals trained to address barriers are unknown. OBJECTIVE, SETTING, AND PARTICIPANTS: To collect pilot data for evaluating perceived barriers to preemptive LRKT and to inform the development of a culturally sensitive intervention to improve families' consideration of LRKT. In 4 structured group interviews of African American and non-African American patients (2 groups) with progressing chronic kidney disease and their family members (2 groups), participants' perceived barriers to initiating LRKT discussions and their views regarding the value of social workers to support discussions were explored.
  
  
  RESULTS
  Patients' barriers included concerns about their (1) ability to initiate discussions, (2) discussions being misinterpreted as donation requests, (3) potential burdening of family members, (4) uncertainty about when to initiate discussions, and (5) inducing guilt or coercing family members. Family members' barriers included (1) feeling overwhelmed by patients' illness, (2) patients' denial about their illness, (3) caregiver stress, and (4) uncertainty about their own health or the health of other family members who might donate or need a kidney in the future. Participants reported that social workers could facilitate difficult or awkward discussions and help families understand the LRKT process, address financial concerns, and cope emotionally. Themes were similar between African Americans and non-African Americans.
  
  
  CONCLUSIONS
  Families identified several barriers to discussing preemptive LRKT that could be addressed by social workers. Further research must be done to determine whether social workers need to tailor interventions to address families' cultural differences.
authors: Division of General Internal Medicine and Welch Center for Prevention, Epidemiology and Clinical Research, 2024 E. Monument Street, Suite 2-600, Baltimore, MD 21287, USA. lboulwa@jhmi.edu
authors: L Ebony
authors: LE
authors: Boulware
authors: Felicia
authors: F
authors: Hill-Briggs
authors: Edward S
authors: ES
authors: Kraus
authors: J Keith
authors: JK
authors: Melancon
authors: Mikiko
authors: M
authors: Senga
authors: Kira E
authors: KE
authors: Evans
authors: Misty U
authors: MU
authors: Troll
authors: Patti
authors: P
authors: Ephraim
authors: Bernard G
authors: BG
authors: Jaar
authors: Donna I
authors: DI
authors: Myers
authors: Raquel
authors: R
authors: McGuire
authors: Brenda
authors: B
authors: Falcone
authors: Bobbie
authors: B
authors: Bonhage
authors: Neil R
authors: NR
authors: Powe
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D015142:Baltimore; D003144:Communication Barriers; D054521:Cultural Competency; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011368:Professional-Family Relations; D012947:Social Work; D009927:Tissue and Organ Procurement