title: Effectiveness of educational and social worker interventions to activate patients' discussion and pursuit of preemptive living donor kidney transplantation: a randomized controlled trial.
abstract: BACKGROUND
  Many patients with chronic kidney disease (CKD) have difficulty becoming actively engaged in the pursuit of preemptive living donor kidney transplantation.
  
  
  METHODS
  The Talking About Live Kidney Donation (TALK) Study was a randomized controlled trial of the effectiveness of educational and social worker interventions designed to encourage early discussions and active pursuit of preemptive living donor kidney transplantation in patients with progressive CKD.
  
  
  METHODS
  We recruited participants with progressive CKD from academically affiliated nephrology practices in Baltimore, MD.
  
  
  METHODS
  Participants randomly received: (1) usual care (routine care with their nephrologists), the (2) TALK education intervention (video and booklet), or the (3) TALK social worker intervention (video and booklet plus patient and family social worker visits).
  
  
  RESULTS
  We followed participants for 6 months to assess their self-reported achievement of behaviors reflecting their discussions about and/or pursuit of living donor kidney transplantation (discussions with family, discussions with physicians, initiating recipient evaluation, completing recipient evaluation, and identifying a potential living donor).
  
  
  METHODS
  We assessed outcomes through a questionnaire at 1-, 3-, and 6-months follow-up.
  
  
  RESULTS
  Participants receiving usual care with their nephrologists (n = 44), TALK education (n = 43), and the TALK social worker (n = 43) were similar at baseline. TALK Study interventions improved participants' living donor kidney transplantation discussion and pursuit behaviors, with the social worker leading to greater patient activation (participants' predicted probability of achieving living donor kidney transplantation discussions, evaluations, or donor identification over 6 months): probabilities were 30% (95% CI, 20%-46%), 42% (95% CI, 33%-54%), and 58% (95% CI, 41%-83%), respectively, in the usual care, TALK education, and TALK social worker groups (P = 0.03).
  
  
  CONCLUSIONS
  Our population was well educated and mostly insured, potentially limiting generalizability of our findings.
  
  
  CONCLUSIONS
  TALK interventions improved discussion and active pursuit of living donor kidney transplantation in patients with progressive CKD and may improve their use of preemptive living donor kidney transplantation.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. lboulwa@jhmi.edu
authors.forename: L Ebony
authors.initials: LE
authors.lastname: Boulware
authors.forename: Felicia
authors.initials: F
authors.lastname: Hill-Briggs
authors.forename: Edward S
authors.initials: ES
authors.lastname: Kraus
authors.forename: J Keith
authors.initials: JK
authors.lastname: Melancon
authors.forename: Brenda
authors.initials: B
authors.lastname: Falcone
authors.forename: Patti L
authors.initials: PL
authors.lastname: Ephraim
authors.forename: Bernard G
authors.initials: BG
authors.lastname: Jaar
authors.forename: Luis
authors.initials: L
authors.lastname: Gimenez
authors.forename: Michael
authors.initials: M
authors.lastname: Choi
authors.forename: Mikiko
authors.initials: M
authors.lastname: Senga
authors.forename: Maria
authors.initials: M
authors.lastname: Kolotos
authors.forename: LaPricia
authors.initials: L
authors.lastname: Lewis-Boyer
authors.forename: Courtney
authors.initials: C
authors.lastname: Cook
authors.forename: Laney
authors.initials: L
authors.lastname: Light
authors.forename: Nicole
authors.initials: N
authors.lastname: DePasquale
authors.forename: Todd
authors.initials: T
authors.lastname: Noletto
authors.forename: Neil R
authors.initials: NR
authors.lastname: Powe
mesh_terms: D000368:Aged; D001294:Attitude to Health; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D051436:Renal Insufficiency, Chronic / Q000601:surgery*; D012947:Social Work; D009927:Tissue and Organ Procurement