title: Understanding Patient Barriers to Kidney Transplant Evaluation.
abstract: BACKGROUND
  Some patients referred for kidney transplant evaluation fail to attend the visit. Our goal was to compare demographic, socioeconomic, and psychologic factors between evaluation visit attendees and absentees.
  
  
  METHODS
  A convenience sample of patients referred and scheduled for kidney transplant evaluation at a single center from November 2012 to December 2013 participated in a phone survey reporting socioeconomic, demographic, and clinical characteristics; health literacy; and perceived knowledge and concerns about transplantation. Absentees were matched by race with attendees. Analyses of differences between groups were performed with chi-square test, Fisher exact test, and t tests. Multivariable logistic regression was adjusted for relevant demographic characteristics.
  
  
  RESULTS
  One hundred four adults participated (61% men, 46% white, 52 ± 12 years). Financial concerns were the most prevalent (67.3% affording medication, 64.1% affording operation). Previous evaluation at a different transplant center (P = 0.029) and being on dialysis (P = 0.008) were significantly associated with absence. Attendance was associated with concerns about finding a living donor (P = 0.038) and higher perceived general knowledge about transplantation (P ≤ 0.001). No differences were appreciated in demographic, socioeconomic, or health literacy factors between groups.
  
  
  CONCLUSIONS
  Both attendee and absentee patients were most concerned with the financial burden of kidney transplantation. Although concerns and perceived knowledge are important correlates of behavior, other considerations such as psychologic factors and prior medical experiences may influence patients' ability to complete the kidney transplant evaluation process. Although this pilot study was conducted in a small sample and has limited generalizability, our findings can guide future research.
authors.affiliation: 1 Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN. 2 Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. 3 University of Tennessee Health Science Center, Memphis, TN. 4 Division of Nephrology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN. 5 Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Dageforde
authors.forename: Amanda
authors.initials: A
authors.lastname: Box
authors.forename: Irene D
authors.initials: ID
authors.lastname: Feurer
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Cavanaugh
mesh_terms: D000041:Absenteeism; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery*; D016030:Kidney Transplantation / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009042:Motivation; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D010361:Patients / Q000523:psychology*; D010465:Perception; D010865:Pilot Projects; D012307:Risk Factors; D012959:Socioeconomic Factors; D014850:Waiting Lists