title: Perceptions about hemodialysis and transplantation among African American adults with end-stage renal disease: inferences from focus groups.
abstract: BACKGROUND
  Disparities in access to kidney transplantation (KT) remain inadequately understood and addressed. Detailed descriptions of patient attitudes may provide insight into mechanisms of disparity. The aims of this study were to explore perceptions of dialysis and KT among African American adults undergoing hemodialysis, with particular attention to age- and sex-specific concerns.
  
  
  METHODS
  Qualitative data on experiences with hemodialysis and views about KT were collected through four age- and sex-stratified (males <65, males ≥65, females <65, and females ≥65 years) focus group discussions with 36 African American adults recruited from seven urban dialysis centers in Baltimore, Maryland.
  
  
  RESULTS
  Four themes emerged from thematic content analysis: 1) current health and perceptions of dialysis, 2) support while undergoing dialysis, 3) interactions with medical professionals, and 4) concerns about KT. Females and older males tended to be more positive about dialysis experiences. Younger males expressed a lack of support from friends and family. All participants shared feelings of being treated poorly by medical professionals and lacking information about renal disease and treatment options. Common concerns about pursuing KT were increased medication burden, fear of surgery, fear of organ rejection, and older age (among older participants).
  
  
  CONCLUSIONS
  These perceptions may contribute to disparities in access to KT, motivating granular studies based on the themes identified.
authors.affiliation: Center on Aging and Health, Johns Hopkins University, Baltimore, MD, USA. meg@jhmi.edu.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA. meg@jhmi.edu.|Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. meg@jhmi.edu.|Johns Hopkins Medical Institutions, 720 Rutland Ave, Turner 034, Baltimore, MD, 21205, USA. meg@jhmi.edu.
authors.forename: Megan L
authors.initials: ML
authors.lastname: Salter
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. komalkumar91@gmail.com.|Johns Hopkins Medical Institutions, 720 Rutland Ave, Turner 034, Baltimore, MD, 21205, USA. komalkumar91@gmail.com.
authors.forename: Komal
authors.initials: K
authors.lastname: Kumar
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. alaw6@jhu.edu.|Johns Hopkins Medical Institutions, 720 Rutland Ave, Turner 034, Baltimore, MD, 21205, USA. alaw6@jhu.edu.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Law
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. ngupta21@jhmi.edu.|Johns Hopkins Medical Institutions, 720 Rutland Ave, Turner 034, Baltimore, MD, 21205, USA. ngupta21@jhmi.edu.
authors.forename: Natasha
authors.initials: N
authors.lastname: Gupta
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. ktmac209@gmail.com.|Johns Hopkins Medical Institutions, 720 Rutland Ave, Turner 034, Baltimore, MD, 21205, USA. ktmac209@gmail.com.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Marks
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. kamna.balhara@gmail.com.|Johns Hopkins Medical Institutions, 720 Rutland Ave, Turner 034, Baltimore, MD, 21205, USA. kamna.balhara@gmail.com.
authors.forename: Kamna
authors.initials: K
authors.lastname: Balhara
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA. mmcadam4@jhmi.edu.|Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. mmcadam4@jhmi.edu.|Johns Hopkins Medical Institutions, 720 Rutland Ave, Turner 034, Baltimore, MD, 21205, USA. mmcadam4@jhmi.edu.
authors.forename: Mara A
authors.initials: MA
authors.lastname: McAdams-DeMarco
authors.affiliation: Johns Hopkins University School of Nursing, Baltimore, MD, USA. laura.taylor@jhu.edu.|Johns Hopkins Medical Institutions, 720 Rutland Ave, Turner 034, Baltimore, MD, 21205, USA. laura.taylor@jhu.edu.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Taylor
authors.affiliation: Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA. dorry@jhmi.edu.|Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA. dorry@jhmi.edu.|Johns Hopkins Medical Institutions, 720 Rutland Ave, Turner 034, Baltimore, MD, 21205, USA. dorry@jhmi.edu.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D000367:Age Factors; D000368:Aged; D001294:Attitude to Health; D015142:Baltimore; D005260:Female; D017144:Focus Groups; D054625:Healthcare Disparities; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods / Q000523:psychology*; D008297:Male; D008396:Maryland; D008875:Middle Aged; D010465:Perception; D010817:Physician-Patient Relations; D036301:Qualitative Research; D011788:Quality of Life; D006435:Renal Dialysis / Q000379:methods / Q000523:psychology*; D018570:Risk Assessment; D012737:Sex Factors; D016896:Treatment Outcome