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Mistrust, misperceptions, and miscommunication: a qualitative study of
preferences about kidney transplantation among African Americans
#MMPMID25769556
Wachterman MW
; McCarthy EP
; Marcantonio ER
; Ersek M
Transplant Proc
2015[Mar]; 47
(2
): 240-6
PMID25769556
show ga
BACKGROUND: Kidney transplantation rates in the United States are lower among
African Americans than among whites. Well-documented racial disparities in access
to transplantation explain some, but not all, of these differences. Prior
survey-based research suggests that African American dialysis patients are less
likely than whites to desire transplantation, but little research has focused on
an in-depth exploration of preferences about kidney transplantation among African
Americans. Thus, the purposes of this study were to explore preferences and to
compare patients' expectations about transplantation with actual status on the
transplant list. METHODS: We conducted semistructured interviews with 16 African
Americans receiving chronic hemodialysis. We analyzed the interviews using the
constant comparative method of qualitative analysis. We also reviewed the
dialysis center's transplant list. RESULTS: Four dominant themes emerged: (1)
varied desire for transplant; (2) concerns about donor source; (3) barriers to
transplantation; and (4) lack of communication with nephrologists and the
transplantation team. A thread of mistrust about equity in the transplantation
process flowed through themes 2-4. In 7/16 cases, patients' understanding of
their transplant listing status was discordant with their actual status.
CONCLUSIONS: Our study suggests that many African Americans on hemodialysis are
interested in kidney transplantation, but that interest is often tempered by
concerns about transplantation, including misconceptions about the risks to
recipients and donors. Mistrust about equity in the organ allocation process also
contributed to ambivalence. The discordance between patients' perceptions of
listing status and actual status suggests communication gaps between African
American hemodialysis patients and physicians. Clinicians should avoid
interpreting ambivalence about transplantation as lack of interest.
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