The Explore Transplant @ Home (ETH) randomized controlled trial assessed the efficacy of two supplementary education strategies for kidney transplant (KT) in dialysis centers: 1) ETH, a video-based, patient-guided program with mailed and texted content (ET-PG) and 2) ET-PG plus educator-guided telephonic coaching (ET-EG). Enrollment targeted low income (<250% of the federal poverty level) and Black patients.

A total of 561 patients were randomized to ET-EG (n=189), ET-PG (n=185), or standard of care (SOC, n=187). Of these, 369 (71% Black) were included in the per-protocol analysis (n=101 ET-EG, n=108 ET-PG, n=160 SOC). Exploratory analyses examined whether the effect of ET-EG or ET-PG differed by educational background (e.g., pro-transplant attitudes and self-efficacy, previous transplant education received, health literacy and education levels) and potential transplant derailers (financial stability, social support, medical mistrust).

In the primary analyses, ETH education conditions increased knowledge, steps taken toward KT, and self-efficacy in comparison to SOC. ET-EG more effectively increased the number of steps taken toward KT compared to SOC among patients with more than a high school education (1.1 steps, 95% CI: 0.3 – 1.9), while patients with a high school education or less had a reduced number of steps taken compared to SOC (-0.9, 95% CI: -1.6 – -0.2). ET-EG more effectively increased living donor KT (LDKT) self-efficacy for patients with insufficient social support (6.6 pts, 95% CI: 2.6 – 10.6) than for those with sufficient social support (0.2, 95% CI: -2.0 – 2.4), as well as for those with higher baseline perceived pros to LDKT (5.3, 95% CI: 2.3 – 8.2) than lower LDKT pros (-1.3, 95% CI: -3.9 – 1.2). ET-PG more effectively increased LDKT self-efficacy for patients with higher baseline transplant knowledge (4.3, 95% CI: 1.5 – 7.1) than for those with less knowledge (-1.7, 95% CI: -4.2 – 0.8).

Supplementary patient- and educator-guided transplant education to Black and lower socioeconomic status dialysis patients can increase their transplant knowledge, self-efficacy, and steps taken to pursue transplant, particularly for those who are more interested in transplant. Additional interventions should be explored to reach patients unaware of or less interested in transplant to ensure they are making informed decisions.

CITATION INFORMATION: Waterman A., Peipert J., Beaumont J. Efficacy of At-Home Transplant Education on Transplant Knowledge and Pursuit in Low-Income and Black Dialysis Patients with Varying Educational Characteristics Am J Transplant. 2017;17 (suppl 3).

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