The Centers for Medicare and Medicaid Services (CMS) requires that dialysis patients be informed of their transplant options. Compared to non-profit dialysis centers, for-profit centers counsel fewer patients about transplant and are less likely to involve family or friends. Less is known about differences in specific transplant education disseminated or covered within educational counseling sessions.

In a national transplant education training conducted with 1,695 adult, chronic U.S. dialysis centers in 2011-2015, we surveyed staff about their use of 15 center- and staff-level education approaches (e.g., designated transplant educator; providing handouts) and 4 barriers (e.g., insufficient time to educate). United States Renal Data System records were linked to determine centers' for-profit or non-profit status (ownership type), and to calculate their transplant wait-listing rates. Multilevel logistic and negative binomial regression models adjusted for staff and center characteristics were used to examine differences by ownership type in the use of transplant education practices and presence of barriers, and in wait-listing rates, respectively.

Participating dialysis centers were 84.7% for-profit and 13.8% were non-profit (1.5% undetermined). Compared to non-profit centers, for-profit centers were more likely to have a formal education program (OR=1.65, 95% CI: 1.20-2.28), have a designated transplant educator/team (OR=2.03, 95% CI: 1.50-2.73) and provide education yearly to all transplant candidates (OR=1.56, 95% CI: 1.11-2.17). However, for-profit centers were also more likely to report a lack of administrative support for education (OR=2.08; 95% CI: 1.20-3.60) and insufficient time to educate (OR=1.40; 95% CI: 1.02-1.92). While there were no differences by ownership type in the use of many education practices, for-profit centers were less likely to have detailed discussions about the risks/benefits of transplant (OR=0.73; 95% CI: 0.55-0.99). Notably, for-profit dialysis centers had lower wait-listing rates than non-profit centers (IRR=0.87, 95% CI: 0.76-0.99).

For-profit dialysis centers are more likely to have a systematic transplant education program that meets CMS requirements, but their staff report more barriers to providing comprehensive risk-benefit information, which may drive lower wait-listing rates. Future research must examine the higher prevalence of these barriers among for-profit dialysis centers.

CITATION INFORMATION: Waterman A, Peipert J, Xiao H, Goalby C, Lentine K. Barriers to Comprehensive Transplant Education at U.S. For-Profit Dialysis Centers and Associations with Waitlist Access. Am J Transplant. 2016;16 (suppl 3).

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