Low-income or racial/ethnic minority dialysis patients (low-income/minority) are less likely to receive transplant education and, ultimately, kidney transplant. We conducted a mixed-methods study with 4 focus groups (n=48) and surveys (n=68) to explore dialysis providers' insights about barriers to transplant education and pursuit for this group. Focus group transcripts were coded for common themes and survey items' mean responses and frequencies were calculated.

Most providers were non-Hispanic White (91%) nurses and social workers, practicing in Midwestern states, with >58% of their transplant-referral candidates belonging to low-income/minority groups. Providers identified transplant education as an important priority (96%). However, they reported facilitating detailed discussions (>15 min) with only 23% of their patients as well as variability in their transplant education practices: “we just kind of do whatever we do” and “many times [patients] may be given a pamphlet and a phone number [without] much follow up.” Providers endorsed many known objective patient barriers (e.g. limited access to transportation), but, when asked about low-income/minority groups, they revealed unanticipated patterns of implicit bias (a subconscious judgment/behavior that associates an object to its evaluation): “Especially in mid-Missouri, not to be biased but, 90% of our patients have no sophisticated knowledge of risk benefit assessment”; “their family members are on dialysis [[hellip]] There's [no living donor] candidate”; “They don't want the surgery, they've been doing great on dialysis”; “I think everybody should get to have a transplant but if they're not going to take care of it then what's the point?” Though unintentional, implicit bias and variability in education practices further disadvantages low-income/minority patients' transplant pursuit.

Systematizing transplant education would minimize providers' ability to be selective when delivering education, and ensure that all patients have access, regardless of income or race/ethnicity. Future work must continue to explore other providers' biases, as well as patients' biases, and how they affect transplant education and pursuit.

CITATION INFORMATION: Gonzalez C, McSorley A.-M, Peipert J, Norris K, Goalby C, Peace L, Lutz P, Waterman A. Implicit Bias in Dialysis Providers' Transplant Education Practices for Low-Income and Racial/Ethnic Minority Patients. Am J Transplant. 2016;16 (suppl 3).

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