Date Approved

8-21-2017

Graduate Degree Type

Dissertation

Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing

First Advisor

Andrea Bostrom

Second Advisor

Janet Winter

Third Advisor

Joan Borst

Fourth Advisor

Kristine Todd

Abstract

Patients who are afforded the opportunity for a kidney transplant tend to have better short and long-term outcomes, including improved physical health, quality of life, and long-term survival over those who are treated with prolonged dialysis (Landreneau, Lee, & Landreneau, 2010; Organ Procurement and Transplantation Network and Scientific Registry of Transplant Recipients (OPTN/SRTR), 2014; Wolfe et al., 1999). At the end of 2012, 402,514 people were being treated with hemodialysis while 40,605 were receiving peritoneal dialysis (USRDS, 2014). At this same time, only 92,885 people were listed on the OPTN national waitlist for kidney transplantation. The aim of this project was to identify barriers that might delay or halt progress toward waitlist placement in a midwestern hospital transplant program.

A patient-focused survey was sent to 346 end stage renal disease patients referred to a kidney transplant center for a pre-transplant work-up in 2014. The survey collected demographic and health literacy data as well as data focused on patient concerns and attitudes toward kidney transplantation. Eighty-eight patients (30% response rate) completed and returned the survey (50% male, 78% White, and a mean age of 62). Data were evaluated in aggregate with further evaluation of data based on race and sex. The question “how confident are you filling out medical forms” was statistically significant (p = .002) for “sex” and “health literacy.” The greatest concerns were “length of time to wait for a kidney transplant” and issues inherent to “finding a living donor.” The survey prompt that “dialysis is not that bad” generated the most negative rating in the attitudes section of the survey.

Thirty-eight percent of respondents were identified as having limited health literacy (Short Literacy Survey [SLS] score 3-9). It is recommended that the SLS be added to initial patient screenings, with findings used to create an individualized care plan designed to assist patients through the pre-transplant evaluation. All patient educational materials need to be evaluated for ease of reading and grade level. Patient education materials must also be created to address specific patient identified barriers (e.g. long wait time for a kidney transplant, finding a living donor, coping with long-term dialysis).

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