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当评估肾移植中心时,患者更看重候补名单而不是移植后的结果。

Patients prioritize waitlist over posttransplant outcomes when evaluating kidney transplant centers.

机构信息

Department of Medicine, Division of Nephrology, Columbia University Vagelos College of Physicians & Surgeons, New York, NY, USA.

The Columbia University Renal Epidemiology (CURE) Group, New York, NY, USA.

出版信息

Am J Transplant. 2018 Nov;18(11):2781-2790. doi: 10.1111/ajt.14985. Epub 2018 Jul 30.

Abstract

Factors that patients value when choosing a transplant center have not been well studied. In order to guide the improvement of patient-facing materials, we conducted an anonymous electronic survey of patients that assessed the relative importance of patient experience, practical considerations, transplant center reputation, center experience, and waitlist when selecting a transplant center. A total of 409 respondents completed the survey, of whom 68% were kidney transplant recipients and 32% had chronic kidney disease or were on dialysis. Participants had mean age 56 ± 12 years and were predominantly female (61%), white (79%), and had an associate's degree or higher (68%). Participants most often prioritized waitlist when evaluating transplant centers (transplanted 26%, chronic kidney disease 40%), and waitlist was almost twice as likely as outcomes to be ranked most important (30% vs 17%). Education level and transplant status were significantly associated with factors used for center prioritization. Waitlisted respondents most commonly (48%) relied on physicians for information when selecting a center, while a minority cited transplant-specific organizations. In order to improve shared decision-making, materials outlining center-specific waitlist features should be prioritized. Novel patient-oriented metrics for measuring transplant center quality that align with patient priorities must be explored.

摘要

患者在选择移植中心时看重的因素尚未得到充分研究。为了指导面向患者材料的改进,我们对患者进行了一项匿名的电子调查,评估患者在选择移植中心时对患者体验、实际考虑因素、移植中心声誉、中心经验和等待名单的相对重要性。共有 409 名受访者完成了调查,其中 68%是肾移植受者,32%患有慢性肾脏病或正在接受透析。参与者的平均年龄为 56 ± 12 岁,主要为女性(61%)、白人(79%),且具有大专或以上学历(68%)。参与者在评估移植中心时最常优先考虑等待名单(移植患者中 26%,慢性肾脏病患者中 40%),且等待名单被列为最重要因素的可能性几乎是结果的两倍(30%比 17%)。教育程度和移植状况与中心优先排序因素显著相关。等待名单上的受访者在选择中心时最常(48%)依赖医生的信息,而少数人引用了移植特定的组织。为了改善共同决策,应优先考虑概述中心特定等待名单特征的材料。必须探索与患者优先事项一致的、以患者为导向的新的衡量移植中心质量的指标。

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