Kim Ellie, Sung Hannah C, Kaplow Katya, Bendersky Victoria, Sidoti Carolyn, Muzaale Abimereki D, Akhtar Jasmine, Levan Macey, Esayed Suad, Khan Amir, Mejia Christina, Al Ammary Fawaz
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA.
Kidney Int Rep. 2024 May 15;9(8):2453-2461. doi: 10.1016/j.ekir.2024.05.009. eCollection 2024 Aug.
Living kidney donor evaluation is a lengthy and complex process requiring in-person visits. Access to transplant centers, travel costs, lost wages, and dependent care arrangements are barriers to willing donors initiating evaluation. Telemedicine can help streamline and epedite the evaluation process. We aimed to deeply understand donor experiences and preferences using hybrid telemedicine video/in-person visits to ease access to donor evaluation or counseling.
We conducted in-depth, semistructured interviews with donors or donor candidates who completed their evaluation through telemedicine/in-person, or in-person only visits at a tertiary transplant center between November 27, 2019 and March 1, 2021. Enrollment continued until data saturation was reached (interviews with 20 participants) when no new information emerged from additional interviews. Transcripts were analyzed using inductive thematic analysis.
Eight themes were identified as follows: (i) reducing financial and logistical burdens (minimizing travel time and travel-related expenses), (ii) enhancing flexibility with scheduling (less time off work and child or family caregiver arrangements), (iii) importance of a walkthrough and establishing shared understanding, (iv) supporting information with technology and visual aids, (v) key role of the coordinator, (vi) preferred visit by provider role (meeting donor surgeon in-person to create rapport and engaging primary care provider in donor evaluation/follow-up), (vii) comparing modality differences in human connection, and (viii) opportunity for family and support network engagement (allowing loved ones to be involved in telemedicine visits irrespective of geographic locations and pandemic restrictions).
Telemedicine/in-person hybrid model can make donor evaluation more accessible and convenient. Our findings help inform about determinants that influence the adoption of telemedicine to initiate donor evaluation to motivate willing donors. In addition, our results call for policy and legislation that support telemedicine services for living donor kidney transplantation across states.
活体肾供体评估是一个漫长而复杂的过程，需要进行面对面的问诊。前往移植中心的交通便利性、交通成本、工资损失以及家属照料安排等，都是有意成为供体者启动评估的障碍。远程医疗有助于简化和加快评估流程。我们旨在通过远程医疗视频/面对面混合问诊，深入了解供体的经历和偏好，以便利供体评估或咨询。
我们对在2019年11月27日至2021年3月1日期间，通过远程医疗/面对面或仅通过面对面方式在一家三级移植中心完成评估的供体或供体候选人进行了深入的半结构化访谈。招募工作持续进行，直至达到数据饱和（对20名参与者进行访谈），即额外访谈未产生新信息。使用归纳主题分析法对访谈记录进行分析。
确定了八个主题，如下：（i）减轻经济和后勤负担（减少出行时间和与出行相关的费用），（ii）提高日程安排的灵活性（减少工作请假时间以及儿童或家庭照料安排），（iii）预演和达成共同理解的重要性，（iv）利用技术和视觉辅助工具提供信息，（v）协调员的关键作用，（vi）根据提供者角色选择偏好的问诊方式（与供体外科医生进行面对面交流以建立融洽关系，并让初级保健提供者参与供体评估/随访），（vii）比较不同问诊方式在人际联系方面的差异，以及（viii）让家人和支持网络参与的机会（允许亲人无论地理位置和疫情限制如何都能参与远程医疗问诊）。
远程医疗/面对面混合模式可使供体评估更易于进行且更加便捷。我们的研究结果有助于了解影响采用远程医疗启动供体评估以激励有意成为供体者的决定因素。此外，我们的研究结果呼吁出台政策和立法，以支持各州开展活体肾移植的远程医疗服务。
