P11.19: System-Level Barriers to Living Donor Kidney Transplantation: A Cross-Sectional Survey Study of Health Professionals
Notice bibliographique
Résumé
Background and objectives: Living donor kidney transplantation (LDKT) is the preferred therapeutic option for patients with end-stage kidney disease and health professionals (HPs) can provide unique insights to improving the delivery of LDKT to patients. We aimed to quantify system-level barriers to LDKT that we have previously identified in our qualitative work and estimate their association with LDKT performance. We also aimed to determine if HP’s characteristics influenced responses and what HPs thought should be priorities to increase LDKT. Methods: We conducted a cross-sectional survey of Canadian health professionals (HPs) and asked participants to rate statements on a Likert scale of 1-5 (strongly disagree-strongly agree). Statements captured themes related to communication, role perception, education/training/comfort, attitudes, referral process, patient as the barrier, and resources/infrastructure. The percentage of participants who agreed with these statements was analyzed and compared by LDKT performance (provincial living donation rates higher versus lower than the national average) and HP characteristics. Results: We obtained 353 complete responses. Overall, themes related to poor communication, poor role perception and HPs education/training/comfort emerged as barriers to LDKT. When compared with HPs from high-performing provinces, those from low-performing provinces had lower odds of agreeing that their province promoted LDKT (aOR=0.27, 95%CI:0.16-0.48). They also had lower odds of initiating discussions about LDKT (aOR=0.30, 95%CI:0.17-0.55), higher odds of agreeing that the transplant team is best suited to discuss LDKT (aOR=2.64, 95%CI:1.60-4.33) and that more resources would increase LDKT discussions from them (aOR=2.06, 95%CI:1.25-3.40). When comparing responses by HP characteristics, non-physician role and <10 years of experience were associated with the level of agreement across several themes. Creating guidelines, streamlining evaluations, and improving communication were ranked as priorities to increase LDKT over patient education. Conclusion: Poor communication between treating teams, poor role perception and HPs lack of education/training/comfort emerged as system-level barriers to LDKT and even HPs themselves identified addressing system-level inefficiencies as priorities to increase LDKT over patient education. More importantly, we report that poor role perception, low resources, and poor infrastructure may be driving differences in LDKT performance in a real-world setting. Our findings have policy implications and can build on the current patient-level work that others are pursuing to increase LDKT. This work is supported by a Research Innovation Grant from the Canadian Donation and Transplant Research Program and 2021 Canada Summer Jobs competition from the Employment and Social Development of the Government of Canada.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,006 | 0,017 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,003 |
| Études des sciences et des technologies | 0,002 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».