Using SDOH to Predict PROs in the Kidney Transplant Process

October 26, 2020
AJMC Staff
AJMC Staff

Understanding patients’ social determinants of health (SDOH), including their past experiences with discrimination and medical mistrust, can help improve patient-reported outcomes (PROs), according to new research.

Certain social determinants of health (SDOH) predict patient-reported outcomes (PROs) in potential kidney transplant, according to a study presented during the American Society of Nephrology Kidney Week.

The findings can help inform transplant teams’ knowledge of these issues in order to improve the experience of these patients, according to researchers.

Research has shown that health-related quality of life (HRQOL) pretransplant predicts both the receipt of a kidney transplant for those with end-stage renal disease (ESRD) as well as mortality post transplant. While SDOH are known to affect clinical outcomes, less is known about how they predict PROs in patients with ESRD before a transplant.

In a prospective cohort study, researchers assessed whether SDOH in the time period shortly after beginning the transplant evaluation process are risk or protective factors for PROs in the time period after being notified of the evaluation outcome (ie, accepted or rejected for transplant), controlling for evaluation outcome.

Of the initial 1152 adults referred for a transplant evaluation between 2010 and 2012, 955 participants completed the second interview, most within 1 year of the transplant evaluation (70% within 6 months, 8% within 6 months up to 12 months, and 22% past 12 months).

To measure satisfaction with the kidney transplant clinic service, researchers assessed participants with the Physical Composite Score (PCS), Mental Health Composite Score (MCS), and Kidney Summary Score (KSS), from the Kidney Disease Quality of Life Short Form (KDQoL-SF) to measure HRQOL, and the Client Satisfaction Questionnaire.

Factors that predicted worse physical, mental, and kidney-related QOL included patients’ experience of discrimination in a medical setting, greater depressive symptoms, and a lower sense of mastery (or control over the forces that affect one's life).

Lower levels of patient-reported medical mistrust predicted greater patient satisfaction with clinical services.

Transplant clinics should consider identifying and reaching out to patients with a low sense of mastery, greater depressive symptoms, or an increased sense of medical mistrust, with additional psychosocial support to improve PROs during the transplant evaluation process, the authors said.

“Transplant teams can use knowledge of how these key social determinants of health predict patient-reported outcomes to improve the experience of patients with kidney failure undergoing transplant evaluation,” said Samuel Swift, PhD, at the University of New Mexico, Albuquerque, in a statement.

Reference

Swift SL, Wang S, Chang C-CH, Pleis JR, et al. Do social determinants of health predict patient-reported outcomes in transplant-eligible ESRD patients? Presented at: American Society of Nephrology Kidney Week. Abstract SU-OR43.