INSPIRE: INterventionS for Promoting kIdney tRansplant Empowerment

(30 Lines) Modified Grant Title: INSPIRE: INterventionS for Promoting kIdney tRansplant Empowerment Kidney transplantation (KTx) is the preferred treatment for patients with end-stage kidney disease. Despite recent changes to the kidney allocation system some individuals are less likely to receive a KTx evaluation, a multi-step process requiring patient referral, patient medical/surgical/psychosocial evaluation, and patient waitlisting. As there are no standardized acceptable metrics for psychosocial evaluations, each of the steps is impacted by provider subjectivity and by multiple barriers that impede the completion of the KTx evaluation process leading to a fraction of patients with end-stage kidney disease listed for a KTx. We have identified barriers and facilitators to the evaluation and waitlisting for KTx including the lack of standardized evaluation criteria and patient barriers such as lack of support and financial concerns. To address these gaps, we propose a multi-level intervention in full partnership with an Executive Stakeholder Board and Workgroups comprised of patients, clinicians, caregivers, and system leaders for dialysis organizations and transplant centers. This work will be built on 2 decades of community-engaged research and trials to improve health in various patient populations. We will work with the Board to develop an intervention based on past work by our team and others, supplemented by formative interview with patients, caregivers, and clinicians. To increase rates of patients receiving KTx evaluation, community health workers who have a personal history of kidney disease will guide patients through the transplant evaluation process. This will include conducting a needs screen and addressing barriers uncovered, including facilitating appointments to address unmet needs such as food insecurity and transportation, control of symptoms and mental health challenges. To increase rates of waitlisting among those evaluated, we will identify subjective language from KTx providers notes and provide education on processes to ensure standardized and objective evaluations for nephrologists. We will evaluate the impact of this multifactorial intervention in a clinical trial among 336 adults with an eGFR <20 ml/min/1.73m2 or on in-center hemodialysis with a primary outcome of transplant waitlisting evaluation completion. Together, we will also develop a blueprint of how to conduct this work, so that it can be used nationally to improve KTx waitlisting and inform policies, systems and practices.