Perceptions of Hispanic Patients With Advanced CKD About Communication and Engagement Regarding Kidney Transplantation: A Qualitative Study.

RATIONALE &

OBJECTIVE

Barriers in access to kidney transplantation (KT) for Hispanic patients with advanced chronic kidney disease (CKD) are often attributed to spoken languages different from those of their health care providers. Effective communication, however, is not limited to language, and involves consideration of social context and background; if successful, it can lead to better engagement. Understanding patients' perspectives on communication and engagement with their providers regarding KT may inform clinical practice, and this was the objective of the present study.

STUDY

DESIGN

Cross-sectional qualitative study.

SETTING &

PARTICIPANTS

Hispanic individuals with advanced CKD who identified Spanish as their primary language.

ANALYTICAL APPROACH: Bilingual staff members conducted 1:1 semistructured interviews using a guide based on published literature on health care disparities. Berlo's communication framework was used to guide analysis of the interviews.

RESULTS

Twenty participants from 5 states (age, 57 ± 11 years; 50% female) were interviewed; 18 were receiving maintenance dialysis, and 11 had diabetes. Participants reported that communication regarding eligibility for KT and the KT process was insufficient to make an informed decision, especially when the information was provided outside of the transplant clinic setting. During the discussions of treatment options with their clinical providers, participants experienced inadequate consideration of their socioemotional well-being. Participants often believed health care providers did not provide sufficient information. Although discordance in spoken language between patients and clinicians was a barrier, it was largely mitigated by interpreters.

LIMITATIONS: Lack of representation from all parts of the country.

CONCLUSIONS

This study identified several areas of suboptimal patient-provider communication and patient engagement for Hispanic patients with advanced CKD. These findings may inform strategies to improve communication and patient engagement, thereby addressing barriers to access to KT for Hispanic patients.

PLAIN-LANGUAGE SUMMARY: Effective communication involves consideration of social context and background and can affect patient engagement with and understanding of treatment options. This study solicited perspectives on communication and engagement about barriers to kidney transplantation (KT) among Spanish-speaking Hispanic patients. Twenty Hispanic patients with advanced chronic kidney disease from 5 states were interviewed. These study participants reported that communication regarding eligibility for KT and the KT process was insufficient to make informed decisions about transplant options. They also reported that clinical providers did not adequately discuss all treatment options or fully consider patients' socioemotional well-being. Patients reported often feeling fearful or discouraged after these conversations. Although differences in spoken language between patients and clinicians was a barrier, it was largely overcome by interpreters. These findings may inform strategies to improve communication and patient engagement, thereby addressing barriers to access to KT for Hispanic patients.