Excluding patients from transplant due to social support: Results from a national survey of transplant providers
Autor: | Joanna Emerson, Norman Daniels, Zeeshan Butt, Elisa J. Gordon, Keren Ladin, Douglas W. Hanto, Tara A. Lavelle, Kelsey N. Berry |
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Rok vydání: | 2018 |
Předmět: |
United Network for Organ Sharing
Male medicine.medical_specialty Health Knowledge Attitudes Practice Waiting Lists Decision Making Eligibility Determination 030230 surgery Article Odds 03 medical and health sciences Social support 0302 clinical medicine Risk Factors Surveys and Questionnaires medicine Immunology and Allergy Humans Pharmacology (medical) Healthcare Disparities Practice Patterns Physicians' Socioeconomic status Transplantation business.industry Patient Selection Social Support Health Status Disparities Quartile Social Class Family medicine Health Care Surveys Practice Guidelines as Topic Regression Analysis Female Listing (finance) business Psychosocial |
Zdroj: | American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons. 19(1) |
ISSN: | 1600-6143 |
Popis: | Social support is used to determine transplant eligibility despite lack of an evidence base and vague regulatory guidance. It is unknown how many patients are disqualified from transplantation due to inadequate support, and whether providers feel confident using these subjective criteria to determine eligibility. Transplant providers (n = 551) from 202 centers estimated that, on average, 9.6% (standard deviation = 9.4) of patients evaluated in the prior year were excluded due to inadequate support. This varied significantly by United Network for Organ Sharing region (7.6%-12.2%), and by center (21.7% among top quartile). Significantly more providers used social support in listing decisions than believed it ought to be used (86.3% vs 67.6%). Nearly 25% believed that using social support in listing determinations was unfair or were unsure; 67.3% felt it disproportionately impacted patients of low socioeconomic status. Overall, 42.4% were only somewhat or not at all confident using social support to determine transplant suitability. Compared to surgical/medical transplant providers, psychosocial providers had 2.13 greater odds of supporting the criteria (P = .03). Furthermore, 69.2% supported revised guidelines for use of social support in listing decisions. Social support criteria should be reconsidered in light of the limited evidence, potential for disparities, practice variation, low provider confidence, and desire for revised guidelines. |
Databáze: | OpenAIRE |
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