THE IMPACT OF SOCIAL SUPPORT ON KIDNEY TRANSPLANT LISTING - PowerPoint PPT Presentation

THE IMPACT OF SOCIAL SUPPORT ON KIDNEY TRANSPLANT LISTING DECISIONS: RESULTS FROM A DISCRETE CHOICE EXPERIMENT Keren Ladin , PhD , MSc Assistant Professor Tufts University ARM 2017 Surgery and Perioperative Care Interest Group Meeting June 23, 2017

Acknowledgements Tara Lavelle , PhD Tufts Medical Center This project was generously Douglas Hanto , MD , PhD , Vanderbilt funded by the Greenwall Zeeshan Butt , PhD , Northwestern Foundation Elisa Gordon , PhD , MPH Northwestern Joanna Emerson , MPH , Tufts We greatly appreciate the Jennifer Perloff , PhD , Brandeis Meghan Olsen , BA , Tufts partnership of the ASTS , AST , Kelsey Berry, PhD Candidate, Harvard and STSW

Social Support in Transplantation CMS requirement : Assess Evidence - base for using and consider social support social support is equivocal in listing decisions with respect to medication Lack of consensus about adherence and post - definitions , process , transplant outcomes importance of this criterion S O C I A L S U P P O R T I N T R A N S P L A N T E V A L U A T I O N S : D I S C R E T E C H O I C E E X P E R I M E N T

Among high quality studies, neither social support nor marital status was predictive of medication adherence or post-transplant outcomes . Social support was not associated with medication adherence. It was associated with superior post-transplant outcomes, but the relationship was not significant among high quality studies. Compared to unmarried recipients, married recipients were more likely to adhere to medication post-transplant, but this relationship was not significant among high quality studies. Marital status was not significantly associated with transplant success. Social support is weakly and inconsistently associated with post- transplant adherence and outcomes.

D I S P A R I T I E S I N C L U S I O N D I S P A R I T I E S I N P A T I E N T O F S O C I A L I N A C C E S S T O E X P E R I E N C E V A L U E T R A N S P L A N T B E T W E E N J U D G E M E N T S F O R C E R T A I N C E N T E R S G R O U P S O F P A T I E N T S P O T E N T I A L C O N C E R N S W I T H " F U Z Z Y " C R I T E R I A

How important is social support to transplant clinicians in determining eligibility? 2 5 7 T A K E Y O U R B E S T G U E S S !

Examine how transplant clinicians weigh the importance of social support for kidney transplantation compared to other factors considered during listing Examine variation in perceived importance of this attribute by clinical role , and ethical beliefs . OBJECTIVES

Conjoint Analysis Stated preference method Originally developed for market analysis Estimation of the relative importance of different factors of a service PREFERENCE Value trade - offs between factors SURVEY Increasingly being used in health applications M E T H O D S

Discrete Choice Experiment Measures how clinicians weigh the importance of different factors PREFERENCE S T E P S T O C O N D U C T I N G D C E SURVEY Literature review and expert stakeholder panel Identify attributes & levels Vary levels to build profiles Ask respondents to evaluate choices Estimate preferences based on answers M E T H O D S

A T T R I B U T E S M E T H O D S

S T A T I S T I C A L A N A L Y S I S C O N D I T I O N A L L O G I S T I C R E G R E S S I O N Dependent variable : Yes / No transplant Independent variables : all transplant recipient factors shown in discrete choice C O N D I T I O N A L A T T R I B U T E I M P O R T A N C E F O R E A C H A T T R I B U T E I N T H E S U R V E Y O V E R A L L A N D S U B G R O U P S ( C L I N I C A L R O L E , E T H I C A L B E L I E F S ) M E T H O D S

S A M P L E S A M P L E N o n - r a n d o m s a m p l e : m e m b e r s h i p o f A S T S a n d S T S W s u r v e y e d i n f a l l 2 0 1 6 5 8 4 R e s p o n d e n t s p a r t i c i p a t e d i n t h e D C E 4 8 % i n v o l v e d i n p s y c h o s o c i a l e v a l u a t i o n s 4 4 % m a l e B a l a n c e d i n t e r m s o f U N O S r e g i o n s , y e a r s i n p r a c t i c e M o s t f r o m a b d o m i n a l t r a n s p l a n t p r o g r a m s R E S U L T S

Conditional Attribute Importance , by Clinical Role

Use of Social Support and Ethical Beliefs

Conditional Attirbute Importance , by Perceived Fairness of Social Support

Conditional Attribute Importance , by Perceived Importance of Reducing Organ Waste

Limitations Stated preferences do not perfectly predict real - world choices Non - random sample Potentially under - powered for organ specific analysis F U T U R E S T E P S Explanatory regression models Qualitative study Assessment of social support evaluation procedures Potential policy implications L I M I T A T I O N S & F U T U R E S T E P S

Availability of social support is very important to clinicians when making listing decisions Y E T V A R I A T I O N I N U S E U N D E R M I N E S U N I F O R M I T Y Disproportionately used by clinicians concerned with organ waste C O N C L U S I O N Seldom considered by those concerned with equity and those who lack confidence in criterion C O N C L U S I O N

THANK YOU! KEREN . LADIN @ TUFTS . EDU @KerenLadin