Improving Indigenous Patient Access to Kidney Transplantation - IMPAKT

Aims

To identify Indigenous Australians' barriers to accessing renal transplantation and to propose strategies to reduce disparities in Indigenous Australians' access to renal transplantation.

Methods

The research program includes the following three component studies:

a survey of Australian nephrologists' attitudes and practices;
an in-depth qualitative study of Indigenous and non-Indigenous end-stage renal disease (ESRD) patients' knowledge, attitudes, education and decision-making concerning transplantation;
a review of the transplant 'work-up' requirements;

Status/Results

The survey of Australian nephrologists' attitudes and practices relating to transplantation (component 1) was undertaken in 2004.Several papers have been published in peer reviewed journals.

Data collection for the in-depth qualitative study (component 2) was completed in February 2006. Interviews were conducted with over 100 staff and over 250 patients from renal units in Queensland, South Australia, Western Australia, New South Wales and the Northern Territory. Several papers have been published regarding this study and analysis of the interviews is ongoing. The approach and learnings from undertaking this large-scale, qualitative research project have informed the methodology and approach adopted by the Kanyini Vascular Collaboration in undertaking the Kanyini Qualitative Study with Aboriginal Health Service partners in urban, rural and remote sites. IMPAKT study findings have fed directly into current approaches to developing national guidelines regarding eligibility for receipt of a kidney transplant.

The review of the transplant 'work-up' requirements (component 3) commenced in July 2006 and a peer-reviewed publication resulted in 2007.

Study Outputs

Morton R, Devitt J, Howard K, Anderson K, Snelling P, Cass A. Patient views about treatment of Stage 5 chronic kidney disease. American Journal of Kidney Diseases 2010; 55 (3): 431-40.

Anderson K, Yeates K, Cunningham J, Devitt J, Cass A. They really want to go back home, they hate it here: The importance of place in Canadian health professionals’ views on the barriers facing Aboriginal patients accessing kidney transplants. Health and Place 2009; 15 (1): 390-3.

Anderson K, Devitt J, Cunningham J, Preece C, Cass A. “All they said was my kidneys were dead”: Indigenous Australian patients' understanding of their chronic kidney disease. Medical Journal of Australia 2008; 189 (9): 499-503.

Devitt J, Cass A, Cunningham J, Preece C, Anderson K and Snelling P. Study Protocol -- Improving Access to Kidney Transplants (IMPAKT): a detailed account of a qualitative study investigating barriers to transplant for Australian Indigenous people with end-stage kidney disease. BMC Health Services Research 2008; 8 (1): 31.

Cass A, Cunningham J, Anderson K, Snelling P, Colman S, Devitt J, Preece C, Eris J. Decision making about suitability for kidney transplantation: results of a national survey of Australian nephrologists. Nephrology 2007; 12 (3): 299-304.

Anderson K, Cass A, Cunningham J, Snelling P, Devitt J, Preece C. The use of psychosocial criteria in Australian patient selection guidelines for kidney transplantation. Social Science and Medicine 2007; 64 (10): 2107-14.

Cunningham J, Cass A, Anderson K, Snelling P, Devitt J, Preece C, Eris J. Australian nephrologists’ attitudes towards living kidney donation. Nephrology Dialysis Transplantation 2006; 21 (5): 1178-83.

Cass A, Devitt J, Preece C, Cunningham J, Anderson K, Snelling P, Eris J, Ayanian JZ. Barriers to access by Indigenous Australians to kidney transplantation – the IMPAKT study. Nephrology 2004; 9: S144-6.

Institute Investigators

Alan Cass
Kate Anderson
Jeannie Devitt

External Investigators

Joan Cunningham (Menzies School of Health Research)
Josette Eris (Statewide Renal Services)
Paul Snelling (Statewide Renal Services)

Collaboration

Menzies School of Health Research, Darwin
Cooperative Research Centre for Aboriginal Health, Darwin
School of Public Health, Sydney University
Specialist renal units, satellite dialysis units and Aboriginal Medical Services in: Sydney; Dubbo; Brewarrina; Darwin; Alice Springs; Brisbane; Cairns; Townsville; Adelaide; Port Augusta; Perth; Kalgoorlie and Broome.
Department of Health Care Policy, Harvard Medical School
Renal unit, Queens University, Ontario, Canada