@article{16012,
  author = {Cass Alan and Devitt J. and Cunningham J. and Preece C. and Anderson K. and Jardine M},
  title = {If you can't comply with dialysis, how do you expect me to trust you with transplantation? Australian nephrologists' views on Indigenous Australians''non-compliance' and their suitability for kidney transplantation},
  abstract = {<p>
ABSTRACT: INTRODUCTION: Indigenous Australians suffer markedly higher rates of end-stage kidney disease (ESKD) but are less likely than their non-Indigenous counterparts to receive a transplant. This difference is not fully explained by measurable clinical differences. Previous work suggests that Indigenous Australian patients may be regarded by treating specialists as 'non-compliers', which may negatively impact on referral for a transplant. However, this decision-making is not well understood. The objectives of this study were to investigate: whether Indigenous patients are commonly characterised as 'non-compliers'; how estimations of patient compliance factor into Australian nephrologists' decision-making about transplant referral; and whether this may pose a particular barrier for Indigenous patients accessing transplants. METHODS: Nineteen nephrologists, from eight renal units treating the majority of Indigenous Australian renal patients, were interviewed in 2005-06 as part of a larger study. Thematic analysis was undertaken to investigate how compliance factors in specialists' decision-making, and its implications for Indigenous patients' likelihood of obtaining transplants. RESULTS: Specialists commonly identified Indigenous patients as both non-compliers and high-risk transplant candidates. Definition and assessment of 'compliance' was neither formal nor systematic. There was uncertainty about the value of compliance status in predicting post-transplant outcomes and the issue of organ scarcity permeated participants' responses. Overall, there was marked variation in how specialists weighed perceptions of compliance and risk in their decision-making. CONCLUSION: Reliance on notions of patient 'compliance' in decision-making for transplant referral is likely to result in continuing disadvantage for Indigenous Australian ESKD patients. In the absence of robust evidence on predictors of post-transplant outcomes, referral decision-making processes require attention and debate.
</p>
},
  year = {2012},
  journal = {International Journal for Equity in Health},
  volume = {11},
  edition = {2012/04/20},
  number = {1},
  pages = {21},
  isbn = {1475-9276 (Electronic)1475-9276 (Linking)},
  note = {International journal for equity in healthInt J Equity Health. 2012 Apr 18;11(1):21.},
  language = {Eng},
}