Factors influencing access to kidney transplantation (FIAT): a protocol of a qualitative study on stakeholders' perspectives

A. Luchtenburg, K. Kloss, S. Redeker, J.J. van Busschbach, J. van de Wetering, S.Y. Ismail

Wednesday 13 march 2019

14:22 - 14:24h at Koningin Máximazaal

Categories: Basaal, Parallelsessie

Parallel session: Parallelsessie III - Basaal I

Background: Approximately 60% of the kidney patients on dialysis are not waitlisted for transplantation. An unknown part of them might be as well eligible for kidney transplantation but has never been assessed for it. Moreover, increasing disparities in access to kidney transplantation are discussed in literature, like for older patients and patients with a migration background. The present qualitative study aims to explore the factors influencing access to kidney transplantation in the Dutch setting. Based on these factors, targets for potential policy changes will be identified in order to improve access to transplantation in the Netherlands.

Methods: Factors on different levels will be investigated by analyzing interviews held with various stakeholders involved in access to transplantation, namely, patients, dialysis nurses, social workers, nephrologists, health insurers and policy makers. These stakeholders will be approached for focus group or individual interviews nationwide in different settings (e.g. transplant centers, general hospitals, conferences, governmental agencies, community centers). The interviews will be audio-recorded and transcribed verbatim. This qualitative data will be analyzed according the principles of Grounded Theory.

Results: Participants will be interviewed in three phases about their beliefs, opinions and attitudes on access to kidney transplantation. The topic list contains the domains clinical, psychological, ethical, social, economic and policy. In a first phase, stakeholders’ perspectives will be explored through individual in-depth or focus group interviews. In a second phase of focus group interviews, stakeholders will be confronted with the outcomes of phase one from the different stakeholder groups in order to create an integrated model of contributing factors. Finally, in the third phase, stakeholders will be invited to focus group discussions about possible solutions for improving access to transplantation based on the results of phase two.

Conclusions: Multi-level factors influencing access to kidney transplantation will be investigated systematically in the Dutch transplant setting by exploring different perspectives of multiple stakeholders, including those perspectives who have rarely been represented in literature (health insurers and policy makers). The final goal is to present a report with national policy recommendations pointing towards a more optimal access to kidney transplantation in The Netherlands.