Education Strategies in Dialysis Centers Associated with Increased Transplant Wait-listing Rates

Background. Transplant education in dialysis centers can increase access to kidney transplant; however, dialysis center transplant barriers are common, and limited research identifies the most effective transplant education approaches. Methods. We surveyed transplant educators in 1694 US dialysis centers about their transplant knowledge, use of 12 education practices, and 8 identified education barriers. Transplant wait-listing rates were calculated using US Renal Data System data. Results. Fifty-two percent of educators orally recommended transplant to patients, 31% had in-center transplant discussions with patients, 17% distributed print educational resources, and 3% used intensive education approaches. Distribution of print education (incident rate ratio: _1.021.15_1.30) and using >1 intensive education practice (_1.001.11_1.23) within dialysis centers were associated with increased wait-listing rates. Several dialysis center characteristics were associated with reduced odds of using education strategies leading to increased wait-listing. Centers with greater percentages of uninsured patients (odds ratio [OR]: _0.960.97_0.99), in rural locations (OR: _0.660.79_0.95), with for-profit ownership (OR: _0.640.77_0.91), and with more patients older than 65 years (OR: _0.050.11_0.23) had lower odds of recommending transplant, while centers with a higher patient-to-staff ratio were more likely to do so (OR: _1.011.03_1.04). Language barriers (OR: _0.480.64_0.86) and having competing work priorities (OR: _0.400.53_0.70) reduced the odds of distributing print education. Providers with greater transplant knowledge were more likely to use >1 intensive educational strategy (OR: _1.011.27_1.60) while providers who reported competing work priorities (OR: _0.510.66_0.84) and poor communication with transplant centers (OR: _0.580.76_0.98) were less likely to do so. Conclusions. Educators should prioritize transplant education strategies shown to be associated with increasing wait-listing rates.