Role of patient factors, preferences, and distrust in health care and access to liver transplantation and organ donation.
Abstract
Despite major improvements in access to liver transplantation (LT), disparities remain.
Little is known about how distrust in medical care, patient preferences, and the origins
shaping those preferences contribute to differences surrounding access. We performed
a single-center, cross-sectional survey of adults with end-stage liver disease and
compared responses between LT listed and nonlisted patients as well as by race. Questionnaires
were administered to 109 patients (72 nonlisted; 37 listed) to assess demographics,
health care system distrust (HCSD), religiosity, and factors influencing LT and organ
donation (OD). We found that neither HCSD nor religiosity explained differences in
access to LT in our population. Listed patients attained higher education levels and
were more likely to be insured privately. This was also the case for white versus
black patients. All patients reported wanting LT if recommended. However, nonlisted
patients were significantly less likely to have discussed LT with their physician
or to be referred to a transplant center. They were also much less likely to understand
the process of LT. Fewer blacks were referred (44.4% versus 69.7%; P = 0.03) or went
to the transplant center if referred (44.4% versus 71.1%; P = 0.02). Fewer black patients
felt that minorities had as equal access to LT as whites (29.6% versus 57.3%; P <
0.001). For OD, there were more significant differences in preferences by race than
listing status. More whites indicated OD status on their driver's license, and more
blacks were likely to become an organ donor if approached by someone of the same cultural
or ethnic background (P < 0.01). In conclusion, our analysis demonstrates persistent
barriers to LT and OD. With improved patient and provider education and communication,
many of these disparities could be successfully overcome. Liver Transplantation 22
895-905 2016 AASLD.
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Journal articlePermalink
https://hdl.handle.net/10161/12749Published Version (Please cite this version)
10.1002/lt.24452Publication Info
Wilder, Julius M; Oloruntoba, Omobonike O; Muir, Andrew J; & Moylan, Cynthia A (2016). Role of patient factors, preferences, and distrust in health care and access to liver
transplantation and organ donation. Liver Transpl, 22(7). pp. 895-905. 10.1002/lt.24452. Retrieved from https://hdl.handle.net/10161/12749.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Cynthia Ann Moylan
Associate Professor of Medicine
My research interests focus on the study of chronic liver disease and primary liver
cancer, particularly from metabolic dysfunction associated steatotic liver disease
(MASLD), formerly called nonalcoholic fatty liver disease (NAFLD). As part of the
MASLD Research Team at Duke, we are investigating the role of environmental contaminants,
epigenetics, and genetics on the development of advanced fibrosis and liver cancer
from MASLD and other chronic liver diseases. We are also intereste
Andrew Joseph Muir
Professor of Medicine
Hepatitis C
Primary sclerosing cholangitis
Cirrhosis
Liver Transplantation
Clinical Trials
Healthcare disparities in liver disease
Outcomes Research
Omobonike Oyindasola Oloruntoba
Assistant Professor of Medicine
Julius Middleton Wilder
Assistant Professor of Medicine
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