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Role of patient factors, preferences, and distrust in health care and access to liver transplantation and organ donation.

dc.contributor.author Wilder, Julius M
dc.contributor.author Oloruntoba, Omobonike O
dc.contributor.author Muir, Andrew J
dc.contributor.author Moylan, Cynthia A
dc.coverage.spatial United States
dc.date.accessioned 2016-09-13T16:55:23Z
dc.date.issued 2016-07
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/27027394
dc.identifier.uri https://hdl.handle.net/10161/12749
dc.description.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.
dc.language eng
dc.publisher Wiley
dc.relation.ispartof Liver Transpl
dc.relation.isversionof 10.1002/lt.24452
dc.title Role of patient factors, preferences, and distrust in health care and access to liver transplantation and organ donation.
dc.type Journal article
duke.contributor.id Wilder, Julius M|0262569
duke.contributor.id Oloruntoba, Omobonike O|0538331
duke.contributor.id Muir, Andrew J|0086790
duke.contributor.id Moylan, Cynthia A|0280057
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/27027394
pubs.begin-page 895
pubs.end-page 905
pubs.issue 7
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Duke Cancer Institute
pubs.organisational-group Duke Clinical Research Institute
pubs.organisational-group Institutes and Centers
pubs.organisational-group Medicine
pubs.organisational-group Medicine, Gastroenterology
pubs.organisational-group School of Medicine
pubs.organisational-group Sociology
pubs.organisational-group Staff
pubs.organisational-group Trinity College of Arts & Sciences
pubs.publication-status Published
pubs.volume 22
dc.identifier.eissn 1527-6473
duke.contributor.orcid Wilder, Julius M|0000-0001-7962-2053
duke.contributor.orcid Moylan, Cynthia A|0000-0001-8454-7086


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