THE IMPACT OF SOCIAL SUPPORT ON KIDNEY TRANSPLANT LISTING - - PowerPoint PPT Presentation
THE IMPACT OF SOCIAL SUPPORT ON KIDNEY TRANSPLANT LISTING DECISIONS: RESULTS FROM A DISCRETE CHOICE EXPERIMENT Keren Ladin , PhD , MSc Assistant Professor Tufts University ARM 2017 Surgery and Perioperative Care Interest Group Meeting June 23,
Keren Ladin, PhD, MSc Assistant Professor Tufts University
ARM 2017 Surgery and Perioperative Care Interest Group Meeting June 23, 2017
Tara Lavelle, PhD Tufts Medical Center Douglas Hanto, MD, PhD, Vanderbilt Zeeshan Butt, PhD, Northwestern Elisa Gordon, PhD, MPH Northwestern Joanna Emerson, MPH, Tufts Jennifer Perloff, PhD, Brandeis Meghan Olsen, BA, Tufts
This project was generously funded by the Greenwall Foundation We greatly appreciate the partnership of the ASTS, AST, and STSW
Kelsey Berry, PhD Candidate, Harvard
S O C I A L S U P P O R T I N T R A N S P L A N T E V A L U A T I O N S : D I S C R E T E C H O I C E E X P E R I M E N T
CMS requirement: Assess and consider social support in listing decisions Lack of consensus about definitions, process, importance of this criterion Evidence-base for using social support is equivocal with respect to medication adherence and post- transplant outcomes
Among high quality studies, neither social support nor marital status was predictive of medication adherence or post-transplant outcomes. Social support was not associated with medication adherence. It was associated with superior post-transplant outcomes, but the relationship was not significant among high quality studies. Compared to unmarried recipients, married recipients were more likely to adhere to medication post-transplant, but this relationship was not significant among high quality studies. Marital status was not significantly associated with transplant success. Social support is weakly and inconsistently associated with post- transplant adherence and outcomes.
P O T E N T I A L C O N C E R N S W I T H " F U Z Z Y " C R I T E R I A
D I S P A R I T I E S I N P A T I E N T E X P E R I E N C E B E T W E E N C E N T E R S I N C L U S I O N O F S O C I A L V A L U E J U D G E M E N T S D I S P A R I T I E S I N A C C E S S T O T R A N S P L A N T F O R C E R T A I N G R O U P S O F P A T I E N T S
T A K E Y O U R B E S T G U E S S !
M E T H O D S
Stated preference method Originally developed for market analysis Estimation of the relative importance of different factors of a service Value trade-offs between factors Increasingly being used in health applications
M E T H O D S
Measures how clinicians weigh the importance of different factors Literature review and expert stakeholder panel Identify attributes & levels Vary levels to build profiles Ask respondents to evaluate choices Estimate preferences based on answers S T E P S T O C O N D U C T I N G D C E
M E T H O D S
A T T R I B U T E S
M E T H O D S S T A T I S T I C A L A N A L Y S I S
C O N D I T I O N A L L O G I S T I C R E G R E S S I O N Dependent variable: Yes/No transplant Independent variables: all transplant recipient factors shown in discrete choice C O N D I T I O N A L A T T R I B U T E I M P O R T A N C E F O R E A C H A T T R I B U T E I N T H E S U R V E Y O V E R A L L A N D S U B G R O U P S ( C L I N I C A L R O L E , E T H I C A L B E L I E F S )
R E S U L T S S A M P L E
N o n - r a n d o m s a m p l e : m e m b e r s h i p o f A S T S a n d S T S W s u r v e y e d i n f a l l 2 0 1 6 5 8 4 R e s p o n d e n t s p a r t i c i p a t e d i n t h e D C E 4 8 % i n v o l v e d i n p s y c h o s o c i a l e v a l u a t i o n s 4 4 % m a l e B a l a n c e d i n t e r m s o f U N O S r e g i o n s , y e a r s i n p r a c t i c e M o s t f r o m a b d o m i n a l t r a n s p l a n t p r o g r a m s
L I M I T A T I O N S & F U T U R E S T E P S
Stated preferences do not perfectly predict real- world choices Non-random sample Potentially under-powered for organ specific analysis Explanatory regression models Qualitative study Assessment of social support evaluation procedures Potential policy implications
F U T U R E S T E P S
C O N C L U S I O N
Disproportionately used by clinicians concerned with
Seldom considered by those concerned with equity and those who lack confidence in criterion
Y E T V A R I A T I O N I N U S E U N D E R M I N E S U N I F O R M I T Y
C O N C L U S I O N
@KerenLadin