Kidney transplantation is considered the gold standard treatment for patients with end-stage renal disease. To maintain a functioning transplant, recipients must commit to indefinite therapy with immunosuppressive medications, which cause frequent side effects and can reduce quality of life.
At least one in five renal transplant recipients exhibit non-adherence to medications, which can lead to devastating consequences, including transplant rejection, graft loss, and death.
In our center we provide education to transplant candidates during the assessment process. However, once listed, a significant period of time may have passed prior to the patient actually receiving a kidney. Post transplant, recipients are often overwhelmed, and express surprise at the prospect of taking lifelong immunosuppressive medications. Their quality of life outcomes do not always match up with their expectations. After informally polling our colleagues across the country we see that our experience is not unique. We also realize that our anecdotal experiences are consistent with the literature.
The Saskatchewan Transplant Program provides care to approximately 400 kidney recipients, including up to 40 new transplants per year. Ample evidence indicates that education and consultation about immunosuppressive medications should occur before transplantation. Presumably, if more intensive and accessible education regarding transplant medications was provided prior to transplantation, patients would be better able to prepare for a successful transition towards optimal adherence following discharge after transplant. However, increasing education and support to transplant candidates demands greater use of care providers’ time and resources in the health region, which are already stretched. Delivery of a video intervention could be provided to patients at low cost and with little impact to existing health care personnel.
The purpose of this project was to produce 6-part educational video series to address this educational gap. A needs assessment was undertaken to provide stakeholder input throughout the production process, which included the input of nearly 50 patients. Two randomized controlled clinical trials are currently being undertaken to determine whether this novel strategy is an effective and efficient means of enhancing patient outcomes, in the pre- and post-transplant settings. Maximizing patient adherence to immunosuppressive medications has the potential to reduce the risk for graft rejection and its consequences on health and health care spending.