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If you can't comply with dialysis how do you expect me to trust you with transplantation? Australian nephrologists' views on indigenous Australians' 'non-compliance' and their suitability for kidney transplantation

Anderson, Kate, Devitt, Jeannie, Cunningham, Joan, Preece, Cilla, Jardine, Meg and Cass, Alan (2012). If you can't comply with dialysis how do you expect me to trust you with transplantation? Australian nephrologists' views on indigenous Australians' 'non-compliance' and their suitability for kidney transplantation. International Journal for Equity in Health,11(1):1-8.

Document type: Journal Article
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Title If you can't comply with dialysis how do you expect me to trust you with transplantation? Australian nephrologists' views on indigenous Australians' 'non-compliance' and their suitability for kidney transplantation
Author Anderson, Kate
Devitt, Jeannie
Cunningham, Joan
Preece, Cilla
Jardine, Meg
Cass, Alan
Journal Name International Journal for Equity in Health
Publication Date 2012
Volume Number 11
Issue Number 1
ISSN 1475-9276   (check CDU catalogue  open catalogue search in new window)
Scopus ID 2-s2.0-84859803535
Start Page 1
End Page 8
Total Pages 8
Place of Publication United Kingdom
Publisher BioMed Central Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract Introduction
Indigenous Australians suffer markedly higher rates of end-stage kidney disease (ESKD) but are less likely than their non-Indigenous counterparts to receive a transplant. This difference is not fully explained by measurable clinical differences. Previous work suggests that Indigenous Australian patients may be regarded by treating specialists as 'non-compliers', which may negatively impact on referral for a transplant. However, this decision-making is not well understood. The objectives of this study were to investigate: whether Indigenous patients are commonly characterised as 'non-compliers'; how estimations of patient compliance factor into Australian nephrologists' decision-making about transplant referral; and whether this may pose a particular barrier for Indigenous patients accessing transplants.

Methods

Nineteen nephrologists, from eight renal units treating the majority of Indigenous Australian renal patients, were interviewed in 2005-06 as part of a larger study. Thematic analysis was undertaken to investigate how compliance factors in specialists' decision-making, and its implications for Indigenous patients' likelihood of obtaining transplants.

Results

Specialists commonly identified Indigenous patients as both non-compliers and high-risk transplant candidates. Definition and assessment of 'compliance' was neither formal nor systematic. There was uncertainty about the value of compliance status in predicting post-transplant outcomes and the issue of organ scarcity permeated participants' responses. Overall, there was marked variation in how specialists weighed perceptions of compliance and risk in their decision-making.

Conclusion

Reliance on notions of patient 'compliance' in decision-making for transplant referral is likely to result in continuing disadvantage for Indigenous Australian ESKD patients. In the absence of robust evidence on predictors of post-transplant outcomes, referral decision-making processes require attention and debate.
Keywords Kidney transplantation
Indigenous peoples
Aboriginal and Torres Strait Islander
Compliance
DOI http://dx.doi.org/10.1186/1475-9276-11-21   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)


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