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首页> 外文期刊>International journal for equity in health >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
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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

机译：如果您无法进行透析，您如何期望我信任您的移植？澳大利亚肾脏科医生对澳大利亚土著人的“不遵守规定”及其对肾脏移植的适用性的看法

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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.
机译：简介澳大利亚土著人罹患终末期肾脏疾病（ESKD）的比率明显较高，但比非土著人接受移植的可能性要小。可测量的临床差异不能完全解释这种差异。先前的工作表明，将专科医生视为“非遵从者”可能会将澳大利亚土著患者视为“非遵从者”，这可能会对转诊转诊产生负面影响。但是，这种决策还没有被很好地理解。这项研究的目的是调查：土著患者是否通常被定性为“非遵从者”？如何将患者依从性因素的估计值纳入澳大利亚肾脏科医生关于移植转诊的决策中;以及这是否会对土著患者进行移植构成特殊障碍。方法作为一项较大研究的一部分，在2005-06年度，采访了来自八个肾脏科的19位肾脏病医生，这些肾脏病科治疗了大多数澳大利亚土著肾脏患者。进行了主题分析，以调查专家决策中的依从性因素如何及其对土著患者获得移植的可能性的影响。结果专家通常将土著患者确定为不符合条件的患者和高危移植患者。 “合规性”的定义和评估既不是正式的也不是系统的。依从性状态在预测移植后结局方面的价值尚不确定，并且参与者的反应弥漫着器官稀缺的问题。总体而言，专家在决策时如何权衡对合规性和风险的看法方面存在明显差异。结论在对移植转诊的决策中依赖患者“依从性”的概念可能会导致澳大利亚土著ESKD患者继续处于不利地位。在缺乏关于移植后结果预测因素的有力证据的情况下，转诊决策过程需要引起关注和辩论。

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