Perceptions of patient candidacy for kidney transplant in the united states: A qualitative study comparing rural and urban nephrologists

Objectives: To explore different perceptions ofurban and rural nephrologists regarding patientsuitability for transplant.Materials and Methods: We conducted 4 focusgroups, each consisting of 4 to 6 nephrologistspracticing in either a rural (n=9) or an urban setting(n=11). A topic guide was developed and modifiedaccording to pilot testing. Broadly stated, openendedqueries probed perceptions about the idealor suboptimal candidates for transplant, perceivedbarriers to transplant, views regarding providinginformation to patients, and strategies that couldimprove transplant rates. At the sessions, all audiowas recorded and professionally transcribed.Responses were pooled, deidentified, and analyzedusing qualitative thematic content analysis.Results: In considering candidacy, urbanparticipants mentioned "age," "compliance," and"functional status"; "support" was a more-prevalenttheme among rural nephrologists. Urban physiciansdiscussed the expected effect of a transplant on a subject's quality of life. As barriers to transplant,"evaluation time" was mentioned by urban groupsonly, and "distance to transplant center" wassuggested by rural nephrologists only. To improvetransplant rates, urban nephrologists suggestedstrategies that would increase the donor pool. Ruralnephrologists, on the other hand, suggested acollaboration between nephrologists and thetransplant center, "limiting listing eligibility" and"financial assistance." Rural nephrologistssuggested providing comparisons of modalities andinformation about selecting subjects.Conclusions: This qualitative study underscoresgeographic differences in perceptions ofnephrologists regarding patient candidacy forkidney transplant, perceived barriers to kidneytransplant, and proposed strategies to increaserates of kidney transplant. These differences arepotential contributors to geographic variations inreferring patients for kidney transplant.