Perceptions of patient candidacy for kidney transplant in the United States: a qualitative study comparing rural and urban nephrologists.

OBJECTIVES To explore different perceptions of urban and rural nephrologists regarding patient suitability for transplant. MATERIALS AND METHODS We conducted 4 focus groups, each consisting of 4 to 6 nephrologists practicing in either a rural (n=9) or an urban setting (n=11). A topic guide was developed and modified according to pilot testing. Broadly stated, open ended queries probed perceptions about the ideal or suboptimal candidates for transplant, perceived barriers to transplant, views regarding providing information to patients, and strategies that could improve transplant rates. At the sessions, all audio was recorded and professionally transcribed. Responses were pooled, de-identified, and analyzed using qualitative thematic content analysis. RESULTS In considering candidacy, urban participants mentioned "age, " "compliance, " and "functional status "; "support " was a more-prevalent theme among rural nephrologists. Urban physicians discussed the expected effect of a transplant on a subject 's quality of life. As barriers to transplant, "evaluation time " was mentioned by urban groups only, and "distance to transplant center " was suggested by rural nephrologists only. To improve transplant rates, urban nephrologists suggested strategies that would increase the donor pool. Rural nephrologists, on the other hand, suggested a collaboration between nephrologists and the transplant center, "limiting listing eligibility " and "financial assistance. " Rural nephrologists suggested providing comparisons of modalities and information about selecting subjects. CONCLUSIONS This qualitative study underscores geographic differences in perceptions of nephrologists regarding patient candidacy for kidney transplant, perceived barriers to kidney transplant, and proposed strategies to increase rates of kidney transplant. These differences are potential contributors to geographic variations in referring patients for kidney transplant.