Unraveling the Hemodialysis Patient Network: Results from the Social Network and Renal Education (SNARE) Transplant Intervention Clinical Trial

RATIONALE & OBJECTIVE: Patient social networks in in-center hemodialysis (HD) facilities may disseminate kidney transplant (KT) information and behaviors. Previously, patients in clustered networks (highest proportion of network members connected with each other [clustering]) completed more KT steps than patients who were central hubs with many network connections (centrality). We hypothesize that participants in clustered networks will more effectively disseminate the information and behaviors of the COmmunicating About Choices in Transplant (COACH) intervention than participants central to the network. STUDY DESIGN: The Social Network and Renal Education (SNARE: Promoting Transplantation) was a double-blind nonrandomized network intervention trial using parallel assignment in which participants on the Monday, Wednesday, Friday (MWF) shifts were assigned to the centrality arm whereas those on the Tuesday, Thursday, Saturday (TTS) shifts were assigned to the clustering arm. SETTINGS & PARTICIPANTS: Transplant-eligible patients at a Mid-Atlantic HD facility whose networks were previously mapped were eligible. INTERVENTION: Four participants from MWF with the highest betweenness centrality and four participants from TTS with the highest clustering coefficient were selected to be information seeds and participate in and disseminate the COACH to their respective arms. OUTCOMES: The number of transplant evaluation steps completed, change in transplant knowledge, and living donation (LD) requests were measured 9 months postintervention for all participants. RESULTS: Twenty-two transplant-eligible patients, including 7 who received the COACH, completed the study. At 9 months, the clustering arm (n = 13) completed more KT evaluation steps than the centrality arm (n = 9; 0.92 ± 1.71 vs -0.44 ± 1.24, P = 0.04). LD requests were not different (3 vs 1, P = 0.88). LIMITATIONS: The coronavirus disease (COVID)-19 pandemic significantly reduced our sample size. Fewer participants in the centrality arm were connected. Arm assignment was not random. CONCLUSIONS: In this novel HD patient network intervention, clustered patients may have greater influence on transplant behaviors than central patients.