Abstract

Purpose: In rural America, the road to obtaining a liver transplant (LTX) often starts at the primary care provider’s (PCP’s) office. Patients with end-stage liver disease (ESLD) in rural communities experience lower rates of wait-listing and higher mortality. This study identifies issues related to the knowledge and perceptions of ESLD and LTX referral among PCPs in rural Kentucky (KY).

Methods: The study protocol involved relying upon a semistructured outline to explore the knowledge, attitude, and perceptions of PCPs toward ESLD and LTX referral among PCPs in rural KY. Inductive thematic analysis was utilized to identify, analyze, and report themes.

Findings: From the focus group interviews, three themes were identified: medical culture, gaps in knowledge, and bias against those with self-induced causes of ESLD. Each theme illuminated barriers to referral for transplant evaluation.

Conclusions: Knowledge gaps, attitudes in medical culture, and biases surrounding ESLD and LTX referral exist in community medicine practice. This highlights the importance of education, resources, and facilitation of LTX referral processes for PCPs.

Document Type

Article

Publication Date

2025

Notes/Citation Information

© 2024 National Rural Health Association.

Digital Object Identifier (DOI)

https://doi.org/10.1111/jrh.12871

Funding Information

Dr. Madabhushi is supported by University of Kentucky, Center for Clinical and Translational Science TL1 Grant (NIH: TL1TR001997). Dr. Gupta is supported by the University of Kentucky, Department of Surgery, Faculty Research Development Grant for this study. Operational funds were also provided by the Division of Transplantation and the Department of Surgery at the University of Kentucky.

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