Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.119247
Revised: February 14, 2026
Accepted: March 26, 2026
Published online: June 18, 2026
Processing time: 126 Days and 8 Hours
Patient education remains an underdeveloped component of care in abdominal transplantation. Despite the benefits of improved health literacy, most educational materials remain inaccessible to the average patient.
To evaluate the impact of educational booklets on comprehension, anxiety, satisfaction, and healthcare utilization among abdominal transplant recipients and donors.
An observational, single-center quality improvement study was conducted in transplant recipients and living donors. Patients received booklets during transplant evaluation, preoperative clinic, or hospital admission. Booklets were developed by transplant surgeons and revised with health literacy experts. Postoperative surveys assessed comprehension, satisfaction, anxiety, and feedback. Patient-reported demographic data and post-operative outcomes were collected from the electronic medical record were analyzed.
Eighty-three patients completed the survey, of which nine were excluded for duplicate entries. Satisfaction with content was high, with 81% reporting reduced feelings of overwhelm and 74% reporting less fear of surgery. The average recommendation rating was 9.4/10, with frequent praise for illustrations, glossary, and surgical explanations. Postoperative outcomes improved following booklet implementation, with reductions in readmission rates, emergency department visits, and coordinator calls. Compared with historical data, readmissions decreased significantly (12.2% vs 22.1%; P = 0.049).
Illustrated educational booklets significantly improved patient comprehension, anxiety, and satisfaction, and reduced unplanned care use. Integrating tailored education into routine transplant care enhances patient expe
Core Tip: Patient education is paramount in ensuring appropriate postoperative outcomes and expectations of the perioperative process. This study highlights that current educational tools for patients undergoing abdominal transplantation may be inadequate, and that illustrated booklets serve patients well. Overall, there was a decrease in postoperative healthcare utilization in the form of readmissions, as well as reduced feelings of overwhelm and fear in the preoperative setting.
- Citation: Di Napoli M, Kadri H, Kessler D, Canty G, Klingenberg K, Pomfret EA, Pomposelli JJ, Pshak T, Choudhury RA, Nydam TL, Baimas-George M. Picturing better outcomes: Illustrated educational booklets improve patient-reported outcomes and reduce healthcare utilization in abdominal transplantation. World J Transplant 2026; 16(2): 119247
- URL: https://www.wjgnet.com/2220-3230/full/v16/i2/119247.htm
- DOI: https://dx.doi.org/10.5500/wjt.v16.i2.119247
While huge strides continue to be made in the technical and medical aspects of transplantation, similar progress in patient transplant education and health literacy has failed to materialize. Nearly 80 million American adults have estimated low literacy, leading the United States Department of Health and Human Services to declare health literacy interventions as a public health priority[1,2]. Low health literacy not only impacts patient-reported outcomes but directly affects informed consent and subsequent perioperative care[3].
Within transplantation, health literacy levels impact access and listing, the probability of approval, and post-transplant outcomes[4,5]. While solid organ transplantation has clear survival and quality-of-life benefits, kidney and liver transplants account for < 10% of patients who need it respectively, pronounced in low-income and minority populations[6-8]. Many waitlisted candidates may be suitable candidates for a living donor graft, yet a lack of knowledge creates reticence to consider it and/or discuss with loved ones[9]. Further, low health literacy is independently associated with not being waitlisted and is a factor in willingness to accept extended criteria organs[10,11].
In the post-operative setting, low health literacy is associated with medication nonadherence, increased hospitalizations, and mortality in the general population[12]. In transplantation, unintentional nonadherence results in over 50% of all late acute rejection episodes, 15% of graft losses, and increased mortality rates[13]. It also impacts emergency department (ED) utilization and recidivism, and it is a common barrier to a successful transition of care in adolescents[14,15].
When patients actually do receive “readable” information, studies consistently demonstrate improved pre- and post-transplant outcomes and reduced racial and socioeconomic disparities[16,17]. For instance, improvements in readability of resources approximated increases in waitlisted patients with low educational attainment by a 3000 absolute increase[18]. Additionally, strategies to decrease complexity and increase care coordination through simplified patient education demonstrated considerable reduction in unscheduled healthcare utilization[19,20].
The vast majority of current transplant organizational materials, however, are scored with “poor understandability”, written well above the average health literacy level of patients[18,21]. Admittedly, the task of ensuring “sufficient” readability for this diverse population is challenging, given the complex nature of transplant. The field encompasses a wide range of topics including pathology and immunology, operations with risks/benefits, and post-transplant medication and lifestyle expectations. Thus, there is a crucial understanding gap in currently available materials and the needs of the transplant patient population.
Given that poor health literacy and a lack of healthcare knowledge are well demonstrated barriers to solid-organ transplantation and impact post operative outcomes, improved education access and resources have arisen as cost-effective, low-risk interventions that could serve significant benefit, particularly in the often-overwhelming environment of transplant[20,22]. This study sought to develop clear, understandable illustrated books to serve as guides for liver and kidney transplant donors and recipients in order to improve patient-reported outcomes and reduce unnecessary healthcare utilization.
This cross-sectional study evaluated the impact of illustrated educational booklets on health literacy and unplanned postoperative healthcare utilization among transplant patients. English-speaking adults at a single institution who were either recipients or living donors of a kidney or liver transplant were eligible. Exclusion criteria included individuals under 18 years of age and non-English speakers. Responses were excluded if patients were not candidates for donation or did not undergo surgery. After providing informed consent, participants received a booklet along with a QR code linking to a FormStack survey (Fishers, Indiana). Living donors (kidney or liver) were given the booklet during their preoperative outpatient visit, while transplant candidates (kidney or liver) received it during their preoperative hospital admission.
The educational booklets were written and illustrated by the senior author, an abdominal transplant surgeon, to improve health literacy among transplant recipients and donors (Figure 1). The recipient booklets provided a comprehensive, illustrated overview of the transplant process, including anatomy and function, causes of renal or liver failure, evaluation steps, types of transplants (living and deceased), surgical procedures, postoperative expectations, immunosuppression management, and common complications. The donor booklets provided detailed information on the process of living donation, including types of living donation (directed vs non-directed), the screening process to become a donor, details of different surgical techniques (i.e.: Minimally invasive vs open), surgical risks and postoperative expectations and follow-up. Each booklet was structured with clear section headings, simplified language, and cartoon-style graphics to enhance accessibility and engagement. The final layout included a detailed table of contents, glossary of “doctor words”, and patient-centered discharge planning resources.
Initial drafts were reviewed by subject-matter experts (Pshak T, Nydam TL, Pomfret EA, Pomposelli JJ) and edited for content accuracy. A professional health literacy editor revised the final versions to target a 4th to 6th grade reading level, aligned with United States Department of Health and Human Services recommendations. Each book explicitly stated that it was intended to supplement, not replace, physician guidance.
An iterative, user-centered design process was employed to optimize booklet development. Structured feedback was gathered from a multidisciplinary advisory panel that included transplant recipients and donors, family members, nephrologists, hepatologists, inpatient and outpatient advanced practice providers, transplant coordinators, nurses, social workers, and pharmacists. Based on this feedback, revised versions were developed and redistributed for additional testing. This cycle continued until consensus was reached on a final version using a modified Delphi methodology involving both the project team and advisory board.
Finalized booklets were disseminated to eligible patients during a six-month study period by medical students or transplant clinic coordinators who were not involved in research activities. Living donors received the materials at their preoperative outpatient visit, while transplant recipients received theirs during preoperative hospital admission. A form with a QR code linking to a survey administered via FormStack was provided to patients at the time they received their booklet. The survey utilized validated instruments to assess patient comprehension, satisfaction, health literacy, and anxiety[23-25]. Patients were instructed to complete the survey upon completion of reading the booklet. The project was reviewed by the Colorado Multiple Institutional Review Board and determined to meet criteria for a quality impro
The aim of this project was to develop and evaluate the effectiveness of illustrated educational booklets in patient-reported outcomes and navigation of the transplant healthcare system. The primary outcome of this analysis was assessment of patient satisfaction with the educational booklets. To evaluate this, participants were asked to complete a 20-item Likert-style questionnaire accessed via a QR code included in the booklets. Each item provided five response options: “strongly disagree”, “disagree”, “neither agree nor disagree”, “agree”, and “strongly agree”. For analytical purposes, the first 12 questions were assessed individually, and responses were numerically codified as follows: “strongly disagree” or “disagree” were scored as 0, “neither agree nor disagree” as 1, “agree” as 2, and “strongly agree” as 3. A composite patient satisfaction metric was created by summing all individual item scores from the full 20-question survey.
Secondary outcomes assessed in the study were downstream effects on healthcare utilization, including 30-day readmissions, ED visits, unscheduled phone calls to transplant coordinators or nursing staff, and missed postoperative visits. Clinical data were abstracted from the institutional electronic medical record system (EPIC Systems, Verona, WI, United States). Encounters not directly related to post-transplant care were excluded from analysis.
Within each of the four patient cohorts (liver donor, liver recipient, kidney donor, and kidney recipient), participants were stratified based on educational attainment (high school or less vs college degree or higher), employment status (full-time or part-time employment, disability or unemployment, and retirement), and history of surgical procedures.
All data analysis was conducted using R 4.4.2 (R Foundation for Statistical Computing, Vienna, Austria). A significance level of 0.05 was used. Fisher’s exact tests were used to compare responses to individual tests as well as the presence or absence of postoperative readmissions, ED visits, unplanned clinic visits, or calls to the transplant coordinator. Student’s t-test or one-way analysis of variance was used to compare aggregated metrics of patient satisfaction between demo
It should be noted that given the quality-improvement nature of this study, the absence of prior data to reliably estimate true effect size, and the use of a single-arm design with only historical comparison, a formal a priori sample size calculation for power was not performed. The sample in this study was solely determined by the number of eligible patients who received the educational intervention and completed the survey during the assessed time period.
A total of 83 individual survey responses were collected of which nine responses were excluded for duplicate entries (n = 3), not a candidate for living donation (n = 2), or did not undergo surgery (n = 4). The analyzed cohort of 74 patients included 6 liver donors, 19 kidney donors, 23 liver recipients, 25 kidney recipients, and 1 simultaneous liver and kidney (SLK) recipient (Table 1). Patient responses to the educational booklets were highly favorable. The average positive response rate (“agree” or “strongly agree”) across all survey items was 87.5%, with individual questions ranging from 75.3% (Question 10) to 98.9% (Question 14). The majority of patients (97%) were satisfied with the content and the way information was presented. Furthermore, 80.9% of patients reported that the book made them feel less overwhelmed, 74.4% reported that the book made them less afraid of surgery, and 94% of patients felt that the book allowed them to better navigate their transplant experience. It was highly recommended that the books be used by other patients (9.39/10 rating). Useful aspects included illustrations, surgical step explanations, glossary of medical terms, and recovery charts and participants recommended the books be provided earlier in the transplant process.
| Liver donors (n = 6) | Kidney donors (n = 19) | Liver recipients (n = 24)1 | Kidney recipients (n = 26)1 | |
| Age at donation or transplant | 41 (34.5-47.5) | 44 (36-51) | 51 (41-56)2 | 55 (49-70)3 |
| Female sex | 4 (66.7) | 11 (57.9) | 6 (33.3)2 | 7 (36.8)3 |
| Primary language | ||||
| English | 6 (100.0) | 19 (100.0) | 23 (95.8) | 25 (96.2) |
| Spanish | 0 (0.0) | 0 (0.0) | 1 (4.2) | 1 (3.8) |
| Highest level of education | ||||
| Less than high school | 0 (0.0) | 1 (5.3) | 1 (4.2) | 2 (7.7) |
| High school/GED | 1 (16.7) | 4 (21.1) | 5 (20.8) | 2 (7.7) |
| College | 2 (33.3) | 9 (47.4) | 14 (58.3) | 13 (50.0) |
| Advanced degree | 3 (50.0) | 5 (26.3) | 4 (16.7) | 9 (34.6) |
| Employment status | ||||
| Full-time | 4 (66.7) | 15 (78.9) | 11 (45.8) | 7 (26.9) |
| Part-time | 0 (0.0) | 1 (5.3) | 1 (4.2) | 3 (11.5) |
| On disability | 0 (0.0) | 0 (0.0) | 5 (20.8) | 2 (7.7) |
| Unemployed | 2 (33.3) | 2 (10.5) | 4 (16.7) | 5 (19.2) |
| Retired | 0 (0.0) | 1 (5.3) | 3 (12.5) | 9 (34.6) |
| History of prior surgeries | 4 (66.7) | 8 (42.1) | 17 (70.8) | 16 (61.5) |
After stratification by educational attainment (high school or less vs college degree or higher), kidney donors with less formal education found the books to more significantly decrease their fear of the postoperative recovery process (P = 0.021). Among kidney recipients, those with less formal education were significantly more likely to rate the booklet as overall helpful compared to those with college education or higher (average satisfaction metrics of 57.0 vs 46.9, respectively; P = 0.013). Liver recipients with less formal education were more likely to present to the ED within 30 days postoperatively compared to those with a college education or higher (P = 0.035).
After stratification by employment status (full-time or part-time employment, disability or unemployment, and retirement), kidney donors who were unemployed or retired found that the books helped them better understand their postoperative medications (P = 0.007) and feel less afraid of postoperative side effects and pain (P = 0.007). All retired patients in this cohort (100%) also believed the book made them feel less overwhelmed, compared to 50% of unemployed patients, and 83.3% of employed patients (P = 0.021).
After stratification by history of surgical procedures, kidney donors naïve to surgery found the books better decreased their fear of the postoperative recovery process (P = 0.028). Liver recipients without a history of prior surgery were also more likely to report that the booklet helped reduce fear related to the operation (P = 0.017).
A total of 74 patients underwent surgery: 6 liver donors, 19 kidney donors, 23 liver recipients, 25 kidney recipients, and 1 SLK recipient. Nine patients (6 liver recipients, 2 kidney recipients, and 1 SLK recipient) were readmitted within 30 days following surgery. Twenty-four patients (1 liver donor, 11 liver recipients, 11 kidney recipients, and 1 SLK recipient) had unplanned outpatient clinic visits. Eight patients (1 kidney donor, 4 liver recipients, and 3 kidney recipients) were evaluated in the ED. Twenty-five patients (3 liver donors, 1 kidney donor, 6 liver recipients, 14 kidney recipients, and 1 SLK recipient) made unexpected phone calls to the transplant coordinator team.
When compared to our institution’s 2023 historical data (Table 2), patients who received the literacy-adapted booklets demonstrated lower rates across all measured outcomes. Historically, liver recipients (n = 141) had a 30-day readmission rate of 44.0% (n = 62) and a 24.1% ED visit rate (n = 34), while kidney recipients (n = 299) had rates of 20.1% (n = 60) and 19.4% (n = 58), respectively. Liver donors (n = 23) had no 30-day readmissions and an 8.7% ED visit rate (n = 2) whereas kidney donors (n = 93) had a 30-day readmission rate of 1.1% (n = 1) and a 17.2% ED visit (n = 16). In the current cohort, readmission rates were reduced among liver recipients [29.2% (n = 7) vs 44.0% (n = 62), P = 0.256] and kidney recipients [11.5% (n = 3) vs 20.1% (n = 60), P = 0.438]. ED visit rates also declined for both liver recipients [16.7% (n = 4) vs 24.1% (n = 34), P = 0.601] and kidney recipients [11.5% (n = 3) vs 19.4% (n = 58), P = 0.437], although none of these comparisons reached statistical significance. Notably, no living donors in the current cohort were readmitted or required ED evaluation, demonstrating improvements across all groups, although not statistically significant.
| Book-receiving (current) cohort | Historical cohort | P value | |
| Liver donors | n = 6 | n = 23 | |
| 30-day readmission | 0 (0.0) | 0 (0.0) | 1.000 |
| Unplanned clinic visits | 1 (16.7) | ||
| 30-day ED encounters | 0 (0.0) | 2 (8.7) | 1.000 |
| Call to transplant coordinators | 3 (50.0) | ||
| Kidney donors | n = 19 | n = 93 | |
| 30-day readmission | 0 (0.0) | 1 (1.1) | 1.000 |
| Unplanned clinic visits | 0 (0.0) | ||
| 30-day ED encounters | 1 (5.3) | 16 (17.2) | 0.069 |
| Call to transplant coordinators | 1 (5.3) | ||
| Liver recipients | n = 241 | n = 141 | |
| 30-day readmission | 7 (29.2) | 62 (44.0) | 0.189 |
| Unplanned clinic visits | 12 (50.0) | ||
| 30-day ED encounters | 4 (16.7) | 34 (24.1) | 0.601 |
| Call to transplant coordinators | 7 (29.2) | ||
| Kidney recipients | n = 261 | n = 299 | |
| 30-day readmission | 3 (11.5) | 60 (20.1) | 0.438 |
| Unplanned clinic visits | 12 (46.2) | ||
| 30-day ED encounters | 3 (11.5) | 58 (19.4) | 0.437 |
| Call to transplant coordinators | 15 (57.7) | ||
| All donors | n = 25 | n = 116 | |
| 30-day readmission | 0 (0.0) | 1 (0.01) | 1.000 |
| Unplanned clinic visits | 1 (4.0) | ||
| 30-day ED encounters | 1 (4.0) | 18 (15.5) | 0.197 |
| Call to transplant coordinators | 4 (16.0) | ||
| All recipients | n = 49 | n = 440 | |
| 30-day readmission | 9 (18.4) | 122 (27.7) | 0.177 |
| Unplanned clinic visits | 23 (46.9) | ||
| 30-day ED encounters | 7 (14.3) | 92 (20.9) | 0.350 |
| Call to transplant coordinators | 21 (42.9) | ||
| Full cohort | n = 74 | n = 556 | |
| 30-day readmission | 9 (12.2) | 123 (22.1) | 0.049 |
| Unplanned clinic visits | 24 (32.4) | ||
| 30-day ED encounters | 8 (10.8) | 110 (19.8) | 0.080 |
| Call to transplant coordinators | 25 (33.8) |
When all patients were aggregated and compared to the historic cohort, overall readmission rates were significantly lower than historic readmission rates [12.2% (n = 9) vs 22.1% (n = 123), P = 0.049] and ED encounters trended lower in the current cohort (10.8 % vs 19.8%, P = 0.080).
This study evaluated the impact of illustrated educational booklets written at appropriate health literacy on postoperative healthcare utilization and patient-reported outcomes in abdominal transplantation. In a diverse cohort of 74 recipients and donors, overall responses were highly favorable, with a mean positive response rate of 88.3% across all survey items. These findings suggest that such booklets may serve as a valuable tool not only for improving patient education but also for reducing early postoperative complications and healthcare utilization.
The value of this intervention is underscored given the educational demographic profile of our institution’s transplant population. Internal data indicate that only 61% of kidney and 59% of liver transplant candidates possess an education level beyond a high school diploma or general educational development. Simultaneously, existing institutional educa
When compared with our institution’s 2023 baseline data, transplant recipients who received booklets experienced lower rates across all measured outcomes. Among liver recipients, the 30-day readmission rate decreased from 44.0% to 29.2%, and ED visits dropped from 24.1% to 16.7%. Similarly, kidney recipients showed reduced readmissions (20.1% to 11.5%) and ED encounters (19.4% to 11.5%). These results are especially notable given the representation of patients with lower educational attainment in the study cohort (Table 1). Within this subgroup, patients were significantly more likely to report the booklets as helpful, suggesting the materials may mitigate disparities linked to health literacy. While none of these observed results were statistically significant (Table 2), this is likely due to a type II error from small sample size. Outcomes were similarly favorable among living donors. No donors experienced 30-day readmissions or ED visits, in contrast to historical donor rates of up to 17.2% for kidney donors and 8.7% for liver donors. These outcomes outperform and compare positively to international benchmark data. Similarly, for kidney donors, readmission rates in other studies and reports range from 3% to 13%[26-28]. Further, when data were aggregated and the entire cohort was compared to historic data, the cohort receiving booklets had a statistically significant decrease in readmissions (12.2% vs 22.1%; P = 0.049). While the lack of a control group in this study makes it difficult to conclude with certainty that the dissemination of these educational tools played a role in this reduced healthcare utilization, it corroborates prior literature with similar findings[29]. Altogether, these improvements, alongside reduced unplanned coordinator calls and clinic visits, suggest a meaningful association between illustrated booklets and reduced early postoperative healthcare utilization.
In addition to addressing logistical and informational gaps in transplant care, these educational booklets were designed to reduce the emotional burden associated with major surgery. Transplantation is a complex and overwhelming process that often triggers anxiety, uncertainty, and fear in both patients and caregivers. This distress not only impairs comprehension but also reduces engagement and postoperative outcomes[30]. Even high-literacy patients may forget or misinterpret key information when under stress. Studies suggest that up to 80% of information from medical visits is forgotten, and nearly half of what is retained may be inaccurate[31]. Solutions, again, include use of illustrated booklets as they allow patients to review information at their own pace, take notes, re-read at home, while reinforcing essential concepts. Such tools have been shown in a randomized controlled trial to improve comprehension, satisfaction, and anxiety among pediatric caregivers, with lower education and unemployment key predictors of benefit[20].
Although the trends observed were favorable, this study has several limitations. The single-center sample size limited statistical power, especially in subgroup analyses. Nonetheless, the consistent directional trends and correlation with perceived usefulness provide a strong foundation for further study. The iterative design process of the booklets also meant that not all patient feedback could be incorporated-however, this was essential to preserve clarity and accessibility. Lastly, it is possible that earlier dissemination of the books to patients may have resulted in increased educational attainment. At the time of evaluation, limited resources precluded broad distribution, particularly given that many patients may not ultimately meet transplant criteria or may not undergo transplantation for several years. Qualitative feedback from participants indicated a strong preference for receiving educational materials earlier in the care continuum, specifically at the time of evaluation. In response to this feedback, future studies are planned to distribute both print and electronic versions of the books at nephrology and hepatology clinics, during transplant center evaluations, and within dialysis clinics to better align education with patient needs and timing.
If validated in larger multicenter trials, the implications of this work are broad. Many institutions have committed to incorporating booklets into transplant pathway and a Spanish-language translation is underway. From a health system perspective, even modest reductions in readmissions and ED visits can yield significant cost savings while enhancing care quality and efficiency.
This study supports the integration of literacy-sensitive, illustrated booklets as a low-cost, scalable, and patient-centered tool to improve transplant education, reduce anxiety, and enhance early postoperative outcomes for both recipients and donors.
| 1. | Health Literacy: A Prescription to End Confusion. Washington (DC): National Academies Press (US); 2004 . [PubMed] |
| 2. | Santana S, Brach C, Harris L, Ochiai E, Blakey C, Bevington F, Kleinman D, Pronk N. Updating Health Literacy for Healthy People 2030: Defining Its Importance for a New Decade in Public Health. J Public Health Manag Pract. 2021;27:S258-S264. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 75] [Cited by in RCA: 176] [Article Influence: 35.2] [Reference Citation Analysis (0)] |
| 3. | Roy M, Corkum JP, Urbach DR, Novak CB, von Schroeder HP, McCabe SJ, Okrainec K. Health Literacy Among Surgical Patients: A Systematic Review and Meta-analysis. World J Surg. 2019;43:96-106. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 16] [Cited by in RCA: 53] [Article Influence: 6.6] [Reference Citation Analysis (0)] |
| 4. | Chen G, Siahaan J, Leon Novelo L, Rizvi I, De Golovine A, Edwards A, Pai A, Dar WA. The Impact of Health Literacy on Kidney Transplant Listing. Prog Transplant. 2022;32:120-128. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 2] [Reference Citation Analysis (0)] |
| 5. | Waterman AD, Peipert JD, Cui Y, Beaumont JL, Paiva A, Lipsey AF, Anderson CS, Robbins ML. Your Path to Transplant: A randomized controlled trial of a tailored expert system intervention to increase knowledge, attitudes, and pursuit of kidney transplant. Am J Transplant. 2021;21:1186-1196. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 10] [Cited by in RCA: 27] [Article Influence: 5.4] [Reference Citation Analysis (0)] |
| 6. | Eggers PW. Has the incidence of end-stage renal disease in the USA and other countries stabilized? Curr Opin Nephrol Hypertens. 2011;20:241-245. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 77] [Cited by in RCA: 71] [Article Influence: 4.7] [Reference Citation Analysis (0)] |
| 7. | Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, Hays R, Howard A, Jones E, Leichtman AB, Merion RM, Metzger RA, Pradel F, Schweitzer EJ, Velez RL, Gaston RS. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol. 2008;3:471-480. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 518] [Cited by in RCA: 447] [Article Influence: 24.8] [Reference Citation Analysis (0)] |
| 8. | Abou Ayache R, Bridoux F, Pessione F, Thierry A, Belmouaz M, Leroy F, Desport E, Bauwens M, Touchard G. Preemptive renal transplantation in adults. Transplant Proc. 2005;37:2817-2818. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 16] [Cited by in RCA: 17] [Article Influence: 0.8] [Reference Citation Analysis (0)] |
| 9. | Blok GA, Morton J, Morley M, Kerckhoffs CC, Kootstra G, van der Vleuten CP. Requesting organ donation: the case of self-efficacy--effects of the European Donor Hospital Education Programme (EDHEP). Adv Health Sci Educ Theory Pract. 2004;9:261-282. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 25] [Cited by in RCA: 24] [Article Influence: 1.1] [Reference Citation Analysis (0)] |
| 10. | Bittermann T, Dwinnells K, Chadha S, Wolf MS, Olthoff KM, Serper M. Low Health Literacy Is Associated With Frailty and Reduced Likelihood of Liver Transplant Listing: A Prospective Cohort Study. Liver Transpl. 2020;26:1409-1421. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 46] [Cited by in RCA: 40] [Article Influence: 6.7] [Reference Citation Analysis (0)] |
| 11. | Cohen S, Cowan V, Rohan V, Pavlakis M, Curry MP, Adler JT, Safa K, Fleishman A, Shenkel J, Rodrigue JR. Willingness of Kidney and Liver Transplant Candidates to Receive HCV-Infected Organs. J Surg Res. 2022;278:342-349. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 3] [Cited by in RCA: 5] [Article Influence: 1.3] [Reference Citation Analysis (0)] |
| 12. | Berkman ND, Sheridan SL, Donahue KE, Halpern DJ, Crotty K. Low health literacy and health outcomes: an updated systematic review. Ann Intern Med. 2011;155:97-107. [PubMed] [DOI] [Full Text] |
| 13. | Serper M, Patzer RE, Reese PP, Przytula K, Koval R, Ladner DP, Levitsky J, Abecassis MM, Wolf MS. Medication misuse, nonadherence, and clinical outcomes among liver transplant recipients. Liver Transpl. 2015;21:22-28. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 60] [Cited by in RCA: 82] [Article Influence: 7.5] [Reference Citation Analysis (0)] |
| 14. | Griffey RT, Kennedy SK, D'Agostino McGowan L, Goodman M, Kaphingst KA. Is low health literacy associated with increased emergency department utilization and recidivism? Acad Emerg Med. 2014;21:1109-1115. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 93] [Cited by in RCA: 107] [Article Influence: 8.9] [Reference Citation Analysis (0)] |
| 15. | Baranwal P, Sathe M, Lobritto SJ, Vittorio J. The impact of health literacy on adolescent and young adult pediatric liver transplant recipients. Liver Transpl. 2024;30:386-394. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 2] [Cited by in RCA: 5] [Article Influence: 2.5] [Reference Citation Analysis (0)] |
| 16. | Waterman AD, McSorley AM, Peipert JD, Goalby CJ, Peace LJ, Lutz PA, Thein JL. Explore Transplant at Home: a randomized control trial of an educational intervention to increase transplant knowledge for Black and White socioeconomically disadvantaged dialysis patients. BMC Nephrol. 2015;16:150. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 37] [Cited by in RCA: 46] [Article Influence: 4.2] [Reference Citation Analysis (0)] |
| 17. | Patzer RE, Perryman JP, Pastan S, Amaral S, Gazmararian JA, Klein M, Kutner N, McClellan WM. Impact of a patient education program on disparities in kidney transplant evaluation. Clin J Am Soc Nephrol. 2012;7:648-655. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 74] [Cited by in RCA: 71] [Article Influence: 5.1] [Reference Citation Analysis (0)] |
| 18. | Bababekov YJ, Hung YC, Rickert CG, Njoku FC, Cao B, Adler JT, Brega AG, Pomposelli JJ, Chang DC, Yeh H. Health Literacy Burden Is Associated With Access to Liver Transplantation. Transplantation. 2019;103:522-528. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 9] [Cited by in RCA: 14] [Article Influence: 2.0] [Reference Citation Analysis (0)] |
| 19. | Wolf MS, Curtis LM, Waite K, Bailey SC, Hedlund LA, Davis TC, Shrank WH, Parker RM, Wood AJ. Helping patients simplify and safely use complex prescription regimens. Arch Intern Med. 2011;171:300-305. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 76] [Cited by in RCA: 82] [Article Influence: 5.5] [Reference Citation Analysis (0)] |
| 20. | Baimas-George M, Watson M, Paton BL, Cosper G, Schmelzer T, Schulman A, Bambini D, Matthews B. Novel Way to Improve Satisfaction, Comprehension, and Anxiety in Caregivers: A Randomized Trial Exploring the Use of Comprehensive, Illustrated Children's Books for Pediatric Surgical Populations. J Am Coll Surg. 2022;234:263-273. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 6] [Reference Citation Analysis (0)] |
| 21. | Kadri H, Muhammad HA, Narayan RR, Melcher ML. Publisher Accreditation Fails to Reflect Higher Content Quality in Liver Transplant YouTube Videos. J Surg Res. 2024;293:95-101. [RCA] [PubMed] [DOI] [Full Text] [Cited by in RCA: 3] [Reference Citation Analysis (0)] |
| 22. | Cohen SM, Baimas-George M, Ponce C, Chen N, Bain PA, Ganske IM, Katz J, Luks FI, Kent TS. Is a Picture Worth a Thousand Words? A Scoping Review of the Impact of Visual Aids on Patients Undergoing Surgery. J Surg Educ. 2024;81:1276-1292. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 8] [Cited by in RCA: 15] [Article Influence: 7.5] [Reference Citation Analysis (0)] |
| 23. | Grogan S, Conner M, Norman P, Willits D, Porter I. Validation of a questionnaire measuring patient satisfaction with general practitioner services. Qual Health Care. 2000;9:210-215. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 112] [Cited by in RCA: 117] [Article Influence: 4.5] [Reference Citation Analysis (0)] |
| 24. | Theunissen M, Peters ML, Schouten EG, Fiddelers AA, Willemsen MG, Pinto PR, Gramke HF, Marcus MA. Validation of the surgical fear questionnaire in adult patients waiting for elective surgery. PLoS One. 2014;9:e100225. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 86] [Cited by in RCA: 110] [Article Influence: 9.2] [Reference Citation Analysis (0)] |
| 25. | Kleefstra S, Kool R, Zandbelt L, de Haes J. An instrument assessing patient satisfaction with day care in hospitals. BMC Health Serv Res. 2012;12:125. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 20] [Cited by in RCA: 26] [Article Influence: 1.9] [Reference Citation Analysis (0)] |
| 26. | Rege A, Leraas H, Vikraman D, Ravindra K, Brennan T, Miller T, Thacker J, Sudan D. Could the Use of an Enhanced Recovery Protocol in Laparoscopic Donor Nephrectomy be an Incentive for Live Kidney Donation? Cureus. 2016;8:e889. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in Crossref: 11] [Cited by in RCA: 17] [Article Influence: 1.7] [Reference Citation Analysis (0)] |
| 27. | Waits SA, Hilliard P, Sheetz KH, Sung RS, Englesbe MJ. Building the case for enhanced recovery protocols in living kidney donors. Transplantation. 2015;99:405-408. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 26] [Cited by in RCA: 33] [Article Influence: 3.0] [Reference Citation Analysis (0)] |
| 28. | Kuo PC, Johnson LB, Sitzmann JV. Laparoscopic donor nephrectomy with a 23-hour stay: a new standard for transplantation surgery. Ann Surg. 2000;231:772-779. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 74] [Cited by in RCA: 72] [Article Influence: 2.8] [Reference Citation Analysis (0)] |
| 29. | Shahid R, Shoker M, Chu LM, Frehlick R, Ward H, Pahwa P. Impact of low health literacy on patients' health outcomes: a multicenter cohort study. BMC Health Serv Res. 2022;22:1148. [RCA] [PubMed] [DOI] [Full Text] [Full Text (PDF)] [Cited by in RCA: 258] [Reference Citation Analysis (0)] |
| 30. | Fink AS, Prochazka AV, Henderson WG, Bartenfeld D, Nyirenda C, Webb A, Berger DH, Itani K, Whitehill T, Edwards J, Wilson M, Karsonovich C, Parmelee P. Predictors of comprehension during surgical informed consent. J Am Coll Surg. 2010;210:919-926. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 91] [Cited by in RCA: 100] [Article Influence: 6.3] [Reference Citation Analysis (0)] |
| 31. | Kessels RP. Patients' memory for medical information. J R Soc Med. 2003;96:219-222. [RCA] [PubMed] [DOI] [Full Text] [Cited by in Crossref: 52] [Cited by in RCA: 107] [Article Influence: 11.9] [Reference Citation Analysis (0)] |