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Kaplan A, Korenjak M, Brown RS. Post-liver transplantation patient experience. J Hepatol 2023; 78:1234-1244. [PMID: 37208108 DOI: 10.1016/j.jhep.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 05/21/2023]
Abstract
Given improvements in post-transplant patient and graft survival, there is a growing need to focus on patient experience and health-related quality of life (HRQOL). Though liver transplantation can be life-saving, it can also be associated with significant morbidity and complications. Patient HRQOL improves after transplantation, but it may not improve to that of age-matched cohorts. Understanding patient experience and the factors that contribute to it, including physical and psychological health, immunosuppression and medication adherence, return to employment or school, financial burden, and expectations, helps when thinking creatively about potential interventions to improve HRQOL.
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Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA
| | | | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA.
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2
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Radomska M, Flores Alves Dos Santos J, Weber K, Baertschi M, Burkhard PR, Herrmann F, Belayachi S, Favez N, Canuto A. Assessing preoperative hope and expectations related to functional neurosurgery: a new questionnaire. BMC Psychol 2022; 10:53. [PMID: 35246249 PMCID: PMC8897841 DOI: 10.1186/s40359-022-00766-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite successful functional neurosurgery, patients suffering from epilepsy or Parkinson's disease may experience postoperative psychological distress and social maladjustments. Difficulties in coping with postoperative changes, even positive ones, have shown to be related to patients' presurgery cognitive representations (i.e., expectations, hope). The aim of this study was to develop an instrument assessing various key features of surgery outcomes' representations, namely the Preoperative Hope and Expectations Questionnaire (PHEQ). METHODS Participants were patients (n = 50) diagnosed with Parkinson's disease (n = 25) or epilepsy (n = 25), candidates for functional neurosurgery (i.e., Deep brain stimulation, anterior temporal lobectomy). Two to three weeks before the planned surgery, they were administrated items assessing their actual state, preoperative expectations, and hope regarding surgery outcomes. They also completed measures assessing optimism, quality of life and mood. RESULTS Exploratory analysis resulted in a 14-item version of the PHEQ composed of two factors (abstract representations, including psychological well-being and concrete representations, such as direct surgery outcomes). The PHEQ demonstrated high internal consistency and good convergent validity. Patients were more prone to express postoperative improvements in terms of hope rather than expectations. They generally focused on concrete rather than abstract features, although patients with Parkinson's disease had higher abstract future-oriented representations. CONCLUSIONS The PHEQ presents satisfactory psychometric properties and may be considered as a reliable instrument for research and clinical practice.
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Tedesco Triccas L, Donovan-Hall M, Dibb B, Burridge JH. A nation-wide survey exploring the views of current and future use of functional electrical stimulation in spinal cord injury. Disabil Rehabil Assist Technol 2021:1-11. [PMID: 34107234 DOI: 10.1080/17483107.2021.1916631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Functional electrical stimulation (FES) can be effective in assisting physical and psychosocial difficulties experienced by people with spinal cord injury. Perceived benefits and barriers of the current and future use of FES within the wider spinal cord injury community is currently unknown. The main objective of this research was to explore the spinal cord injury community's views of the use of FES to decrease disability in rehabilitation programmes. MATERIALS AND METHODS An online and paper questionnaire was distributed to people with spinal cord injury, health care professionals and researchers working in spinal cord injury settings in the United Kingdom. RESULTS A total of 299 participants completed the survey (152 people with spinal cord injury, 141 health care professionals and 6 researchers). Common views between groups identified were: (1) FES can be beneficial in improving physical and psychosocial aspects and that (2) adequate support and training for FES application was provided to users. Barriers to FES use included a lack of staff time and training, financial cost and availability of the equipment. Sixty three percent of non-users felt they would use FES in the future if they had the opportunity. CONCLUSIONS Users' views were important in identifying that FES application can be beneficial for people with spinal cord injury but also has some resourceful barriers. In order to increase use, future research should focus on reducing the cost of FES clinical service and also address implementation of awareness and training programmes within spinal units and community rehabilitation settings.IMPLICATIONS FOR REHABILITATIONUsers of functional electrical stimulation think that it is beneficial for improving physical and psychosocial limitations after spinal cord injuryBarriers to FES use include a lack of staff time and training, financial cost and availability of the equipment have been suggested by people with spinal cord injury and health care professionals Education and implementation programs for health care professionals and people with spinal cord injury are now necessary to increase the awareness about functional electrical stimulation applicationReduction of FES cost could also increase its uptake in spinal cord injury clinical services.
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Affiliation(s)
- Lisa Tedesco Triccas
- Faculty of Health Sciences, University of Southampton, Southampton, UK.,Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | | | - Bridget Dibb
- School of Psychology, University of Surrey, Guildford, UK
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4
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Åberg F. Quality of life after liver transplantation. Best Pract Res Clin Gastroenterol 2020; 46-47:101684. [PMID: 33158471 DOI: 10.1016/j.bpg.2020.101684] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 08/31/2020] [Indexed: 01/31/2023]
Abstract
Liver transplantation (LT) enables rapid transition from critical illness and poor prognosis back to health. After LT, health-related quality of life (HRQoL) generally becomes comparable to that of the general population, although some deficits in mainly physical domains are frequent. However, recipients continue to have symptoms related to immunosuppression, complications, and other things, which impact HRQoL and the recipient's ability to regain independence and re-establish function in everyday life. Less than half of LT recipients return to work. Reportedly, HRQoL seems to deteriorate slightly over the long-term, but still remains satisfactory. Physical fatigue is common, but recent studies show that structured exercise programs improve both fatigue and HRQoL. Emerging evidence also suggests that continued patient information, structured psychosocial support systems, and caregiver involvement might further help improve long-term HRQoL. More research is needed to gain better understanding of the factors affecting long-term HRQoL, and how to best improve HRQoL.
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Affiliation(s)
- Fredrik Åberg
- Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki University, Helsinki, Finland; The Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden.
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5
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Beyond Survival in Solid Organ Transplantation: A Summary of Expert Presentations from the Sandoz 6th Standalone Transplantation Meeting, 2018. Transplantation 2020; 103:S1-S13. [PMID: 31449167 DOI: 10.1097/tp.0000000000002846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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6
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Ferreira SC, de Oliveira Penaforte FR, Cardoso A, da Silva MVT, Lima AS, Correia MITD, Anastácio LR. Association of food cravings with weight gain, overweight, and obesity in patients after liver transplantation. Nutrition 2019; 69:110573. [PMID: 31585257 DOI: 10.1016/j.nut.2019.110573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE After liver transplantation (LTx), patients often gain weight and many become overweight or obese; however, the association between LTx and food craving (FC) is unknown. The aim of this study was to describe FC among patients after LTx and verify its association with weight gain and obesity. METHODS This was a cross-sectional study that assessed 301 patients who underwent LTx (55.1 ± 12.7 y of age; time since LTx 6.6 ± 4.4 y; 64.1% men). Pregnant or nursing women were excluded. Patients were interviewed once either in the outpatient clinic or by completing the online questionnaire, from August 2016 to February 2017. RESULTS The median weight variation after Ltx was 8 kg (ranging from -16 to +41 kg). At evaluation, 62.5% (n = 188) of the patients presented excessive weight and 22.3% (n = 67) presented with obesity. The average score on the Food Craving Questionnaire-State (FCQ-S) was 33.4 ± 9 and for the Food Craving Questionnaire-Trait (FCQ-T) the median score was 68 (39-163). The FCQ-T dimensions of lack of control, preoccupation, emotion, environmental triggers/stimuli, and guilt correlated positively with weight gain (P < 0.05). The desire dimension on the FCQ-S was significantly associated with overweight in post-LTx patients (P < 0.05) and the FCQ-T dimensions [negative reinforcement (P = 0.013), lack of control (P = 0.016), emotion (P = 0.009), environmental triggers/stimuli (P = 0.029), and guilt (P = 0.007)] were associated with obesity. CONCLUSION Lack of control, preoccupation, emotion, trigger, and guilt were positively correlated with weight gain. Desire was significantly associated with overweight. Negative reinforcement, lack of control, emotion, environmental triggers/stimuli, and guilt were associated with obesity.
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Affiliation(s)
- Samanta Catherine Ferreira
- Food Science Post Graduation Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Amanda Cardoso
- Nutrition Course, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Agnaldo Silva Lima
- Surgery Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Lucilene Rezende Anastácio
- Food Science Post Graduation Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Food Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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7
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McLean KA, Drake TM, Sgrò A, Camilleri-Brennan J, Knight SR, Ots R, Adair A, Wigmore SJ, Harrison EM. The effect of liver transplantation on patient-centred outcomes: a propensity-score matched analysis. Transpl Int 2019; 32:808-819. [PMID: 30793373 DOI: 10.1111/tri.13416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/19/2018] [Accepted: 02/18/2019] [Indexed: 12/21/2022]
Abstract
It is unclear whether liver transplantation confers an increase in health-related quality of life (HR-QoL) across all dimensions of health. This study aimed to estimate the effect of liver transplantation on HR-QoL. Pre- and post-transplantation patients attending an outpatient clinic were invited to complete the condition-specific 'Short form of liver disease QOL' questionnaire. Mixed-effect linear regression and propensity-score matching (PSM) on pretransplantation characteristics were used to estimate the difference in overall HR-QoL associated with transplantation. Of 454/609 (74.5%) eligible patients who were included in the analysis, 102 (22.5%) patients fall under pretransplantation category, and 352 (77.5%) were under post-transplantation category. Overall HR-QoL post-transplantation significantly increased in patients without hepatocellular carcinoma (HCC) (β = 16.84, 95% CI: 13.33 to 20.35, P < 0.001), but not with HCC (β = 1.25, 95% CI: -5.09 to 7.60, P = 0.704). Donation after circulatory death (DCD) organ recipients had a significantly lower HR-QoL (β = -4.61, 95% CI: -8.95 to -0.24, P = 0.043). Following PSM, transplantation was associated with a significant increase in overall HR-QoL (average treatment effect: 6.3, 95% CI: 2.1-10.9). There is a significant improvement in HR-QoL attributable to transplantation in this cohort. Post-transplantation HR-QoL was affected by several factors, including HCC status and DCD transplantation, which has important implications for counselling prior to liver transplantation.
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Affiliation(s)
- Kenneth A McLean
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Thomas M Drake
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Alessandro Sgrò
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Julian Camilleri-Brennan
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Stephen R Knight
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Riinu Ots
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Anya Adair
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Stephen J Wigmore
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Ewen M Harrison
- Scottish Liver Transplant Unit, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK
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8
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Aversa M, Chowdhury NA, Tomlinson G, Singer LG. Preoperative expectations for health-related quality of life after lung transplant. Clin Transplant 2018; 32:e13394. [DOI: 10.1111/ctr.13394] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Meghan Aversa
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- University Health Network; Toronto Ontario Canada
| | | | - George Tomlinson
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- University Health Network; Toronto Ontario Canada
| | - Lianne G. Singer
- Department of Medicine; University of Toronto; Toronto Ontario Canada
- University Health Network; Toronto Ontario Canada
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Englschalk C, Eser D, Jox RJ, Gerbes A, Frey L, Dubay DA, Angele M, Stangl M, Meiser B, Werner J, Guba M. Benefit in liver transplantation: a survey among medical staff, patients, medical students and non-medical university staff and students. BMC Med Ethics 2018; 19:7. [PMID: 29433496 PMCID: PMC5810023 DOI: 10.1186/s12910-018-0248-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 01/29/2018] [Indexed: 12/23/2022] Open
Abstract
Background The allocation of any scarce health care resource, especially a lifesaving resource, can create profound ethical and legal challenges. Liver transplant allocation currently is based upon urgency, a sickest-first approach, and does not utilize capacity to benefit. While urgency can be described reasonably well with the MELD system, benefit encompasses multiple dimensions of patients’ well-being. Currently, the balance between both principles is ill-defined. Methods This survey with 502 participants examines how urgency and benefit are weighted by different stakeholders (medical staff, patients on the liver transplant list or already transplanted, medical students and non-medical university staff and students). Results Liver transplant patients favored the sickest-first allocation, although all other groups tended to favor benefit. Criteria of a successful transplantation were a minimum survival of at least 1 year and recovery of functional status to being ambulatory and capable of all self-care (ECOG 2). An individual delisting decision was accepted when the 1-year survival probability would fall below 50%. Benefit was found to be a critical variable that may also trigger the willingness to donate organs. Conclusions The strong interest of stakeholder for successful liver transplants is inadequately translated into current allocation rules.
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Affiliation(s)
- Christine Englschalk
- Department of General, Visceral, Vascular and Transplant Surgery, Klinikum der Universität München, Marchioninistrasse 15, 81377, München, Germany
| | - Daniela Eser
- Department of Psychiatry and Psychotherapy, Klinikum der Universität München, Nußbaumstraße 7, 80336, München, Germany
| | - Ralf J Jox
- Institute of Ethics, History and Theory of Medicine, LMU Munich, Lessingstr. 2, 80336, München, Germany
| | - Alexander Gerbes
- Department of Medicine II, Klinikum der Universität München, Marchioninistrasse 15, 81377, München, Germany
| | - Lorenz Frey
- Department of Anesthesiology, Klinikum der Universität München, Marchioninistrasse 15, 81377, München, Germany
| | - Derek A Dubay
- Department of Surgery, Division of Transplant Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Martin Angele
- Department of General, Visceral, Vascular and Transplant Surgery, Klinikum der Universität München, Marchioninistrasse 15, 81377, München, Germany
| | - Manfred Stangl
- Department of General, Visceral, Vascular and Transplant Surgery, Klinikum der Universität München, Marchioninistrasse 15, 81377, München, Germany
| | - Bruno Meiser
- Transplant Center Munich, Klinikum der Universität München, Marchioninistrasse 15, 81377, München, Germany
| | - Jens Werner
- Department of General, Visceral, Vascular and Transplant Surgery, Klinikum der Universität München, Marchioninistrasse 15, 81377, München, Germany
| | - Markus Guba
- Department of General, Visceral, Vascular and Transplant Surgery, Klinikum der Universität München, Marchioninistrasse 15, 81377, München, Germany. .,Transplant Center Munich, Klinikum der Universität München, Marchioninistrasse 15, 81377, München, Germany.
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10
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Chiu CC, Lee KT, Wang JJ, Sun DP, Lee HH, Shi HY. Health-Related Quality of Life before and after Surgical Resection of Hepatocellular Carcinoma: A Prospective Study. Asian Pac J Cancer Prev 2018; 19:65-72. [PMID: 29373894 PMCID: PMC5844638 DOI: 10.22034/apjcp.2018.19.1.65] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and Objectives: This large-scale prospective cohort study of a Taiwan population applied generalized estimating equations (GEEs) to evaluate changing trends in health-related quality of life (HRQoL) and to compare predictors of HRQoL before and after surgical resection of hepatocellular carcinoma (HCC) performed during 2011-2014. Materials and Methods: The Short Form-36 Health Survey (SF-36) and Functional Assessment of Cancer Therapy-Hepatobiliary were used in a preoperative assessment and in 3- and 6-month postoperative assessments of 332 HCC patients. Results: The HRQoL was signficantly (p<0.05) improved at 3 months after surgical resection of HCC and plateaued at 6 months after surgery. Scores for both the SF-36 Physical Component Summary (PCS) and Mental Component Summary (MCS) were significantly higher at the third month after surgery (p<0.05) compared to the preoperative period. Both scores also exceeded the norms after hepatic resection of HCC. However, PCS scores were generally higher than MCS scores throughout the study period. After adjusting for time effects and baseline predictors, GEE approaches revealed the following explanatory variables for HRQoL: time of HRQoL assessment, gender, age, education, coresidence with family, chemotherapy, average length of hospital stay, and preoperative functional status. Conclusions: Hepatic resection significantly increased HRQoL in patients with HCC (p<0.05). However, an evaluation of HRQoL after hepatic resection should consider several factors other than outcomes of the surgery itself. Additionally, patients should be advised that their HRQoL improvement after surgery might depend not only on the success of surgery, but also on their preoperative functional status.
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Affiliation(s)
- Chong-Chi Chiu
- Department of General Surgery, Chi Mei Medical Center, Liouying, Taiwan
- Department of General Surgery, Chi Mei Medical Center, Tainan, Taiwan
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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11
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O'Dell MI, Wright L. Electronic Psychosocial Evaluation Tool: Use in a Living Donor Organ Transplant Program. Prog Transplant 2016; 13:97-104. [PMID: 12841515 DOI: 10.1177/152692480301300205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychosocial evaluation of potential organ donors ensures that these patients are prepared for donation and that their psychosocial issues have been addressed. The determination that the decision to donate an organ has been made voluntarily by a competent individual is a primary concern for living donor transplant programs, which must work to the highest ethical standard in this unique area of medicine. Identification of potential vulnerabilities on the part of the donor permits monitoring and/or intercession both before and after donation. Ensuring the confidentiality of patient information is important and represents a cornerstone of social work practice. At our institution, social workers have developed an electronic recording tool for use in evaluating organ donors; this tool is designed to maximize quality and ease of information gathering, ensure standardization of practice across programs, simplify record keeping, and enhance communication while minimizing time investment and ensuring patient confidentiality.
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Eftekar M, Pun P. Psychiatric risk factors predicting post-liver transplant physical and psychiatric complications: a literature review. Australas Psychiatry 2016; 24:385-92. [PMID: 26879076 DOI: 10.1177/1039856215627400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The psychiatric assessment of potential liver transplant recipients is becoming increasingly common in clinical practice. In such assessments, the psychiatrist is invited by the transplant team to assess the patient prior to the patient receiving a transplant liver to identify factors that could predict an unsuccessful post-transplant course, whether this is from a psychiatric or physical perspective. This review examined published research from 2000 to 2014 on psychological risk factors predicting post-transplant physical and psychiatric complications. CONCLUSIONS Based on the strength of the evidence available, our review identified four risk factors: mood disorders; social supports; substance misuse; and alcohol dependence. These factors could potentially provide a framework to guide the evaluation and prediction of psychological and physical complications post-liver transplantation.
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Affiliation(s)
- Mahdod Eftekar
- Consultation Liaison Psychiatrist, Consultation Liaison Psychiatry Department, Princess Alexandra hospital, Woolloongabba, QLD, Australia
| | - Paul Pun
- Consultation Liaison Psychiatrist, Consultation Liaison Psychiatry Department, Princess Alexandra hospital, Woolloongabba, QLD, Australia
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Abstract
Quality of life is an important outcome indicator of experiences associated with liver transplantation. Unfortunately, quality of life has been defined in many different ways, causing confusion and misconceptions among practitioners, researchers, policy makers, and patients. This exploratory qualitative study was initiated to gain greater understanding regarding the adult transplant recipients' experiences with liver transplantation in order to direct future studies with this population and to assist in selection of a relevant quality of life survey tool for quantitative investigation. Twelve informants (7 women, 5 men) shared their experiences in face-to-face interviews conducted by the researcher. Analysis of these interviews reveals the importance of physiologic, psychological, social, spiritual, family, and socioeconomic aspects of quality of life for liver transplant recipients.
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Affiliation(s)
- Kathy B Bean
- University of Texas at Arlington, School of Nursing, Arlington, Tex, USA
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14
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Bernstein M, Potvin D, Martin DK. A Qualitative Study of Attitudes Toward Error in Patients Facing Brain Tumour Surgery. Can J Neurol Sci 2016; 31:208-12. [PMID: 15198445 DOI: 10.1017/s0317167100053841] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
AbstractBackground:Medical error is an extremely important component of patient safety and requires intense study. The present investigation undertook to examine patients' perceptions and attitudes regarding medical error.Methods:Qualitative case study methodology was used. We conducted 30 face-to-face interviews with patients within one week of undergoing a neurosurgical operation for a brain tumour. Interviews were audiotaped and transcribed and the data subjected to thematic analysis.Results:Three overarching themes emerged from the data: 1) trust in the patient's surgeon was of paramount importance; 2) patients'views toward medical error varied between fear and vulnerability to no concern; and 3) discussion of error was felt to be beneficial as it could help the medical profession decrease future errors and could help dispel the patient's fear and anxiety about the upcoming surgery.Conclusions:Patients'trust in their physician/surgeon is of paramount importance in allaying their fears about the possible occurrence and impact of medical error during their treatment. The level of concern about error varies among patients, but most felt that discussion of error was a good thing.
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Affiliation(s)
- Mark Bernstein
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
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15
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Cavallini J, Forsberg A, Lennerling A. Social function after solid organ transplantation: An integrative review. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/0107408315592335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The way organ transplant recipients depend on social interactions to develop and experience social health and well-being is similar to that of the general population. A transplant may result in a close to full recovery of health status, but the physical and social problems can persist in some patients. The focus on improving the recipients’ social participation has therefore become an important issue. The purpose of this integrative literature review was study social function after solid organ transplantation, that is, kidney, liver, lung or heart. An integrative review was performed on studies that matched the selection criteria and published in peer-reviewed journals from January 2000 to December 2014. The information from the text was extracted and patterns of social function were categorized into different subgroups that were further looked at, and five categories emerged: 1) work, 2) education, 3) daily activities and leisure, 4) social adaption and 5) barriers. The key aspects of social functioning involve five vital domains, that is, work, education, daily activities and leisure, social adaption and barriers. Returning to work appears to be the most important for the recipients independently of the transplanted organ.
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Affiliation(s)
| | - Anna Forsberg
- Department of Health Sciences, Lund University, Sweden
- Department of Transplantation and Cardiology, Skåne University Hospital, Sweden
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Sweden
- The Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Sweden
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Abstract
Compressive neuropathies of the upper extremity are common and can result in profound disability if left untreated. Nerve releases are frequently performed, but can be complicated by both iatrogenic events and progression of neuropathy. In this review, we examine the management of postoperative complications after 2 common nerve compression release procedures: carpal tunnel release and cubital tunnel release.
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Affiliation(s)
- Katherine B. Santosa
- House Officer, Section of Plastic Surgery, Department of Surgery,
University of Michigan Health System
| | - Kevin C. Chung
- Professor of Surgery, Section of Plastic Surgery, Department of
Surgery, University of Michigan Health System
| | - Jennifer F. Waljee
- Assistant Professor, Section of Plastic Surgery, Department of
Surgery, University of Michigan Health System
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17
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Psychological Differences of Patients and Relatives according to Post-Transplantation Anxiety. SPANISH JOURNAL OF PSYCHOLOGY 2014; 11:250-8. [DOI: 10.1017/s1138741600004285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The aim of this investigation is to analyze the psychological differences of patients and their relatives according to the formers' post-transplantation anxiety. We used two groups of participants: transplant patients (n = 166) and close relatives (n = 166). Four questionnaires were applied: a Psychological Survey (to both groups), the Hospital Anxiety and Depression Scale, and the Quality of Life Questionnaire (to the transplant patients), and the Leeds Scales for the Self-Assessment of Anxiety and Depression (to the relatives). Participants were assessed twice: post-Intensive Care Unit (ICU; when patients were moved from the ICU to the Transplantation Unit) and post-hospital (one year after transplant). Results showed that high anxiety in patients just after organ transplant was related to an increase of anxiety and depression symptoms both in patients and relatives one year after transplant; it was also related to a decrease in the quality of life of these patients.
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Malik P, Kohl C, Holzner B, Kemmler G, Graziadei I, Vogel W, Sperner-Unterweger B. Distress in primary caregivers and patients listed for liver transplantation. Psychiatry Res 2014; 215:159-62. [PMID: 24210743 DOI: 10.1016/j.psychres.2013.08.046] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 03/26/2013] [Accepted: 08/18/2013] [Indexed: 10/26/2022]
Abstract
Orthotopic liver transplantation (LTx) has become a routine procedure in the treatment of end-stage liver disease. During the waiting period for transplantation, the patient's family members are also highly affected. We examined the course of distress and quality of life (QOL) in 47 patients awaiting LTx and distress in 24 caregivers at baseline and in intervals of 4-6 weeks, using The Hospital Anxiety and Depression Scale (HADS) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). All subscales of the EORTC QLQ-C30, except emotional functioning, were lower than normal at baseline. Little change in patients' QOL was observed during the waiting period. In the HADS, there were significantly higher anxiety scores in caregivers than in patients both at baseline and after 1-2 months and the third assessment, with the difference after 3-5 months reaching almost significance. Caregivers' anxiety levels increased significantly. Relatives showed more depression than patients only at month 1-2 and a significant increase in depression from baseline to month 1-2. In patients, depression scores remained relatively stable throughout all visits. Our results emphasize the importance of evaluation of psychic stress especially in relatives during the waiting period for LTx.
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Affiliation(s)
- Peter Malik
- Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Claudia Kohl
- Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Bernhard Holzner
- Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Georg Kemmler
- Department of General Psychiatry, Medical University Innsbruck, Innsbruck, Austria
| | - Ivo Graziadei
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang Vogel
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Sperner-Unterweger
- Department of Biological Psychiatry, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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Waljee J, McGlinn EP, Sears ED, Chung KC. Patient expectations and patient-reported outcomes in surgery: a systematic review. Surgery 2013; 155:799-808. [PMID: 24787107 DOI: 10.1016/j.surg.2013.12.015] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 12/10/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent events in health care reform have brought national attention to integrating patient experiences and expectations into quality metrics. Few studies have comprehensively evaluated the effect of patient expectations on patient-reported outcomes (PROs) after surgery. The purpose of this study is to systematically review the available literature describing the relationship between patient expectations and postoperative PROs. METHODS We performed a search of the literature published before November 1, 2012. Articles were included in the review if (1) primary data were presented, (2) patient expectations regarding a surgical procedure were measured, (3) PROs were measured, and (4) the relationship between patient expectations and PROs was specifically examined. PROs were categorized into 5 subgroups: Satisfaction, quality of life (QOL), disability, mood disorder, and pain. We examined each study to determine the relationship between patient expectations and PROs as well as study quality. RESULTS From the initial literature search yielding 1,708 studies, 60 articles were included. Fulfillment of expectations was associated with improved PROs among 24 studies. Positive expectations were correlated with improved PROs for 28 studies (47%), and poorer PROs for 9 studies (15%). Eighteen studies reported that fulfillment of expectations was correlated with improved patient satisfaction, and 10 studies identified that positive expectations were correlated with improved postoperative. Finally, patients with positive preoperative expectations reported less pain (8 studies) and disability (15 studies) compared with patients with negative preoperative expectations. CONCLUSION Patient expectations are inconsistently correlated with PROs after surgery, and there is no accepted method to capture perioperative expectations. Future efforts to rigorously measure expectations and explore their influence on postoperative outcomes can inform clinicians and policymakers seeking to integrate PROs into measures of surgical quality.
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Affiliation(s)
- Jennifer Waljee
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Evan P McGlinn
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Erika Davis Sears
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI.
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Schulz T, Niesing J, Homan van der Heide JJ, Westerhuis R, Ploeg RJ, Ranchor AV. Great expectations? Pre-transplant quality of life expectations and distress after kidney transplantation: A prospective study. Br J Health Psychol 2013; 19:823-38. [DOI: 10.1111/bjhp.12081] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 10/23/2013] [Indexed: 12/01/2022]
Affiliation(s)
- Torben Schulz
- Department of Health Sciences; University Medical Center Groningen; University of Groningen; the Netherlands
| | - Jan Niesing
- Department of Abdominal Surgery; University Medical Center Groningen; University of Groningen; the Netherlands
| | | | | | - Rutger J. Ploeg
- Department of Abdominal Surgery; University Medical Center Groningen; University of Groningen; the Netherlands
| | - Adelita V. Ranchor
- Department of Health Sciences; University Medical Center Groningen; University of Groningen; the Netherlands
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Ostler C, Ellis-Hill C, Donovan-Hall M. Expectations of rehabilitation following lower limb amputation: a qualitative study. Disabil Rehabil 2013; 36:1169-75. [DOI: 10.3109/09638288.2013.833311] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Limitations on Surrogate Decision-Making for Emergent Liver Transplantation. J Surg Res 2012; 172:48-52. [DOI: 10.1016/j.jss.2011.04.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2011] [Revised: 04/04/2011] [Accepted: 04/19/2011] [Indexed: 11/21/2022]
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Scott PJ, Brown VL. Resumption of valued activities in the first year post liver transplant. Occup Ther Health Care 2012; 26:48-63. [PMID: 23899107 DOI: 10.3109/07380577.2011.643856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
ABSTRACT Current practice in education of transplant recipients includes general guidelines about return to involvement in life activities emphasizing medical precautions during wound healing and avoidance of activities that present risk of infection or rejection. This approach assumes patients gradually resume pre-transplant involvement in life activities: an assumption that has not been tested. Using the Canadian Occupational Performance Measure, this cross-sectional descriptive pilot study (n = 20) explored differences in the performance of activities of daily living, instrumental activities of daily living, leisure, and productivity at three time periods within the first year. Results showed basic daily tasks are stable by the third month but some instrumental tasks declined by the end of the first year post transplant. Results indicated that there were significant differences in the Short Form-36 mental component score of the group performing "worse than expected" suggesting that preparation of recipients is needed to enable them to set realistic expectations. Results indicate the need for a longitudinal study of the resumption patterns of life activities for realistic expectations of recovery and guidelines for the treatment team.
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Affiliation(s)
- Patricia J Scott
- 1Department of Occupational Therapy, Indiana University, Indianapolis, Indiana, USA
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Rodrigue JR, Hanto DW, Curry MP. Patients' expectations and success criteria for liver transplantation. Liver Transpl 2011; 17:1309-17. [PMID: 21656656 DOI: 10.1002/lt.22355] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Patient-reported outcomes are important to consider when the relative success of liver transplantation (LT) is being evaluated. Our primary objective was to examine the expectations for LT and the criteria for its success across 4 domains of functioning (pain, fatigue, emotional distress, and interference with daily activities) from the perspective of patients who were wait-listed for LT. One hundred four adult patients with a mean wait-list time of 16.5 ± 13 months completed a semistructured interview with a modified version of the Patient-Centered Outcomes Questionnaire (PCOQ). The patients reported moderate usual levels of pain, fatigue, emotional distress, and interference with daily activities (mean rating range = 3.8-6.2), and they attached great importance to improvements in these domains after LT (mean rating range = 7.3-8.0). Patients considered a mean reduction in pain of 33% to be a successful LT outcome. A reduction in fatigue of 56%, a reduction in emotional distress of 44%, and a reduction in interference with daily activities of 54% represented successful LT across these domains. Patients with more severe illness had higher expectations for fatigue (r = -0.30, P = 0.002) and interference with daily activities (r = -0.24, P = 0.015). Cluster and correlational analyses provided support for the validity of the PCOQ with LT patients. Our findings underscore the importance and value of using patient-centered assessments to better understand the ways in which patients prioritize LT outcomes and define transplantation success. Patient-centered assessments have the potential to facilitate provider-patient communication by helping patients to prioritize their goals for LT and make informed choices on the basis of those priorities.
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Affiliation(s)
- James R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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Scott PJ. Occupational therapy services to enable liver patients to thrive following transplantation. Occup Ther Health Care 2011; 25:240-56. [PMID: 23899078 DOI: 10.3109/07380577.2011.600427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT Transplantation is the only viable treatment for end-stage liver failure. With advances in biomedicine and surgical technique, survival rates have improved and current research is beginning to focus on patient-related outcomes such as of quality of life (QOL) and life satisfaction. However, attention to the rehabilitation needs of those patients whose lives are saved, is lagging. Pretransplantation, there are serious strains to role function and limitations to mental and physical capacity. Following transplantation, the ability to perform once easy familiar tasks is difficult for a prolonged recovery period. Within a year many people do well, others do not. Little has been done for this latter group. The purpose of this article is to systematically describe the contributions occupational therapy can make to the people struggling with the challenges faced during the transplantation process. The first part presents a framework for understanding the impact of end-stage liver disease, then the transplant, and the subsequent recovery through the combination of two frameworks: the International Classification of Functioning Disability and Health (ICF) and the Model of Human Occupation. The second part of this article will present the implications for occupational therapists throughout seven stages: (1) decline in health, (2) organ failure, (3) referral for transplantation, (4) the waiting period, (5) the transplant surgery, (6) recovery, and (7) return of health. Attention to the needs of transplant recipients who lack the adaptive skills to resume productive lifestyles has the capacity to improve participation outcomes for this population.
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Affiliation(s)
- Patricia J Scott
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, Indiana University, Indianapolis, Indiana, USA
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Nåden D, Bjørk IT. Patients’ experiences in hospital following a liver transplantation. Scand J Caring Sci 2011; 26:169-77. [DOI: 10.1111/j.1471-6712.2011.00911.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ruppert K, Kuo S, DiMartini A, Balan V. In a 12-year study, sustainability of quality of life benefits after liver transplantation varies with pretransplantation diagnosis. Gastroenterology 2010; 139:1619-29, 1629.e1-4. [PMID: 20600035 DOI: 10.1053/j.gastro.2010.06.043] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 05/24/2010] [Accepted: 06/04/2010] [Indexed: 12/02/2022]
Abstract
BACKGROUND & AIMS As life-extending benefits of liver transplantation (LTX) are realized, the focus of improving outcomes after LTX transitioned from merely extending quantity of life to improving quality of life (QOL). Numerous cross-sectional studies have shown that QOL improves within 1 year after LTX; however, the long-term prospective pattern of QOL is not known. We assessed the sustainability of early QOL benefits after LTX. METHODS Patients who underwent LTX (n = 381) were followed for 12 years. We collected clinical information, survival data, and data on 5 QOL domains: physical distress (PHY), psychological distress (PSY), social/role function (SRF), personal function (PF), and general health perception (GHP). Mixed model analysis was used to determine whether initial gains in QOL were sustained long term. Outcomes were analyzed according to the primary liver diagnosis. RESULTS After 12 years, liver recipients had marked declines in PHY (P < .001), SRF (P = .006), and GHP (P < .001) scores, whereas improvements in PSY (P = .09) and PF (P = .09) were sustained. Women had worse outcomes in PHY and PF than men. Patients with autoimmune disease had decreased QOL PHY, SRF, PF, and GHP domains. Patients with alcoholic liver disease and hepatitis C initially had lower QOL in all domains, with the greatest decreases in PHY (P < .001) and PF (P = .03). CONCLUSIONS Although QOL improves within 1 year after patients receive liver transplants, not all groups of patients achieve or sustain the same level of QOL for 12 years. QOL decreases with time in most areas. Efforts should be made to improve QOL and function in the initial recovery period in liver transplant recipients.
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Affiliation(s)
- Kristine Ruppert
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA.
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Pérez-San-Gregorio M, Martín-Rodríguez A, Pérez-Bernal J, Maldonado M. Quality of life in spanish patients with liver transplant. Clin Pract Epidemiol Ment Health 2010; 6:79-85. [PMID: 21139984 PMCID: PMC2995160 DOI: 10.2174/1745017901006010079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 06/09/2010] [Accepted: 06/17/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Liver transplantation is the optimal method of treatment in patients with end-stage liver failure. Transplantation medicine has significantly progressed in the last time, but some psychology and psychosomatic problems still remain unsolved. Health-Related Quality of Life (HRQL) in liver transplant is considered a useful measure of evolutionary process of the illness. OBJECTIVE The authors analyzed the evolution of HRQL in pre-transplant (waiting-list patients) and post-transplant (first year after liver transplant) periods of liver transplant Spanish patients. METHODS A prospective and longitudinal study was carried out among patients who received a liver transplant from a deceased donor. They were assessed in four phases: at the time of inclusion on the transplant waiting-list, and 3, 6, and 12 months after receiving the graft. We used a structured interview and SF-36 and Euroqol-5D (EQ-5D) Health Questionnaires. RESULTS The greater differences were found between pre-transplant and post-transplant stages with less well-being in the stage before the transplant. No significantly differences were observed when comparing the 3, 6 and 12 months from post-transplant stage. CONCLUSION The HQRL of liver patients improved after the transplant, being appreciated a tendency to the stabilization from three months onwards. We suggest that the psychological intervention, in liver patients, should be conducted in waiting-list patients and in the first 3 months post-transplant, periods with a poor mental health (anxiety, depression, and stress by fear to the unknown thing) and a low adhesion to the treatment that can generate a smaller graft and/or patient survival.
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Affiliation(s)
- M.A Pérez-San-Gregorio
- Department of Personality, Evaluation and Treatment Psychological, University of Seville, Spain
| | - A Martín-Rodríguez
- Department of Personality, Evaluation and Treatment Psychological, University of Seville, Spain
| | - J Pérez-Bernal
- University of Seville, Hospital Virgen del Rocío, Coordinator of Transplants, Spain
| | - M.D Maldonado
- Department of Medical Biochemistry and Molecular Biology, Immunology Area, University of Seville Medical School, Spain
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van Ginneken BTJ, van den Berg-Emons HJG, Metselaar HJ, Tilanus HW, Kazemier G, Stam HJ. Effects of a rehabilitation programme on daily functioning, participation, health-related quality of life, anxiety and depression in liver transplant recipients. Disabil Rehabil 2010; 32:2107-12. [PMID: 20455791 DOI: 10.3109/09638288.2010.482174] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE Fatigue is a chronic problem in liver transplant recipients and may influence daily functioning and health-related quality of life (HRQoL). This study aimed to evaluate the effects of a fatigue-reducing physical rehabilitation programme on daily functioning, participation, HRQoL, anxiety and depression among liver transplant recipients. METHOD Eighteen fatigued liver transplant recipients (mean age 51 years, 10 men/8 women) participated in a 12-week rehabilitation programme, which included supervised exercise training and daily physical activity counselling. We assessed pre- and post-programme health-related daily functioning, participation, HRQoL, anxiety and depression using questionnaires. RESULTS After the programme, patients showed improvements in daily functioning (23.6%, p = 0.007), the participation domain 'autonomy outdoors' (34.1%, p = 0.001), and the HRQoL domains 'physical functioning' (11.5%, p = 0.007) and 'vitality' (21.5%, p = 0.022). Anxiety and depression were unchanged post-programme. CONCLUSIONS Rehabilitation using supervised exercise training and daily physical activity counselling can positively influence daily functioning, participation and HRQoL among fatigued liver transplant recipients.
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Affiliation(s)
- B T J van Ginneken
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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WINTERLING J, SIDENVALL B, GLIMELIUS B, NORDIN K. Expectations for the recovery period after cancer treatment - a qualitative study. Eur J Cancer Care (Engl) 2009; 18:585-93. [DOI: 10.1111/j.1365-2354.2008.00933.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
With improvements in patient and graft survival after liver transplantation, recipient quality of life (QOL) has become an important focus of patient care and clinical outcomes research. To provide a better understanding of the instruments used to assess QOL in the adult liver transplant population, we conducted a systematic review of the MEDLINE database and Cochrane library. Our review identified 128 relevant articles utilizing more than 50 different QOL instruments. Generic health status instruments are the most commonly used, and among them the Medical Outcomes Study Short Form-36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Beck Depression Inventory (BDI) are the most prevalent. Few studies (16%) included targeted, disease-specific instruments. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Quality of Life questionnaire, the Liver Disease Quality of Life questionnaire, and the Chronic Liver Disease questionnaire are the most frequently employed targeted instruments; however, these instruments have been designed to assess QOL in patients with chronic liver disease rather than patients after liver transplantation. The present review focuses on the psychometric properties of the existing QOL instruments and discusses their individual strengths and limitations in evaluating liver transplantation recipients. The lack of a gold-standard QOL instrument for liver transplant recipients is an impediment to cross-study comparisons. We conclude that the development of a QOL instrument specifically for liver transplant recipients will improve QOL assessment in this population leading to a more nuanced understanding of the factors that influence transplant recipients' well-being.
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Affiliation(s)
- Colleen L. Jay
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Zeeshan Butt
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Daniela P. Ladner
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Anton I. Skaro
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
| | - Michael M. Abecassis
- Division of Organ Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL 60611, USA
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Patients Undergoing Liver Transplantation: Psychosocial Characteristics, Depressive Symptoms, and Quality of Life. Transplant Proc 2008; 40:802-4. [DOI: 10.1016/j.transproceed.2008.02.059] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Winterling J, Glimelius B, Nordin K. The importance of expectations on the recovery period after cancer treatment. Psychooncology 2008; 17:190-8. [PMID: 17534865 DOI: 10.1002/pon.1216] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purpose was to study expectations concerning recovery-related changes in life, e.g. beliefs regarding future adjustment back to 'normal' life after curative cancer treatment, whether these expectations were met and their importance for both patients' and their spouses' quality of life and psychological distress. Sixty-two patients and 42 spouses took part in the study. Data on recovery-related expectations, measured using a study-specific questionnaire (RRE), on quality of life using EORTC-QLQ C-30 and on psychological distress using HADS, were collected directly after completion of treatment, four and 16 months later. Optimism was measured using LOT at the last follow-up. The results demonstrate that patients generally had higher recovery-related expectations than did their spouses, and their expectations were also fulfilled to a lesser degree at both follow-ups. However, the expectations, or whether these were met, were generally not associated with their quality of life or psychological distress. The few associations that were made indicated that fulfilled expectations meant higher quality of life and/or less distress. The participants' optimism was associated with both their quality of life and psychological distress. It is concluded that optimism influenced the participants' quality of life and psychological distress to a higher degree than did their recovery-related expectations.
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Affiliation(s)
- Jeanette Winterling
- Department of Public Health and Caring Sciences, Section of Caring Sciences, Uppsala University, Sweden.
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Dudley T, Chaplin D, Clifford C, Mutimer DJ. Quality of life after liver transplantation for hepatitis C infection. Qual Life Res 2007; 16:1299-308. [PMID: 17665316 DOI: 10.1007/s11136-007-9244-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2006] [Accepted: 07/10/2007] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Transplantation is a life-saving option for patients with liver disease. However, recovery is variable. Impairments in physical health, emotional wellbeing and quality of life are reported. Quality of life may be worse after transplantation for hepatitis C virus (HCV) infection. OBJECTIVE To identify factors that could impact on quality of life after liver transplantation for HCV infection. METHODS A qualitative design was used. Data were collected by in-depth interview. Colaizzi's framework for data analysis was used. RESULTS Varying levels of physical and psychological disability persist for many years after liver transplantation. Participants described living productive and meaningful lives. Many reported a more positive outlook on life since transplantation. Many felt stigmatised by the association of liver disease with alcohol/drug misuse. Participants described the uncertainty of life after transplantation. While all expressed gratitude to the donor, emotional responses to the donation varied. CONCLUSIONS Transplant recipients exchange one health state for another. Pre-transplant preparation should encourage realistic expectations of life after transplantation. Before transplantation, potential recipients should be given an opportunity to discuss the donation process. This may reduce the burden of emotional debt experienced by some recipients. Feelings of stigma and future uncertainty may be worse for transplant recipients with HCV. A qualitative approach can provide deeper insight into issues affecting quality of life after transplantation for HCV, and explain some of the ambiguous and contradictory findings of previous quantitative studies.
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Affiliation(s)
- Tracey Dudley
- The Liver Transplant and Hepatobiliary Surgery Unit, 3rd Floor Nuffield House, Queen Elizabeth Hospital, Birmingham, B15 2TH, UK.
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Ortega F, Valdés C, Ortega T. Quality of life after solid organ transplantation. Transplant Rev (Orlando) 2007. [DOI: 10.1016/j.trre.2007.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Greenspan AI, Wolf SL, Kelley ME, O'Grady M. Tai chi and perceived health status in older adults who are transitionally frail: a randomized controlled trial. Phys Ther 2007; 87:525-35. [PMID: 17405808 DOI: 10.2522/ptj.20050378] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Tai chi, a Chinese exercise derived from martial arts, while gaining popularity as an intervention for reducing falls in older adults, also may improve health status. The purpose of this study was to determine whether intense tai chi (TC) exercise could improve perceived health status and self-rated health (SRH) more than wellness education (WE) for older adults who are transitionally frail. SUBJECTS Study subjects were 269 women who were >or=70 years of age and who were recruited from 20 congregate independent senior living facilities. METHODS Participants took part in a 48-week, single-blind, randomized controlled trial. They were randomly assigned to receive either TC or WE interventions. Participants were interviewed before randomization and at 1 year regarding their perceived health status and SRH. Perceived health status was measured with the Sickness Impact Profile (SIP). RESULTS Compared with WE participants, TC participants reported significant improvements in the physical dimension and ambulation categories and borderline significant improvements in the body care and movement category of the SIP. Self-rated health did not change for either group. DISCUSSION AND CONCLUSION These findings suggest that older women who are transitionally frail and participate in intensive TC exercise demonstrate perceived health status benefits, most notably in ambulation.
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Affiliation(s)
- Arlene I Greenspan
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop K-63, Atlanta, GA 30341, USA.
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Cleemput I, Kesteloot K, De Geest S, Dobbels F, Vanrenterghem Y. Health professionals' perceptions of health status after renal transplantation: a comparison with transplantation candidates' expectations. Transplantation 2003; 76:176-82. [PMID: 12865806 DOI: 10.1097/01.tp.0000072807.46212.fa] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Renal transplantation is frequently considered superior to other renal replacement therapy in terms of survival and quality-of-life outcome. In this study, it was examined whether physicians and nurses have accurate perceptions of health status after renal transplantation (RTX) and whether renal transplant candidates have realistic expectations about posttransplant quality of life. METHODS A comparative descriptive design was used for the comparison of physicians' and nurses' perceived and patients' expected and actual health status after RTX. Health status perceptions were measured by means of the EQ-5D self-report questionnaire. RTX candidates (n=107) were followed longitudinally from November 1999 until July 2001. Transplant patients (n=29) were surveyed 14 days and 4, 8, and 12 months after discharge from hospital. All physicians and nurses (n=123) had regular contact with dialysis or RTX patients. RESULTS Physicians' and nurses' perceptions of health status after RTX were significantly lower than patients' expectations. Transplant nurses' and physicians' valuations were closer to patients' actual health status after transplantation than valuations of nurses on the dialysis or nephrology ward or at the outpatient clinic. CONCLUSIONS RTX candidates frequently have higher expectations about their quality of life after transplantation than physicians and nurses who have regular contact with renal transplant patients. Physicians' and nurses' perceptions are closer to the actual health state after transplantation than patients' expectations. Thus, physicians and nurses are a reliable source of information for patients about the health state they can expect after transplantation.
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Affiliation(s)
- Irina Cleemput
- Centre for Health Services and Nursing Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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O'Dell MI, Wright L. Electronic psychosocial evaluation tool: use in a living donor organ transplant program. Prog Transplant 2003. [PMID: 12841515 DOI: 10.7182/prtr.13.2.u062300815v72438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychosocial evaluation of potential organ donors ensures that these patients are prepared for donation and that their psychosocial issues have been addressed. The determination that the decision to donate an organ has been made voluntarily by a competent individual is a primary concern for living donor transplant programs, which must work to the highest ethical standard in this unique area of medicine. Identification of potential vulnerabilities on the part of the donor permits monitoring and/or intercession both before and after donation. Ensuring the confidentiality of patient information is important and represents a cornerstone of social work practice. At our institution, social workers have developed an electronic recording tool for use in evaluating organ donors; this tool is designed to maximize quality and ease of information gathering, ensure standardization of practice across programs, simplify record keeping, and enhance communication while minimizing time investment and ensuring patient confidentiality.
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