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Winterling J, Pahnke S, Lagnebjörk J, Hägglund H, Larfors G, Lenhoff S, Kisch AM. Worries and Psychological Well-Being in Potential Hematopoietic Stem Cell Donors Before Donation-A Swedish National Study. Transplant Proc 2023; 55:242-248. [PMID: 36528407 DOI: 10.1016/j.transproceed.2022.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The physical risks involved in donating hematopoietic stem cells have been thoroughly studied, but little is known about the psychological risks potential donors might face before donation. The aim of this study was to describe potential the pre-donation worries and psychological well-being of hematopoietic stem cell donors and investigate possible associations between donor characteristics and psychological well-being. METHODS In a cross-sectional, national cohort study, we describe pre-donation worries and psychological well-being and investigate possible associations between donor characteristics and psychological well-being. A questionnaire was sent to prospective adult hematopoietic stem cells donors. RESULTS The study included 210 participants, 47% of whom were related and 53% unrelated to the recipient. Of the participants, 39% reported great worry about the recipient and 12% great worry about themselves as potential donors. Symptoms of anxiety were expressed by 21%, whereas symptoms of depression were uncommon and perceived general mental health was slightly lower than in the Swedish population. Great worry about oneself, lower age, and female sex were related to increased anxiety and lower mental health. CONCLUSION This study highlighted that some potential donors report high levels of pre-donation worry and that greater worry about oneself, lower age, and female sex are associated with lower psychological well-being. Although further studies are needed to investigate this psychological risk over time, it is clear that some potential donors are particularly vulnerable.
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Affiliation(s)
- Jeanette Winterling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical unit HHLH, Comprehensive Cancer Centre, Karolinska University Hospital, Stockholm, Sweden.
| | - Simon Pahnke
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johanna Lagnebjörk
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Hägglund
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Larfors
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Stig Lenhoff
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Annika M Kisch
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Institute of Health Sciences, Lund University, Sweden
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2
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Randall J, Miller JJ. A conceptual framework of the psychosocial elements that should be assessed in candidates for hematopoietic cell transplant: Social workers' and psychologists' perspectives. J Psychosoc Oncol 2022; 41:303-320. [PMID: 35972239 DOI: 10.1080/07347332.2022.2104677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Background: The aim of this work was to explicate a conceptual framework of psychosocial elements assessed in candidates for hematopoietic cell transplant (HCT) and to explore differences in the conceptualization based on the use of risk rating scales in clinical practice.Methods: Concept mapping is a mixed methods participatory approach to elicit and organize the ideas of a group of stakeholders and produce a composite conceptual framework. Participants were social workers and psychologists with experience assessing HCT candidates.Results: Participants brainstormed 114 psychosocial elements and conceptualized them into 12 distinct clusters: Transplant Mindset, Support System, Caregiver, Lodging and Transportation, Financial and Legal, Work, Demographic Characteristics, Mental Health, Communication, Educational and Resource Needs, Physical Functioning, and Cognition. Participants who used risk rating scales did not prioritize the importance of the clusters differently than those who did not.Conclusions: The conceptualization converges and diverges with the literature. Divergences are of particular interest since the perspectives of practicing psychosocial professionals have been largely absent from the literature. The conceptual framework can guide psychosocial providers in assessing patients. Assessing the caregiver is a high priority, as is evaluating the patient's mental health and mindset about transplant.
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Affiliation(s)
- Jill Randall
- Raymond A. Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - J Jay Miller
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
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3
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Eigeland JA, Jones L, Sheeran N, Moffitt RL. Critical physician behaviors in the formation of a good physician-patient relationship: Concept mapping the perspective of patients with chronic conditions. PATIENT EDUCATION AND COUNSELING 2022; 105:198-205. [PMID: 34023173 DOI: 10.1016/j.pec.2021.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A robust physician-patient relationship has been linked to better health outcomes for a range of chronic conditions. Our study aimed to identify physician behaviors patients consider contribute to good physician-patient relationships. METHOD Fifty patients with a chronic condition and a self-reported good physician-patient relationship were interviewed using the Critical Incidents technique and asked to describe observable behaviors that contributed to their good physician-patient relationship. A sub-sample of 30 participants rated the importance of each behavior and sorted them into self-labelled, mutually exclusive, and conceptually homogenous categories. Multivariate concept mapping with hierarchal cluster analysis was performed. RESULTS Patients reported 65 behaviors, which were grouped into six overarching domains: valuing the whole person, investigation and future planning, collaboration and empowerment, validation and emotional support, politeness and courtesy, and professionalism. CONCLUSION Results indicate patients with chronic conditions have a broader conceptualization and identified additional behaviors that reflect components of the physician-patient relationship than has been identified in researcher and practitioner based models. PRACTICE IMPLICATIONS Practitioners could utilize these concrete behaviors when forming relationships with their patients. These behaviors could also be incorporated into a tool designed to teach and assess the physician-patient relationship.
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Affiliation(s)
| | - Liz Jones
- School of Applied Psychology, Griffith University, Brisbane, Australia.
| | - Nicola Sheeran
- School of Applied Psychology, Griffith University, Brisbane, Australia.
| | - Robyn L Moffitt
- Psychology, School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia.
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4
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Polomeni A. « Faire le deuil » en temps d’innovations thérapeutiques. PSYCHO-ONCOLOGIE 2020. [DOI: 10.3166/pson-2020-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Nous traitons la problématique du deuil dans le cadre de l’allogreffe de cellules souches hématopoïétiques à partir d’un donneur haplo-identique. L’analyse d’un cas clinique permet d’interroger l’application systématique des catégories du normal et du pathologique au deuil, la surmédicalisation des sujets endeuillés ainsi que l’injonction sociale à « faire son deuil », selon les modalités décrites par la nosographie psychiatrique. Les modalités d’accompagnement des donneurs endeuillés seront questionnées en réaffirmant la pertinence d’une clinique nourrie par une réflexion psychanalytique.
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5
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Li L, Yang L, Dong C, Yang Q, Huang W, Liao T, Sun X. Psychosocial Assessment of Donors in Pediatric Living Donor Liver Transplantation: A Systematic Review. Transplant Proc 2020; 53:3-15. [PMID: 32631582 DOI: 10.1016/j.transproceed.2020.02.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/22/2020] [Accepted: 02/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pediatric living donor liver transplantation (LDLT) is the only way to save children with end-stage liver disease. The donor for liver transplantation (LT) may have a complicated psychosocial condition. PURPOSE This review aims to identify the domains of the donor psychosocial questions that should be addressed and summarize the aspects and tools future psychosocial assessments should include. METHODS We searched the PubMed, Medline, Cochrane Library, Embase, Web of Science, and Google Scholar databases for the terms pediatric, liver transplantation, donor, and psychosocial. We used the Joanna Briggs Institute Critical Appraisal Tool to appraise reporting quality. Two researchers independently selected the papers and performed data extraction and quality appraisal. RESULTS The articles included in this review contain 26 quantitative studies and 2 qualitative studies. The study quality was moderate to high. Donors have ambivalence, anxiety, the need for family and social support, the need for adequate information, distress, and low self-esteem during the preoperative period. In the postoperative period they have poor psychological condition, panic disorder, conversion disorder and substance use/abuse disorder, abnormal family functioning, better psychosocial outcome, or among others. The assessment methods consisted of the questionnaire survey and semi-structured interview. Among the 28 studies, 17 different psychosocial domains were mentioned. The most frequently referred to was family and social support. CONCLUSION The contents of the psychosocial assessment must include anxiety or depression, family and social support, ambivalence, information, and positive psychosocial characteristics. Assessment methods should use the questionnaire survey and semi-structured interview. According to this review, future research can develop a specific psychosocial assessment tool for pediatric LT donors.
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Affiliation(s)
- Lin Li
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Li Yang
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China.
| | - Chunqiang Dong
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Qiaoling Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Weijia Huang
- Department of Health Management, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Tingting Liao
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Xihui Sun
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
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6
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Polomeni A, Culat-Farhat M, Desbrosses Y, Andrianne C, Ainaoui M, Baillie E, Bancillon N, de Bentzmann N, Bouya S, Duteil E, Fraysse C, Issarni D, Ruscassie A, Sauze S, Thibert JB, Yakoub-Agha I, Faucher C. [Related donors follow-up: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. Bull Cancer 2019; 107:S94-S103. [PMID: 31006487 DOI: 10.1016/j.bulcan.2019.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/13/2019] [Accepted: 02/18/2019] [Indexed: 11/15/2022]
Abstract
Since 2010 there has been an exponential increase of the number of transplants performed from related donors. The development of haploidentical transplants increases the resort to related-donation, which presents two main advantages: a less important financial cost and a faster availability of the graft. Standards for mandatory accreditation exist, but the adherence to these recommendations is not optimal: currently, different practices regarding the organizational modalities of care, recruitment criteria, qualification and follow-up of related donors have been observed among French transplant centers. The Francophone Society of Marrow Transplant and Cellular Therapy (SFGM-TC) has developed guidelines for the consent and the non-eligibility criteria for hematopoietic stem cell donors. A multidisciplinary group has devised a booklet as a medium to inform donors about hematopoietic cell donation and transplantation in a clear and accessible language. This paper provides recommendations on post-donation follow-up, taking into account both medical standards and organizational constraints of French centers. Some tools are proposed.
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Affiliation(s)
- Alice Polomeni
- Assistance publique-Hôpitaux de Paris, hôpital Saint-Antoine, service d'hématologie clinique et thérapie cellulaire, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
| | - Marjorie Culat-Farhat
- CHRU Jean-Minjoz, service d'hématologie, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - Yohan Desbrosses
- CHRU Jean-Minjoz, service d'hématologie, 3, boulevard Fleming, 25030 Besançon cedex, France
| | - Christelle Andrianne
- CHU de Liège, service d'hématologie clinique, avenue de l'Hôpital, B35, 4000 Liège, Belgique
| | - Malika Ainaoui
- CHRU de Lille, service des maladies du sang, rue Michel-Polorovski, 59037 Lille cedex, France
| | - Evelyne Baillie
- CHRU de Lille, service des maladies du sang, rue Michel-Polorovski, 59037 Lille cedex, France
| | - Nelly Bancillon
- CHU d'Angers, service des maladies du sang, 4, rue Larrey, 49933 Angers, France
| | - Natacha de Bentzmann
- IUCT-Oncopole, service d'hématologie hautement protégé (greffe de moelle osseuse), avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Salaheddine Bouya
- Hôpital Saint-Éloi, service d'aphérèse thérapeutique et hémovigilance, 80, avenue Augustin-Fliche, 34295 Montpellier, France
| | - Elodie Duteil
- IUCT-Oncopole, service d'hématologie hautement protégé (greffe de moelle osseuse), avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - Christine Fraysse
- CHU de Montpellier, hôpital Saint-Éloi, centre de greffes adultes et pédiatriques, département d'hématologie clinique, 80, avenue Augustin-Fliche, 34925 Montpellier cedex 5, France
| | | | - Agnès Ruscassie
- IUCT-Oncopôle, service soins de support, avenue Irène-Joliot-Curie, 31100 Toulouse, France
| | - Séverine Sauze
- CHU d'Angers, service des maladies du sang, 4, rue Larrey, 49933 Angers, France
| | - Jean-Baptiste Thibert
- Établissement français du sang Bretagne, service de thérapie cellulaire, rue Pierre-Jean-Gineste, BP 91614, 35016 Rennes cedex, France
| | | | - Catherine Faucher
- Agence de la Biomédecine, pôle stratégie prélèvements greffes CSH, direction prélèvements/greffes CSH, direction générale médicale et scientifique, 1, avenue du Stade-de-France, 93212 Saint-Denis-la-Plaine cedex, France
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7
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Potts S, Vitinius F, Erim Y, Gazdag G, Gribble R, Ismail SYS, Massey EK, Maldonado J, Mucsi I, Novak M, Niazi SK, Schneekloth TD, Syngelakis M, Zimbrean P. Mental health assessment of altruistic non-directed kidney donors: An EAPM consensus statement. J Psychosom Res 2018; 107:26-32. [PMID: 29502760 DOI: 10.1016/j.jpsychores.2017.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Stephen Potts
- University of Edinburgh, Dept. Of Psychological Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, United Kingdom.
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, University Hospital of Cologne, Universitätsklinikum Köln (AöR), Kerpener Str. 62, D - 50937 Köln, Cologne, Germany.
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital of Erlangen, Germany
| | - Gabor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc Hospital, Koves ut 1, 1204 Budapest, Hungary; Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa utca 6, 1083 Budapest, Hungary
| | - Robert Gribble
- Royal Prince Alfred Hospital, Haberfield, New South Wales, Australia
| | - S Y Sohal Ismail
- Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, Office NA-2013, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands.
| | - Emma K Massey
- Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, Office 510, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Jose Maldonado
- Stanford University School of Medicine, Stanford, CA 94305-5718, United States
| | - Istvan Mucsi
- Department of Medicine (Nephrology), University of Toronto, Kidney Transplant Program, Toronto General Hospital, University Health Network, 585 University Avenue 11PMB-188, Toronto, ON M5G 2N2, Canada
| | - Marta Novak
- Division of Consultation/Liaison Psychiatry, UHN - Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Shehzad Khan Niazi
- Department of Psychiatry & Psychology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, United States.
| | - Terry D Schneekloth
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, United States
| | - Markos Syngelakis
- Division of Psychosomatic Medicine, First Psychiatric Clinic, Aristotle University of Thessaloniki, G. Papageorgiou General Hospital, Thessaloniki, Greece
| | - Paula Zimbrean
- Yale University School of Medicine, Department of Psychiatry, 20 York St Fitkin 611, New Haven, CT 06510, United States; Yale University School of Medicine, Department of Surgery (Transplant), 20 York St Fitkin 611, New Haven, CT 06510, United States
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8
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Massey EK, Timmerman L, Ismail SY, Duerinckx N, Lopes A, Maple H, Mega I, Papachristou C, Dobbels F. The ELPAT living organ donor Psychosocial Assessment Tool (EPAT): from 'what' to 'how' of psychosocial screening - a pilot study. Transpl Int 2017; 31:56-70. [PMID: 28850737 DOI: 10.1111/tri.13041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/20/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Abstract
Thorough psychosocial screening of donor candidates is required in order to minimize potential negative consequences and to strive for optimal safety within living donation programmes. We aimed to develop an evidence-based tool to standardize the psychosocial screening process. Key concepts of psychosocial screening were used to structure our tool: motivation and decision-making, personal resources, psychopathology, social resources, ethical and legal factors and information and risk processing. We (i) discussed how each item per concept could be measured, (ii) reviewed and rated available validated tools, (iii) where necessary developed new items, (iv) assessed content validity and (v) pilot-tested the new items. The resulting ELPAT living organ donor Psychosocial Assessment Tool (EPAT) consists of a selection of validated questionnaires (28 items in total), a semi-structured interview (43 questions) and a Red Flag Checklist. We outline optimal procedures and conditions for implementing this tool. The EPAT and user manual are available from the authors. Use of this tool will standardize the psychosocial screening procedure ensuring that no psychosocial issues are overlooked and ensure that comparable selection criteria are used and facilitate generation of comparable psychosocial data on living donor candidates.
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Affiliation(s)
- Emma K Massey
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Lotte Timmerman
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sohal Y Ismail
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Nathalie Duerinckx
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium.,Heart Transplant Program, Department of Cardiovascular Sciences, University Hospitals of Leuven, Leuven, Belgium
| | - Alice Lopes
- Psychiatry and Health Psychology Unit, Centro Hospitalar do Porto, Porto, Portugal
| | - Hannah Maple
- Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Inês Mega
- Hepato-Biliar-Pancreatic and Transplantation Center, Hospital Curry Cabral, Lisbon, Portugal
| | - Christina Papachristou
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
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9
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Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:S1-S109. [PMID: 28742762 PMCID: PMC5540357 DOI: 10.1097/tp.0000000000001769] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
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Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Dorry L. Segev
- Johns Hopkins University, School of Medicine, Baltimore, MD
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10
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Mandell MS, Smith AR, Dew MA, Gordon DB, Holtzman S, Howell T, DiMartini AF, Butt Z, Simpson MA, Ladner DP, Freise CE, McCluskey SA, Fisher RA, Guarrera JV, Olthoff KM, Pomfret EA. Early Postoperative Pain and its Predictors in the Adult to Adult Living Donor Liver Transplantation Cohort Study. Transplantation 2016; 100:2362-2371. [PMID: 27517726 PMCID: PMC5077637 DOI: 10.1097/tp.0000000000001442] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known about how well postoperative pain is managed in living liver donors, despite pain severity being the strongest predictor of persistent pain with long-lasting disability. METHODS We conducted a prospective multicenter study of 172 living liver donors. Self-reported outcomes for pain severity, activity interference, affective (emotional) reactions, adverse effects to treatment, and perceptions of care were collected using the American Pain Society Patient Outcomes Questionnaire-Revised. Mixed-effects linear regression was used to identify demographic and psychosocial predictors of subscale scores. RESULTS Donors were young (36.8 ± 10.6) and healthy. Of 12 expert society analgesic recommendations for postoperative pain management, 49% received care conforming to 3 guidelines, and only 9% to 4 or 5. More than half reported adverse effects to analgesic treatment for moderate to severe pain that interfered with functional activity; however, emotional distress to pain was unexpectedly minimal. Female donors had higher affective (β = 0.88, P = 0.005) and adverse effects scores (β = 1.33, P < 0.001). Donors with 2 or more medical concerns before surgery averaged 1 unit higher pain severity, functional interference, adverse effects, and affective reaction subscale scores (β range 1.06-1.55, all P < 0.05). Receiving information about pain treatment options increased perception of care subscale scores (β = 1.24, P = 0.001), whereas depressive symptoms before donation were associated with lower scores (β = -1.58, P = 0.01). CONCLUSIONS Donors have a distinct profile of pain reporting that is highly influenced by psychological characteristics. Interventions to improve pain control should consider modifying donor behavioral characteristics in addition to optimizing pain care protocols.
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Affiliation(s)
| | - Abigail R. Smith
- Department of Biostatistics, University of Michigan
- Arbor Research Collaborative for Health, University of Pittsburgh
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh
- Department of Psychology, University of Pittsburgh
- Department of Epidemiology, University of Pittsburgh
- Department of Biostatistics, University of Pittsburgh
| | | | - Susan Holtzman
- Department of Psychology, University of British Columbia
| | | | - Andrea F. DiMartini
- Department of Psychiatry, University of Pittsburgh
- Department of Surgery, University of Pittsburgh
| | - Zeeshan Butt
- Department of Medical Social Sciences, Northwestern University
| | | | - Daniela P. Ladner
- Northwestern University Transplant Outcomes Research Collaborative, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | - Robert A. Fisher
- Department of Transplant Surgery, Virginia Commonwealth University, Richmond, VA (current affiliation, Beth Israel Deaconess Department of Surgery, Harvard University)
| | - James V. Guarrera
- Department of Surgery, Columbia University College of Physicians and Surgeons
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