The relationship of socio-demographic factors and satisfaction with social support at five and 10 yr after heart transplantation

The psychosocial experiences and supportive care preferences of organ transplant recipients and their carers who live in regional Australia

BACKGROUND

There is no evidence that being a rural or regional organ transplant recipient has adverse physical health outcomes post-surgery compared with those experienced by people living in cities, but the impact of living remotely from transplant centres on psychosocial outcomes has not been explored.

OBJECTIVE

To identify the social, emotional, psychological, spiritual, informational and practical issues associated with being a regionally based organ transplant recipient or carer and determine how support services could be improved for this group.

DESIGN/ SETTING/ PARTICIPANTS

Twenty-two purposively sampled adult Australians who lived outside metropolitan centres and had received an organ transplant (n = 15) or were the primary carer of someone who had received one (n = 7), participated in semi-structured, telephone interviews. Qualitative data were collected until data saturation was reached and were analysed using thematic analysis.

RESULTS

Five key themes (plus subthemes) were identified: (a) travelling for specialist transplant care takes a toll, (b) unique transplant-related psychological and emotional issues experienced before and after transplants, (c) caring for transplant recipients is a demanding role, (d) lay, peer and professional support, including rural general practitioners and accommodation facilities, help ease the burden, but (e) significant barriers to accessing transplant-focused psychosocial support exist.

CONCLUSION

Novel methods of delivering targeted, transplant-specific information and psychosocial care to rural transplant recipients and their carers, employers and rural health professionals require development and evaluation. Strategies might be delivered by peers or professionals via telehealth, telephone, social media or websites for example, depending on preferences and level of need.

Quality of Life, Adherence Behavior, and Social Support Among Renal Transplant Recipients in China: A Descriptive Correlational Study

BACKGROUND

Quality of life (QoL) is an important indicator for evaluating therapeutic outcomes and mortality in renal transplant recipients, but there is scarce information regarding QoL, adherence behavior, social support and their relationships. This study assessed these factors among renal transplant recipients.

METHODS

Using a descriptive, correlational, cross-sectional design, this study included a convenience sample of 253 kidney transplant recipients. Structured questionnaires were used to collect data.

RESULTS

The scores on QoL domains (except the social functioning domain [P = .909]) were lower in our recipients than in the general Chinese population norm (P = .0000001). Time since transplantation (P = .041) and education (P = .013) were factors affecting QoL scores. The mean total adherence behavior score was 60.64 ± 7.71. Occupation and time since transplantation affected the total adherence behavior score. There was an alarming percentage of nonadherence in our transplant recipients (27.5%-72.3%). The mean total social support score was 40.76 ± 9.51. The total social support score (P = .0000087) was lower than the general Chinese population norm. Occupation (P = .0000087) education (P = .010), marital status (P = .013), payment method (P = .028) and monthly income (P = .007) affected the total social support score; there were significant relationships between physical health, psychological health, adherence behavior (r = .145, P = .022; r = .153, P = .016), and social support (r = .211, P = .001; r = .301, P = .000).

CONCLUSIONS

The findings demonstrate somewhat deficient QoL among renal transplant recipients compared with the general population. Social support, adherence behavior, time since transplantation and education significantly influenced QoL for our recipients, and social support had the most significant influence on adherence behavior and QoL.

Exploring the developmental tasks of emerging adults after paediatric heart transplantation: a cross-sectional case control study

OBJECTIVE

Paediatric heart transplantation (PHTX) comprises 12% of all cardiac transplants and many of the children now survive into adulthood. Only a few studies have investigated the long-term psychosocial well-being of young adult patients after PHTX; no studies have investigated developmental tasks of emerging adulthood in different domains (family, social environment, education and profession, partnership, social environment).

SETTING

Specialised heart centre in Germany.

PARTICIPANTS

Thirty-eight young adults aged 22.11 years (SD=4.7) who underwent PHTX and a control group of 46 participants with no known chronic diseases, aged 22.91 years (SD=1.8), participated in the study.

OUTCOME MEASURES

All participants completed the following questionnaires: sociodemographic, the F-SozU, to measure perceived social support, the Gießener Beschwerde-Bogen to measure subjective complaints experienced by patients, the KIDSCREEN-27 to measure well-being and the SF-36 to measure health-related quality of life (QoL).

RESULTS

'Family': the quality of the relationship with the parents was found to be equal in both groups, while PHTX patients stayed in closer spatial proximity to their parents. 'Social environment': PHTX patients reported lower social support by peers than the control group. 'Education and profession': PHTX patients most often worked full-time (23%), had no job and/or received a pension (21%). In comparison, most of the healthy controls did an apprenticeship (40%) and/or worked part time (32%). 'Partnership': fewer of the PHTX patients had a partner than the control group while relationship duration did not differ. In exploratory regression analyses, social support by peers predicted physical QoL, whereas physical complaints and the physical role predicted mental QoL in PHTX patients.

CONCLUSIONS

Our exploratory findings highlight important similarities and differences in specific developmental tasks between PHTX patients and healthy controls. Future studies should focus on developmental tasks of PHTX patients in this age group more systematically, investigating their role in physical and mental well-being in a confirmatory manner.

Preoperative psychological evaluation of uterus transplant recipients, partners, and living donors: Suggested framework

Uterus transplant has become a real option for women with uterine-factor infertility to become pregnant and give birth. The screening before uterus transplant consists of a multidisciplinary evaluation and includes the potential recipient, living donor, and, to some extent, the recipient's partner and future co-parent. The psychological evaluation has evolved from broad-based screening in the first uterus transplant trial, where the aim was to find suitable candidates for a novel experimental procedure with an unknown outcome, to a more directed screening with specific psychological domains for a complex infertility treatment with promising results. This report outlines a consensus by investigators with pioneering experience in the field of the key factors and suggests a framework for psychological evaluation of recipients and their partners as well as for live uterus donors before uterus transplant. We identify the main areas of particular value to the recipient screening (general psychological health, factors associated with infertility, and medication adherence), the partner (general psychological health and factors associated with infertility), and the living donor (psychological health and motivation to donate, especially in the case of the nondirected donor).

The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support

The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.

Repercussões no cotidiano dos pacientes pós-transplante cardíaco

Resumo Objetivo Conhecer as repercussões no cotidiano de pacientes submetidos a transplante cardíaco. Métodos Trata-se de estudo descritivo, qualitativo, conduzido em um centro de transplantes do nordeste brasileiro. Nove pacientes submetidos ao transplante cardíaco participaram do estudo, tendo sido utilizada para coleta dos dados a técnica de grupo focal, facilitada em quatro reuniões. Os recortes de suas falas resultaram em duas categorias temáticas: ser transplantado cardíaco - o antes e o depois; e sentimentos e percepções sobre o transplante cardíaco. Resultados A pessoa submetida ao transplante identificou as modificações positivas obtidas após o procedimento, porém ressentiu-se com as inúmeras proibições, com interferência direta em seu cotidiano; as limitações decorrentes do transplante ganharam destaque e não permitiram que os pacientes se sentissem realmente curados. Conclusão Os participantes reconheceram o transplante cardíaco como uma solução para seus sintomas clínicos, contudo, com significativa perda de autonomia, obrigando-os a um intenso esforço adaptativo.