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Perry JM, Deutsch-Link S, Marfeo E, Serper M, Ladin K. Assessing reliability and validity of SIPAT and opportunities for improvement: A single-center cohort study. Liver Transpl 2024; 30:356-366. [PMID: 37938131 DOI: 10.1097/lvt.0000000000000299] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/30/2023] [Indexed: 11/09/2023]
Abstract
Psychosocial assessment is a standard component of patient evaluations for transplant candidacy. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a widely used measure to assess psychosocial risk for transplant. However, there are questions regarding the SIPAT's reliability and validity. We examined the SIPAT's psychometric performance and its impact on equitable access to transplant in a diverse cohort of 2825 patients seeking liver transplantation between 2014 and 2021 at an urban transplant center. The SIPAT demonstrated good internal consistency reliability at the overall score [Cronbach's α = 0.85, 95% CI (0.83, 0.86)] and domain levels (0.80 > α > 0.70). There was mixed support for structural validity, with poor overall model fit in confirmatory factor analysis and 50% of questions achieving the 0.70-factor loadings threshold. Adjusting for sociodemographic variables, the odds of not being waitlisted for psychosocial reasons were three times higher for patients with Medicaid insurance than patients with private insurance [OR 3.24, 95% CI (2.09, 4.99)] or Medicare [OR 2.89, 95% CI (1.84, 4.53)], mediated by higher SIPAT scores. Black patients had nearly twice the odds of White patients [OR 1.88, 95% CI (1.20, 2.91)], partially mediated by higher social support domain scores. Patients with Medicaid, non-White patients, and those without a college degree scored significantly higher on collinear questions, disproportionately contributing to higher SIPAT scores. The SIPAT did not perform equally across insurance type, race/ethnicity, and education groups, with the lowest subgroup validity associated with patient readiness and psychopathology domains. The SIPAT should be interpreted with caution, especially as a composite score. Future studies should examine validity in other populations.
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Affiliation(s)
- Jennifer M Perry
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Sasha Deutsch-Link
- Division of Gastroenterology & Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elizabeth Marfeo
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Marina Serper
- Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Keren Ladin
- Department of Community Health, Tufts University, Medford, Massachusetts, USA
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Takano K, Kobayashi S, Oshibuchi H, Tsutsui J, Mishima N, Ito S, Kamba R, Akaho R, Nishimura K. Association of the Stanford Integrated Psychosocial Assessment for Transplant and 1-Year Outcome of Living Kidney Transplantation in Japan. J Acad Consult Liaison Psychiatry 2024; 65:14-24. [PMID: 37778460 DOI: 10.1016/j.jaclp.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/16/2023] [Accepted: 09/25/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Because most kidney transplantations in Japan are performed on the basis of living donors, after-transplant outcomes should achieve optimum results, overcoming participants' possible reduced adherence. OBJECTIVE To investigate the association between the Japanese version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-J) and outcomes, 1 year after the patient's living kidney transplant (LKT). METHODS The prospective cohort study was undertaken at Tokyo Women's Medical University Hospital from January 2020 to July 2021, with a 1-year follow-up period. The SIPAT-J assesses 18 psychosocial risk factors: (1) Patient's Readiness Level and Illness Management (SIPAT A), (2) Social Support System Level of Readiness (SIPAT B), (3) Psychological Stability and Psychopathology (SIPAT C), and (4) Lifestyle and Effect of Substance Use (SIPAT D). The evaluators, a psychiatrist and 3 clinical psychologists, conducted an independent, blinded application of the SIPAT-J using participants' medical records. The study focused on physical composite outcomes, psychiatric outcomes, and nonadherent behaviors. RESULTS The participants were 173 LKT recipients (median age [interquartile range], 51 [38-59]); 67.1% were male and 67.1% were employed. The median (interquartile range) SIPAT scores were SIPAT A [7 (5-9)], SIPAT B [7 (5-9)], SIPAT C [2 (0-4)], SIPAT D [3 (3-4)], and SIPAT total [20 (16-23)]. The physical composite outcome was 25 (14.5%), psychiatric outcome 9 (5.2%), and nonadherent behavior 17 (9.8%). SIPAT C (odds ratio = 1.34, 95% confidence interval = 1.06-1.72, P = 0.02) was significantly associated with the psychiatric outcome. SIPAT B (odds ratio = 1.49, 95% confidence interval = 1.12-1.98, P = 0.01) and SIPAT total (odds ratio = 1.13, 95% confidence interval = 1.03-1.24, P = 0.01) were significantly associated with nonadherent behaviors. There was no significant association between the SIPAT and physical composite outcomes. CONCLUSION This study is the first to examine the association between SIPAT and physical and psychiatric outcomes 1 year after LKT, controlling for follow-up periods and factors other than SIPAT. Comprehensive psychosocial assessment before LKT and early identification of factors that may negatively affect transplant success can allow targeted interventions to be implemented and increase the likelihood of favorable recipient outcomes.
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Affiliation(s)
- Kosuke Takano
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan; Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
| | - Hidehiro Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
| | - Junko Tsutsui
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan; Department of Psychology, Faculty of Human Science, Denen-chofu University, Kawasaki City, Japan
| | - Nano Mishima
- Department of Psycho-Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoko Ito
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Rumiko Kamba
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
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Takano K, Oshibuchi H, Kobayashi S, Tsutsui J, Ito S, Kamba R, Akaho R, Nishimura K. Characterization of the stanford integrated psychosocial assessment for transplant for heart, liver, and kidney transplant candidates in Japan. Biopsychosoc Med 2023; 17:24. [PMID: 37461076 DOI: 10.1186/s13030-023-00281-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive psychosocial assessment proven useful for predicting the outcomes of organ transplantation that is expected to be useful in Japan. However, the characteristics of organ-specific SIPAT scores for organ transplant recipient candidates in Japan are unclear and, to date, the SIPAT has not been properly utilized in clinical practice. The purpose of this study was to present basic data that can be used to establish the relation between SIPAT scores and post-transplantation psychosocial outcomes as well as organ-specific outcomes. METHODS This study included 167 transplant recipient candidates (25 heart, 71 liver, and 71 kidney) who completed a semi-structured interview based on the Japanese version of SIPAT (SIPAT-J) prior to transplantation. The differences between organs in terms of SIPAT scores and differences in SIPAT scores based on demographic data were comparatively analyzed. RESULTS The total SIPAT scores were higher for liver recipient candidates than for heart recipient candidates (P = .019). Regarding the subscales, SIPAT B (social support system) scores were higher for liver and kidney recipient candidates than for heart recipient candidates (P = .021), whereas SIPAT C (psychological stability and psychopathology) scores were higher for liver recipient candidates than for kidney recipient candidates (P = .002). Recipient candidates with a history of psychiatric treatment and those who were unemployed had higher SIPAT scores, regardless of the transplant organ, than recipient candidates without a history of psychiatric treatment and those who were employed (P < .001, P = .016, respectively). CONCLUSIONS There were notable differences in the total SIPAT-J and subscale scores among the liver, heart, and kidney recipient candidates. Each organ was associated with specific psychosocial issues that should be addressed before transplantation. Interventions such as information provision and patient education based on SIPAT assessment results for each organ may improve recipient post-transplant outcomes.
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Affiliation(s)
- Kosuke Takano
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Hidehiro Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
| | - Sayaka Kobayashi
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Kamoda, Kawagoe-shi, Saitama, Saitama, 1981, 350-8550, Japan
| | - Junko Tsutsui
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
- Faculty of Human Science, Denen-chofu University, 3-4-1 Higashiyurigaoka, Asao-ku, Kawasaki City, Kawasaki-shi, Kanagawa, 215-8542, Japan
| | - Satoko Ito
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Rumiko Kamba
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
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Olt CK, Thuita LW, Soltesz EG, Tong MZ, Weiss AJ, Kendall K, Estep JD, Blackstone EH, Hsich EM. Value of psychosocial evaluation for left ventricular assist device candidates. J Thorac Cardiovasc Surg 2023; 165:1111-1121.e12. [PMID: 34053742 PMCID: PMC10443599 DOI: 10.1016/j.jtcvs.2021.04.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/24/2021] [Accepted: 04/13/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Left ventricular assist devices require a psychosocial assessment to determine candidacy despite limited data correlating with outcome. Our objective is to determine whether the Stanford Integrated Psychosocial Assessment for Transplant, a tool validated for transplant and widely used by left ventricular assist device programs, predicts left ventricular assist device program hospital readmissions and death. METHODS We performed a retrospective analysis of adults at the Cleveland Clinic with Stanford Integrated Psychosocial Assessment for Transplant scores before primary left ventricular assist device program implantation from April 1, 2013, to December 31, 2018. The primary outcome was unplanned hospital readmissions censored at death, transplantation, and transfer of care. The secondary outcome was death. RESULTS There were 263 patients in the left ventricular assist device program with a median (Q1, Q3) Stanford Integrated Psychosocial Assessment for Transplant score of 16 (8, 28). During a median follow-up 1.2 years, 56 died, 65 underwent transplantation, and 21 had transferred care. There were 640 unplanned hospital readmissions among 250 patients with at least 1 outpatient visit at our center. In a multivariable analysis, Stanford Integrated Psychosocial Assessment for Transplant components but not total Stanford Integrated Psychosocial Assessment for Transplant score was associated with readmissions. Psychopathology (Stanford Integrated Psychosocial Assessment for Transplant C-IX) was associated with hemocompatibility (coefficient 0.21 ± standard error 0.11, P = .040) and cardiac (0.15 ± 0.065, P = .02) readmissions. Patient readiness was associated with noncardiac (Stanford Integrated Psychosocial Assessment for Transplant A-III, 0.24 ± 0.099, P = .016) and cardiac (Stanford Integrated Psychosocial Assessment for Transplant A-low total, 0.037 ± 0.014, P = .007) readmissions. Poor living environment (Stanford Integrated Psychosocial Assessment for Transplant B-VIII) was associated with device-related readmissions (0.83 ± 0.34, P = .014). Death was associated with organic psychopathology or neurocognitive impairment (Stanford Integrated Psychosocial Assessment for Transplant C-X, 0.59 ± 0.21, P = .006). CONCLUSIONS Total Stanford Integrated Psychosocial Assessment for Transplant score was not associated with left ventricular assist device program readmission or mortality. However, we identified certain Stanford Integrated Psychosocial Assessment for Transplant components that were associated with outcome and could be used to create a left ventricular assist device program specific psychosocial tool.
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Affiliation(s)
| | - Lucy W Thuita
- Department of Quantitative Health Sciences, Cleveland, Ohio
| | - Edward G Soltesz
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michael Z Tong
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Aaron J Weiss
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio
| | | | - Jerry D Estep
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Quantitative Health Sciences, Cleveland, Ohio; Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio; Transplant Center, Cleveland, Ohio
| | - Eileen M Hsich
- Cleveland Clinic Heart and Vascular Institute, Cleveland, Ohio; Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Satoko I, Oshibuchi H, Tsutsui J, Kobayashi S, Takano K, Sugawara H, Kamba R, Akaho R, Ishida H, Maldonado J, Nishimura K. Psychosocial Assessment of Transplant Candidates: Inter-rater Reliability and Concurrent Validity of the Japanese Version of the Stanford Integrated Psychosocial Assessment for Transplantation. J Acad Consult Liaison Psychiatry 2021; 63:345-353. [PMID: 34863909 DOI: 10.1016/j.jaclp.2021.10.004] [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: 06/17/2021] [Revised: 09/19/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to provide a standardized, objective, and evidence-based psychosocial evaluation of the main pretransplant psychosocial risk factors that may influence transplant outcomes. OBJECTIVE Because established assessment procedures or standardized tools designed to perform pre-solid organ transplant psychosocial evaluation are currently unavailable in Japan, the present study aimed to develop and preliminarily validate the Japanese version of the SIPAT. METHODS First, the Japanese version of the SIPAT was developed using standard forward-back-translation procedures. Then, the Japanese versions of the SIPAT and the Japanese version of Psychosocial Assessment of Candidates for Transplant were retrospectively and blindly applied to 107 transplant cases by 4 independent raters. RESULTS The interrater reliability of the scores obtained with the Japanese version of the SIPAT was excellent (Pearson's correlation coefficient = 0.86). The concurrent validity of the SIPAT to the Psychosocial Assessment of Candidates for Transplant for each examiner was substantial (Spearman's rank correlation coefficient = -0.66). CONCLUSION These findings suggest that the Japanese version of the SIPAT is a promising and reliable instrument. Further research is required to test the predictive validity of the Japanese version of the SIPAT.
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Affiliation(s)
- Ito Satoko
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidehiro Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan; Department of Child Psychiatry, Kanagawa Children's Medical Center, Yokohama-shi, Kanagawa, Japan.
| | - Junko Tsutsui
- Faculty of Human science Denen-chofu University, Kawasaki city, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kosuke Takano
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroko Sugawara
- Department of Psychiatry, Kansai Rosai Hospital, Amagasaki, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Rumiko Kamba
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Jose Maldonado
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
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Thisayakorn P, Sakunwetsa D, Tangwongchai S, Jirakran K, Lolak S, Maldonado JR. The Psychosocial Assessment of Transplant Candidates: Internal Consistency, Interrater Reliability, and Content Validity of the Thai Version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-Thai Version). Transplant Proc 2021; 53:779-785. [PMID: 33741202 DOI: 10.1016/j.transproceed.2021.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 02/10/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Standardized pretransplant psychosocial assessment is critically needed in Thailand to optimize medical and psychosocial outcomes after transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive and evidence-based tool that has demonstrated excellent reliability and predictive value in many psychosocial transplant studies. We translated the SIPAT into Thai and explored the validity and reliability of the SIPAT-Thai version among Thai transplant recipients. METHODS We translated the original SIPAT into Thai following the World Health Organization's standard forward-backward translation procedure and then cross-sectionally assessed its validity and reliability in 110 Thai solid organ transplant candidates. The correlation between background data, total, and sectional scoring results of SIPAT-Thai were also analyzed. RESULTS The SIPAT-Thai demonstrated moderate to good reliability, which was represented by internal consistency with a Cronbach α of .751 and interrater reliability with a κ value at 0.767. The index of item-objective congruence value was 0.94, indicating good the content validity. CONCLUSIONS The SIPAT-Thai was systematically translated and shown to have acceptable validity and a moderate to good reliability index. The use of the SIPAT-Thai would provide a standardized, evidence-based, and a more systematic pretransplant psychosocial evaluation process for transplant candidates in Thailand.
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Affiliation(s)
- Paul Thisayakorn
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Dussadee Sakunwetsa
- Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Ketsupa Jirakran
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sermsak Lolak
- Department of Psychiatry, Virginia Commonwealth University, Inova Fairfax Medical Campus, Fairfax, Virginia
| | - Jose R Maldonado
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Factors Affecting Quality of Life in Liver Transplant Candidates: An Observational Study. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health-related quality of life (HRQOL) before and after liver transplant (LT) is an important outcome in LT candidates as, in these patients, HRQOL is commonly impaired. However, evidence regarding factors that influence HRQOL in patients with end-stage liver disease is inconclusive. The aim of the present study was to identify factors associated with poor HRQOL. An observational study was conducted over LT candidates. The 36-item Short Form Health Survey (widely used to assess HRQOL) and the Hospital Anxiety and Depression Scale were administered to 211 patients during the pre-transplant assessment. Baseline demographic and clinical data were also collected. Multiple regression analysis was performed to investigate risk factors for poor HRQOL. Female sex (lower B = 7.99 95%C = 0.07–15.92, higher B = 18.09 95%CI = 7.56–28.62), encephalopathy (lower B = −9.45, 95%CI = −14.59–−4.31, higher B = −6.69, 95%CI = −13.13 to −0.25), higher MELD scores (lower B = −1.14, 95%CI = −1.67 to −0.61, higher B = −0.33, 95%CI = −0.65 to −0.12), anxiety (lower B = −3.04 95%C = −4.71 to −1.36, higher B = −1.93 95%CI = −3.39 to −0.47)and depression (lower B = −3.27 95%C = −4.46 to −2.08, higher B = −1.02 95%CI = −1.90 to −0.13) symptoms were associated to poorer HRQOL. Psychosocial interventions should be addressed to liver transplant candidates, especially to women, patients with anxiety, depression or episodes of encephalopathy, in order to prevent the impact that these conditions can have on HRQOL.
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Parker WF, Chin MH. Epistemic Authority and Trust in Shared Decision Making About Organ Transplantation. AMA J Ethics 2020; 22:E408-415. [PMID: 32449657 DOI: 10.1001/amajethics.2020.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Patient epistemic authority acknowledges respect for a patient's knowledge claims, an important manifestation of patient autonomy that facilitates shared decision making in medicine. Given the scarcity of deceased donor organs, transplantation programs state that patient promises of compliance cannot be taken at face value and exclude candidates deemed untrustworthy. This article argues that transplant programs frequently lack the data to make this utilitarian calculation accurately, with the result that, in practice, the psychosocial evaluation of potential transplant candidates is discriminatory and unfair. Historically excluded candidates, such as patients suffering from alcohol use, have turned out to benefit highly from transplantation. Transplant programs should tend to trust patients when they claim to be good potential organ stewards, thereby respecting patient autonomy, advancing justice, and saving more lives.
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Affiliation(s)
- William F Parker
- Instructor of pulmonary and critical care medicine, senior fellow at the MacLean Center for Clinical Medical Ethics at the University of Chicago in Illinois
| | - Marshall H Chin
- Richard Parrillo Family Professor of Healthcare Ethics in the Department of Medicine, associate director of the MacLean Center for Clinical Medical Ethics at the University of Chicago in Illinois
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Bottesi G, Granziol U, Forza G, Volpe B, Feltrin A, Battermann F, Cavalli C, Cillo U, Gerosa G, Fraiese A, Rea F, Loy M, Maiorano D, Rizzi I, Leandro G, Ferraro C, Biasi C, Donato D, Vidotto G, Maldonado JR. The Psychosocial Assessment of Transplant Candidates: Inter-Rater Reliability and Predictive Value of the Italian Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). PSYCHOSOMATICS 2020; 61:127-134. [DOI: 10.1016/j.psym.2019.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
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