1
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Loban K, Horton A, Robert JT, Hales L, Parajuli S, McAdams-DeMarco M, Sandal S. Perspectives and experiences of kidney transplant recipients with graft failure: A systematic review and meta-synthesis. Transplant Rev (Orlando) 2023; 37:100761. [PMID: 37120965 DOI: 10.1016/j.trre.2023.100761] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Kidney transplant recipients with graft failure are a rapidly rising cohort of patients who experience high morbidity, mortality, and fragmented transitions of care between transplant and dialysis teams. Current approaches to improving care focus on medical and surgical interventions, increasing re-transplantation, and improving coordination between treating teams with little understanding of patient needs and perspectives. METHODS We undertook a systematic literature review of personal experiences of patients with graft failure. Six electronic and five grey literature databases were searched systematically. Of 4664 records screened 43 met the inclusion criteria. Six empirical qualitative studies and case studies were included in the final analysis. Thematic synthesis was used to combine data that included the perspectives of 31 patients with graft failure and 9 caregivers. RESULTS Using the Transition Model, we isolated three interconnected phases as patients transition through graft failure: shattering of lifestyle and plans associated with a successful transplant; physical and psychological turbulence; and re-alignment by learning adaptive strategies to move forward. Critical factors affecting coping included multi-disciplinary healthcare approaches, social support, and individual-level factors. While clinical transplant care was evaluated positively, participants identified gaps in the provision of information and psychosocial support related to graft failure. Graft failure had a profound impact on caregivers especially when they were living donors. CONCLUSIONS Our review reports patient-identified priorities for improving care and can help inform research and guideline development that strives to improve the care of patients with graft failure.
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Affiliation(s)
- Katya Loban
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Anna Horton
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jorane-Tiana Robert
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lindsay Hales
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mara McAdams-DeMarco
- Department of Surgery, NYU Grossman School of Medicine and NYU Langone Health, New York, NY, USA
| | - Shaifali Sandal
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
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2
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Tang J, Kerklaan J, Wong G, Howell M, Scholes-Robertson N, Guha C, Kelly A, Tong A. Perspectives of solid organ transplant recipients on medicine-taking: Systematic review of qualitative studies. Am J Transplant 2021; 21:3369-3387. [PMID: 33866675 DOI: 10.1111/ajt.16613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/16/2021] [Accepted: 04/02/2021] [Indexed: 01/25/2023]
Abstract
Medicine-taking among transplant recipients is a complex and ubiquitous task with significant impacts on outcomes. This study aimed to describe the perspectives and experiences of medicine-taking in adult solid organ transplant recipients. Electronic databases were searched to July 2020, and thematic synthesis was used to analyze the data. From 119 studies (n = 2901), we identified six themes: threats to identity and ambitions (impaired self-image, restricting goals and roles, loss of financial independence); navigating through uncertainty and distrust (lacking tangible/perceptible benefits, unprepared for side effects, isolation in decision-making); alleviating treatment burdens (establishing and mastering routines, counteracting side effects, preparing for the unexpected); gaining and seeking confidence (clarity with knowledge, reassurance through collective experiences, focusing on the future outlook); recalibrating to a new normal posttransplant (adjusting to ongoing dependence on medications, in both states of illness and health, unfulfilled expectations); and preserving graft survival (maintaining the ability to participate in life, avoiding rejection, enacting a social responsibility of giving back). Transplant recipients take medications to preserve graft function, but dependence on medications jeopardizes their sense of normality. Interventions supporting the adaptation to medicine-taking and addressing treatment burdens may improve patient satisfaction and capacities to take medications for improved outcomes.
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Affiliation(s)
- James Tang
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jasmijn Kerklaan
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Department of Pediatric Nephrology, Academic Medical Center, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Nicole Scholes-Robertson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Chandana Guha
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Ayano Kelly
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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3
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van Zanten R, de Weerd A, Betjes M, Boer-Verschragen M, Massey EK. Is simplification of immunosuppressive medication a way to promote medication adherence of kidney transplant recipients? Findings from a randomized controlled trial. Transpl Int 2021; 34:1703-1711. [PMID: 34448273 PMCID: PMC9292224 DOI: 10.1111/tri.13993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022]
Abstract
After kidney transplantation, a strict immunosuppressive medication regimen is necessary for graft survival. However, nonadherence to medication has been shown to occur early after transplantation and to increase over time. Weaning the recipient off dual therapy onto monotherapy in order to reduce immunosuppressive burden may also be a way to promote adherence, although little is known about the impact of such a regimen on fear of rejection. We performed a cohort study on medication adherence and fear of rejection in a randomized, investigator‐driven, open‐label, single‐centre pilot study. Recipients were randomized at 6‐months post‐transplant to either continue Tacrolimus and Mycophenolate mofetil (TAC/MMF) or to taper MMF at 6 months and discontinue MMF at 9 months (TAC monotherapy). Recipients completed questionnaires about medication adherence and fear of rejection at 6 and 12‐months post‐transplantation. Medication adherence was significantly higher in the TAC monotherapy group compared to dual TAC/MMF therapy group (χ2 (1) = 4.582; P = 0.032). We found no difference in fear of rejection between the two groups of recipients (P = 0.887). Simplification of the medication regimen is a potential tool for increasing adherence in clinical practice (Netherlands Trial Register – NL4672).
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Affiliation(s)
- Regina van Zanten
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annelies de Weerd
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel Betjes
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marieken Boer-Verschragen
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Emma K Massey
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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4
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Kidney Transplant Recipient Attitudes Toward a SARS-CoV-2 Vaccine. Transplant Direct 2021; 7:e713. [PMID: 34131585 PMCID: PMC8196090 DOI: 10.1097/txd.0000000000001171] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/25/2021] [Accepted: 04/08/2021] [Indexed: 11/26/2022] Open
Abstract
A widely accepted severe acute respiratory syndrome 2 (SARS-CoV-2) vaccine could protect vulnerable populations, but the willingness of solid organ transplant recipients (SOTRs) to accept a potential vaccine remains unknown. Methods We conducted a national survey of 1308 SOTRs and 1617 non-SOTRs between November 11 and December 2, 2020 through the network of the National Kidney Foundation. Results Respondents were largely White (73.2%), female (61.1%), and college graduates (56.2%). Among SOTRs, half (49.5%) were unsure or would be unwilling to receive a SARS-CoV-2 vaccine once available. Major concerns included potential side effects (85.2%), lack of rigor in the testing and development process (69.7%), and fear of incompatibility with organ transplants (75.4%). Even after the announcement of the high efficacy of the mRNA-1273 vaccine (Moderna Inc.) at the time of survey distribution, likeliness to receive a vaccine only slightly increased (53.5% before announcement versus 57.8% after the announcement). However, 86.8% of SOTRs would accept a vaccine if recommended by a transplant provider. Conclusions SOTRs reported skepticism in receiving a potential SARS-CoV-2 vaccine, even after announcements of high vaccine efficacy. Reassuringly, transplant providers may be the defining influence in vaccine acceptance and will likely have a critical role to play in promoting vaccine adherence.
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5
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The experiences of adult heart, lung, and heart-lung transplantation recipients: A systematic review of qualitative research evidence. PLoS One 2020; 15:e0241570. [PMID: 33175900 PMCID: PMC7657484 DOI: 10.1371/journal.pone.0241570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 10/18/2020] [Indexed: 11/19/2022] Open
Abstract
Aim To review evidence about the experience of being the recipient of a donated heart, lungs, or heart and lungs. Design A systematic review (registered with PROSPERO: CRD42017067218), in accordance with PRISMA guidelines. Data sources Seven databases and Google Scholar were searched in May 2017 and July 2019 for papers reporting English-language research that had used qualitative methods to investigate experiences of adult recipients. Review methods Quality was assessed and results were analysed thematically. Results 24 papers (reporting 20 studies) were eligible and included. Their results were organised into three chronological periods: pre-transplant (encompassing the themes of ‘dynamic psychosocial impact’, ‘resources and support’), transplant (‘The Call’, ‘intensive care unit’), and post-transplant (‘dynamic psychosocial impact’, ‘management’, ‘rejection’). Sub-themes were also identified. It was evident that contemplating and accepting listing for transplantation entailed or amplified realisation of the precipitating illness’s existential threat. The period surrounding transplantation surgery was marked by profound, often surreal, experiences. Thereafter, although life usually improved, it incorporated unforeseen challenges. The transplantation clinic remained important to the recipient. The meaning of the clinic and its staff could be both reassuring (providing care and support) and threatening (representing onerous medical requirements and potential organ rejection). Conclusion This review has implications for the psychosocial care of transplant recipients and indicates the need for further research to gain insight into the experience of receiving a donated heart and/or lung. Impact Medical consequences of heart and lung transplantation are well documented; this is the first systematic review of research using qualitative methods to investigate the experience of heart, lung, and heart-and-lung transplantation. The psychosocial impact of transplantation was found to be dynamic and complex, with notable features evident before, during, and after transplantation. Clinic staff remained significant to recipients. It is clear that recipients need continuing psychosocial as well as medical support.
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6
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Forsberg A, Kisch AM, Paulsson A, Ragntoft C, Dalvindt M, Lennerling A. Fear of graft rejection after heart transplantation - a nationwide cross-sectional cohort study. Eur J Cardiovasc Nurs 2020; 20:71-79. [PMID: 33570598 DOI: 10.1177/1474515120937838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/08/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cellular rejection is most common 3-6 months after heart transplantation while chronic rejection, that is, cardiac allograft vasculopathy and malignancy are the most common causes of death in heart-transplant recipients beyond the third year after transplantation. However, the heart transplantation recipient's perceived threat of graft rejection has never been explored. AIM The aim was to explore perceived threat of the risk of graft rejection and its relationship to psychological wellbeing, fatigue, health literacy, adherence and self-efficacy 1-5 years after heart transplantation. METHODS In a nationwide, cross-sectional study that constituted part of the Self-management after thoracic transplantation project, 79 heart recipients (68% men and 32% women with a mean age of 52.6 years) were investigated after one year (n=28), two years (n=17), three years (n=11), four years (n=17) and five years (n=6). The instruments used were: the Perceived Threat of the Risk of Graft Rejection, the Psychological General Well-being, Self-efficacy for Managing Chronic Disease, the Multidimensional Fatigue Inventory, the Newest Vital Sign and the Basel Assessment of Adherence to Immunosuppressive Medication Scale. RESULTS Twenty-eight per cent of the heart transplantation recipients perceived graft rejection as a serious threat. Intrusive anxiety was low and 37% perceived the threat of the risk of graft rejection as being beyond their control. Heart transplant recipients with high level of fatigue and low psychological well-being reported stronger intrusive anxiety and less control. CONCLUSION A perceived threat of the risk of graft rejection is present in the everyday lives of heart transplantation recipients and is strongly related to overall psychological well-being.
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Affiliation(s)
- Anna Forsberg
- Institute of Health Sciences, Lund University, Sweden.,Department of Thoracic surgery, Skåne University Hospital, Lund, Sweden
| | - Annika M Kisch
- Institute of Health Sciences, Lund University, Sweden.,Department of Haematology, Skåne University Hospital, Lund, Sweden
| | - Annika Paulsson
- Department of Thoracic surgery, Skåne University Hospital, Lund, Sweden
| | - Cecilia Ragntoft
- Department of Thoracic surgery, Skåne University Hospital, Lund, Sweden
| | - Marita Dalvindt
- Institute of Health Sciences, Lund University, Sweden.,Department of Thoracic surgery, Skåne University Hospital, Lund, Sweden
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Sweden
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7
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Ranahan M, Von Visger J, Kayler LK. Describing barriers and facilitators for medication adherence and self-management among kidney transplant recipients using the information-motivation-behavioral skills model. Clin Transplant 2020; 34:e13862. [PMID: 32199030 DOI: 10.1111/ctr.13862] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/05/2020] [Accepted: 03/13/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND We aimed to develop an adapted information-motivation-behavioral skills (IMB) model to describe barriers and facilitators for adherence and self-management among kidney transplant recipients. METHODS We conducted a review of literature about kidney transplant recipients' knowledge, perceptions, and experiences and organized our results using the IMB framework. We then conducted interviews with transplant recipients and transplant providers to supplement our literature search. RESULTS Our proposed adaption of the IMB model describes informational, motivational, and behavioral skills barriers and facilitators for medication adherence and self-management among kidney transplant recipients. Moderating factors influence not only behavioral skills, but also recipients' understanding of information and motivation to adhere and practice self-management. CONCLUSION By using the IMB model to organize current research and interviews with recipients and providers, we developed an adapted model for medication adherence and self-management. Results are promising to impact future educational and behavioral interventions for kidney transplant recipients.
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Affiliation(s)
- Molly Ranahan
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
| | - Jon Von Visger
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
| | - Liise K Kayler
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, New York, USA.,Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, New York, USA
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8
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Forsberg A, Nilsson M, Jakobsson S, Lennerling A, Kisch A. Fear of graft rejection 1-5 years after lung transplantation-A nationwide cohort study. Nurs Open 2018; 5:484-490. [PMID: 30338093 PMCID: PMC6177545 DOI: 10.1002/nop2.184] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/21/2018] [Indexed: 11/25/2022] Open
Abstract
AIM To explore the perceived threat of the risk of graft rejection and its relationship to psychological general well-being and self-efficacy 1-5 years after lung transplantation. DESIGN A nationwide, cross-sectional cohort study as a part of the Self-management after thoracic transplantation study. METHODS A total of 117 lung transplant recipients due for their yearly follow-up one (N = 35), two (N = 28), three (N = 23), four (N = 20) and 5 years (N = 11) after lung transplantation were included. We used three instruments; the Perceived Threat of the Risk of Graft Rejection, the Psychological General Well-being and Self-efficacy in chronic illness. RESULTS The lung recipients reported an overall low perceived threat of the risk of graft rejection with no gender differences. Intrusive anxiety explained 24.7% of the variance in the PGWB-sum (p ≤ 0.001) and makes a statistically significant (β = -497; p ≤ 0.001) unique contribution to the overall psychological general well-being (95%CI 3.004-1.515).
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Affiliation(s)
- Anna Forsberg
- Institute of Health SciencesLund UniversityLundSweden
- Department of Thoracic Transplantation and CardiologySkåne University HospitalSkåneSweden
| | - Madeleine Nilsson
- Queen Silvia Children´s Hospital, Sahlgrenska University HospitalGothenburgSweden
| | - Sofie Jakobsson
- Institute of Health and Care SciencesUniversity of GothenburgGothenburgSweden
| | - Annette Lennerling
- Institute of Health and Care SciencesUniversity of GothenburgGothenburgSweden
- The Department of TransplantationSahlgrenska University HospitalGothenburgSweden
| | - Annika Kisch
- The Department of HaematologySkåne University HospitalSkåneSweden
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9
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Almgren M, Lennerling A, Lundmark M, Forsberg A. The meaning of being in uncertainty after heart transplantation - an unrevealed source to distress. Eur J Cardiovasc Nurs 2016; 16:167-174. [PMID: 27146379 DOI: 10.1177/1474515116648240] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND As many as 88% of heart transplant recipients (HTRs) suffer from psychological distress. Both psychosocial factors and physical health are associated with increased psychological distress. However, the causes and impacts of psychological distress are unclear. HTRs strive for a sense of control over their health and daily lives in order to improve their psychological well-being. Perceived control was found to be related to the patients' construction of normality, their emotional state, as well as their thoughts and feelings of uncertainty about the future. AIM An in-depth exploration of the meaning of uncertainty during the first year after a heart transplantation (HTX). METHOD A phenomenological-hermeneutic method was employed. Interviews were conducted with 14 patients, four women and ten men, with a mean age of 51 years (range: 28-67 years). RESULTS Being in uncertainty after HTX means losing a sense of coherence, which shatters the HTR's whole worldview. The HTRs search for meaning and strive for coherence, which is no longer achievable. By using a nursing theory, we understand that uncertainty should be seen as a natural state among HTRs. It constitutes the starting point from which the HTRs can reorganise their self-structure and find a new view of life. When striving for normality, certainty and predictability (i.e., the healthcare professional's perspective), we block or prolong this process, thus causing distress among HTRs because they are unable to create a new orientation in life. CONCLUSION This study presents a hypothesis of the primary cause of psychological distress after HTX and provides a useful framework for how to approach this condition.
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Affiliation(s)
- Matilda Almgren
- 1 Skåne University Hospital, Thoracic Intensive Care Unit, Lund, Sweden.,2 Department of Health Sciences at Lund University, Lund, Sweden
| | - Annette Lennerling
- 3 The Transplant Centre Sahlgrenska University Hospital, Gothenburg, Sweden.,4 The Institute of Health and Caring Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Martina Lundmark
- 1 Skåne University Hospital, Thoracic Intensive Care Unit, Lund, Sweden.,2 Department of Health Sciences at Lund University, Lund, Sweden
| | - Anna Forsberg
- 2 Department of Health Sciences at Lund University, Lund, Sweden.,5 Skåne University Hospital, Department of Transplantation and Cardiology, Lund, Sweden
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10
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Well, I Wouldn't be Any Worse Off, Would I, Than I am Now? A Qualitative Study of Decision-Making, Hopes, and Realities of Adults With Type 1 Diabetes Undergoing Islet Cell Transplantation. Transplant Direct 2016; 2:e72. [PMID: 27500262 PMCID: PMC4946514 DOI: 10.1097/txd.0000000000000581] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/14/2016] [Indexed: 01/21/2023] Open
Abstract
Background For selected individuals with type 1 diabetes, pancreatic islet transplantation (IT) prevents recurrent severe hypoglycemia and optimizes glycemia, although ongoing systemic immunosuppression is needed. Our aim was to explore candidates and recipients' expectations of transplantation, their experience of being on the waiting list, and (for recipients) the procedure and life posttransplant. Methods Cross-sectional qualitative research design using semistructured interviews with 16 adults (8 pretransplant, 8 posttransplant; from 4 UK centers (n = 13) and 1 Canadian center (n = 3)). Interviews were audio-recorded, transcribed, and underwent inductive thematic analysis. Results Interviewees were aged (mean ± SD) 52 ± 10 years (range, 30-64); duration of diabetes, 36 ± 9 years (range, 21-56); 12 (75%) were women. Narrative accounts centered on expectations, hopes, and realities; decision-making; waiting and uncertainty; the procedure, hospital stay, and follow-up. Expected benefits included fewer severe hypoglycemic episodes, reduced need for insulin, preventing onset/progression of complications and improved psychological well-being. These were realized for most, at least in the short term. Most interviewees described well-informed, shared decision-making with clinicians and family, and managing their expectations. Although life “on the list” could be stressful, and immunosuppressant side effects were severe, interviewees reported “no regrets.” Posttransplant, interviewees experienced increased confidence, through freedom from hypoglycemia and regained glycemic control, which tempered any disappointment about continued reliance on insulin. Most viewed their transplant as a success, though several reflected upon setbacks and hidden hopes for becoming “insulin-free.” Conclusions Independently undertaken interviews demonstrated realistic and balanced expectations of IT and indicate how to optimize the process and support for future IT candidates.
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11
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Jamieson NJ, Hanson CS, Josephson MA, Gordon EJ, Craig JC, Halleck F, Budde K, Tong A. Motivations, Challenges, and Attitudes to Self-management in Kidney Transplant Recipients: A Systematic Review of Qualitative Studies. Am J Kidney Dis 2016; 67:461-78. [DOI: 10.1053/j.ajkd.2015.07.030] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 07/19/2015] [Indexed: 12/20/2022]
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12
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Ordin YS, Karayurt Ö. Effects of a Support Group Intervention on Physical, Psychological, and Social Adaptation of Liver Transplant Recipients. EXP CLIN TRANSPLANT 2015; 14:329-37. [PMID: 25890597 DOI: 10.6002/ect.2014.0220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Liver transplant recipients must adapt to a new life after transplant. We report the effects of a support group on physical and psychosocial adaptation of liver transplant recipients. MATERIALS AND METHODS The study used a quasi-experimental design, comparing an intervention group and a control group. Data were collected between January 2011 and May 2012 with 73 liver transplant recipients. A patient identification form, Modified Transplant Symptom Occurrence and Symptom Distress Scale - 58, and SF-36 were used for data collection. The intervention group attended support group meetings, while the control group received a routine follow-up. Data were analyzed with t test and The Repeated Measures ANOVA with 1 between-group factor. RESULTS The results indicated that the support group intervention increases physical, psychological, and social adaptation of liver transplant recipients. Specifically, this effect of the support group was accrued after support group intervention and decreased 3 months after intervention. CONCLUSIONS A support group intervention can have a positive effect on liver transplant recipients' physical, psychological, and social adaptations.
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Affiliation(s)
- Yaprak S Ordin
- From the Surgical Nursing Department, Faculty of Nursing, Dokuz Eylül University, Izmir, Turkey
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13
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Forsberg A, Lennerling A, Fridh I, Karlsson V, Nilsson M. Understanding the Perceived Threat of the Risk of Graft Rejections: A Middle-Range Theory. Glob Qual Nurs Res 2015; 2:2333393614563829. [PMID: 28462294 PMCID: PMC5342851 DOI: 10.1177/2333393614563829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 11/17/2014] [Indexed: 11/18/2022] Open
Abstract
From a clinical viewpoint, graft rejection is one of the greatest threats faced by an organ transplant recipient (OTR). We propose a middle-range theory (MRT) of Perceived Threat of the Risk of Graft Rejection (PTRGR) as a contribution to the practice of transplant nursing. It could also apply to the detection of risky protective behavior, that is, isolation, avoidance, or non-adherence. The proposed MRT covers the following concepts and the relationship between them: transplant care needs, threat reducing interventions, intervening variables, level of PTRGR, protective strategies, and evidence-based practice. Parts of this theory have been empirically tested and support the suggested relationship between some of the concepts. Further tests are needed to strengthen the theoretical links. The conceptual framework might serve as a guide for transplant nurses in their efforts to promote post-transplant health and reduce threat-induced emotions.
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Affiliation(s)
- Anna Forsberg
- Lund University, Lund, Sweden.,Skåne University Hospital, Lund, Sweden
| | - Annette Lennerling
- Sahlgrenska University Hospital, Gothenburg, Sweden.,University of Gothenburg, Göteborg, Sweden
| | - Isabell Fridh
- University of Gothenburg, Göteborg, Sweden.,University of Borås, Borås, Sweden
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14
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Bardet JD, Charpiat B, Bedouch P, Rebillon M, Ducerf C, Gauchet A, Tourette-Turgis C, Allenet B. Illness representation and treatment beliefs in liver transplantation: An exploratory qualitative study. ANNALES PHARMACEUTIQUES FRANÇAISES 2014; 72:375-87. [DOI: 10.1016/j.pharma.2014.05.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 05/26/2014] [Accepted: 05/27/2014] [Indexed: 01/23/2023]
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15
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Fernando DK, McIntosh AM, Bladin PF, Wilson SJ. Common experiences of patients following suboptimal treatment outcomes: implications for epilepsy surgery. Epilepsy Behav 2014; 33:144-51. [PMID: 24681640 DOI: 10.1016/j.yebeh.2014.02.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Revised: 02/12/2014] [Accepted: 02/14/2014] [Indexed: 10/25/2022]
Abstract
Few studies have investigated the patient experience of unsuccessful medical interventions, particularly in the epilepsy surgery field. The present review aimed to gain insight into the patient experience of seizure recurrence after epilepsy surgery by examining the broader literature dealing with suboptimal results after medical interventions (including epilepsy surgery). To capture the patient experience, the literature search focused on qualitative research of patients who had undergone medically unsuccessful interventions, published in English in scholarly journals. Twenty-two studies were found of patients experiencing a range of suboptimal outcomes, including seizure recurrence, cancer recurrence and progression, unsuccessful joint replacement, unsuccessful infertility treatment, organ transplant rejection, coronary bypass graft surgery, and unsuccessful weight-loss surgery. In order of frequency, the most common patient experiences included the following: altered social dynamics and stigma, unmet expectations, negative emotions, use of coping strategies, hope and optimism, perceived failure of the treating team, psychiatric symptoms, and control issues. There is support in the epilepsy surgery literature that unmet expectations and psychiatric symptoms are key issues for patients with seizure recurrence, while other common patient experiences have been implied but not systematically examined. Several epilepsy surgery specific factors influence patient perceptions of seizure recurrence, including the nature of postoperative seizures, the presence of postoperative complications, and the need for increased postoperative medications. Knowledge of common patient experiences can assist in the delivery of patient follow-up and rehabilitation services tailored to differing outcomes after epilepsy surgery.
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Affiliation(s)
- Dinusha K Fernando
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville 3010, Australia
| | - Anne M McIntosh
- Melbourne Brain Centre, Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Australia; Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Australia; Department of Neurology, The Royal Melbourne Hospital, Melbourne, Australia; Department of Neurology, Austin Health, Melbourne, Australia
| | - Peter F Bladin
- Comprehensive Epilepsy Program, Austin Health, Melbourne, Australia
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, The University of Melbourne, Parkville 3010, Australia; Epilepsy Research Centre, Department of Medicine, Austin Health, The University of Melbourne, Australia; Comprehensive Epilepsy Program, Austin Health, Melbourne, Australia.
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Gill P, Lowes L. Renal transplant failure and disenfranchised grief: participants' experiences in the first year post-graft failure--a qualitative longitudinal study. Int J Nurs Stud 2014; 51:1271-80. [PMID: 24560891 DOI: 10.1016/j.ijnurstu.2014.01.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 01/19/2014] [Accepted: 01/24/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Renal transplant failure has a devastating impact on patients and their families. However, little research has been conducted in this area, which limits insight and understanding of the transplant failure experience that could subsequently inform clinical practice. OBJECTIVES To explore participants' experiences of renal transplant failure in the first year post-graft failure. DESIGN A qualitative, longitudinal study informed by Heideggerian hermeneutics. PARTICIPANTS AND SETTINGS A purposive sample of 16 participants (8 recipients, 8 'significant others') from a regional renal transplant unit and 3 District General Hospitals in South-West England. METHODS Data were collected through a series of three recorded, semi-structured interviews in the first year post-renal transplant failure. Data analysis was informed by a three-step analytical process. RESULTS Renal transplantation was the treatment of choice and had a transformative effect on the lives of all participants. Graft failure has 2 distinct phases; failing and failed and the transition from one phase to the other is unpredictable, uncertain and stressful. Transplant failure had a devastating impact on all participants, regardless of time since transplantation and resulted in feelings of shock, grief, loss, anger, guilt and depression. Dialysis was disruptive and demanding and served as a constant reminder of transplant failure and lost freedom. Participants grieved the loss of their 'previous life' and 'imagined future' but, beyond the understanding of close family members, these losses appeared unrecognised, particularly by health professionals. Participants used various coping mechanisms to deal with stressors associated with transplant failure. Factors affecting coping and adjusting included improved physical health and social support, which was especially important within the marital dyad. Healthcare services were positively evaluated, although information concerning the prospect of transplant failure and support post-graft failure could be improved. CONCLUSION Renal transplant failure has a profound impact on recipients, spouses and other close family members and appears to resemble a form of disenfranchised grief. The theory of disenfranchised grief provides a coherent explication of participants' experiences in this study, which should help inform clinical practice, particularly in relation to the provision of information and emotional support post-graft failure.
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Affiliation(s)
- Paul Gill
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd CF37 1DL, UK.
| | - Lesley Lowes
- School of Healthcare Sciences, Cardiff University, 35-43 Newport Road, Cardiff CF24 0AB, UK.
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Nilsson M, Forsberg A, Lennerling A, Persson LO. Coping in relation to perceived threat of the risk of graft rejection and Health-Related Quality of Life of organ transplant recipients. Scand J Caring Sci 2012. [DOI: 10.1111/scs.12007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Anna Forsberg
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences; Gothenburg Sweden
- Department of Health Sciences, Faculty of Medicine; Lund University; Gothenburg Sweden
| | - Annette Lennerling
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences; Gothenburg Sweden
- The Transplant Institute; Sahlgrenska University Hospital; Gothenburg Sweden
| | - Lars-Olof Persson
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences; Gothenburg Sweden
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Ordin YS, Karayurt Ö, Wellard S. Investigation of adaptation after liver transplantation using Roy's Adaptation Model. Nurs Health Sci 2012; 15:31-8. [DOI: 10.1111/j.1442-2018.2012.00715.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 05/10/2012] [Accepted: 05/16/2012] [Indexed: 12/23/2022]
Affiliation(s)
- Yaprak S. Ordin
- Department of Surgical Nursing; Dokuz Eylul University; Izmir; Turkey
| | - Özgül Karayurt
- Department of Surgical Nursing; Dokuz Eylul University; Izmir; Turkey
| | - Sally Wellard
- School of Health Sciences; University of Ballarat; Ballarat; Victoria; Australia
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Lennerling A, Forsberg A. Self-reported non-adherence and beliefs about medication in a Swedish kidney transplant population. Open Nurs J 2012; 6:41-6. [PMID: 22509233 PMCID: PMC3322447 DOI: 10.2174/1874434601206010041] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Revised: 02/14/2012] [Accepted: 02/23/2012] [Indexed: 12/26/2022] Open
Abstract
Background: Patients’ non-adherence to immunosuppressant treatment after organ transplantation may lead to organ failure, graft loss and death. Non-adherence among Swedish kidney transplant recipients has not previously been studied. Hence the aim of this study was to explore non-adherence among Swedish kidney transplant recipients by using self-report instruments as well as testing the hypothesis that there is a difference in self-reported symptoms, beliefs about medicine and social support between respondents with or without self reported non-adherence. Materials and Methodology: In the present cross sectional study 250 renal transplant recipients participated by replying to a questionnaire. Two validated instruments were included, one on beliefs about medicine (the BMQ©), the other on nonadherence (the BAASIS©). Results: Only 46 % never failed to follow the medical treatment with respect to taking the drugs, dosage or timing (>2 hrs from prescribed time). Timing was the most frequently reported deviation (48 %). Forty-seven patients (16 %) had failed taking at least one dose of the prescribed immunosuppressants during the past four weeks. Four individuals had reduced the prescribed doses. Only one reported taking a ‘drug holiday’. Nine participants reported stronger concerns than necessities for immunosuppressive medication. For the BMQ the necessity scores were extremely high while the scores for concern were low. Risk behaviour identified by the BAASIS had no association in risk attitudes as identified in the BMQ. The only factor relating to non-adherence was lack of social support (p=0.022). Conclusion: In general adherence was high. Identification of the exceptions remains a challenge.
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Affiliation(s)
- Annette Lennerling
- Transplant Institute, Sahlgrenska University Hospital, Bruna Straket 5, 6 floor, 413 45 Gothenburg, Sweden
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Urstad KH, Wahl AK, Andersen MH, Øyen O, Fagermoen MS. Renal recipients' educational experiences in the early post-operative phase--a qualitative study. Scand J Caring Sci 2012; 26:635-42. [PMID: 22417055 DOI: 10.1111/j.1471-6712.2012.00972.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Renal recipients need to acquire significant amount of knowledge for their life post-transplantation. More knowledge on kidney recipients' experiences after transplantation with regard to the patient education provided is needed. Sixteen renal recipients were interviewed 4-6 weeks post-transplantation about content and methods in the patient education programme. Data were analysed in the hermeneutic tradition. The patients experienced barriers towards learning in the early post-operative phase. Kidney transplantation was expressed as a 'turning point in life', causing learning difficulties because of both physical and mental stress. Survival knowledge was the label for topics concerning medication and rejection as they were experienced as essential for life. Situational knowledge, that is, knowledge related to recipients' individual life situations, requires further details in the main topics provided. The difference between knowing and practising what was taught was experienced as troublesome. The recipients expressed that a supportive learning atmosphere characterized by patience, respect, continuity and active participation was essential. This study revealed new knowledge about renal recipients' need for individual application of the educational content, as well as cognitive difficulties, and other factors impacting on learning in the early post-operative phase. The patients' perspective is an important and useful aid in creating effective interventions in this field.
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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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Scott AM, Martin SC, Stone AM, Brashers DE. Managing multiple goals in supportive interactions: using a normative theoretical approach to explain social support as uncertainty management for organ transplant patients. HEALTH COMMUNICATION 2011; 26:393-403. [PMID: 21409670 DOI: 10.1080/10410236.2011.552479] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In this study, we used a normative theoretical perspective to examine the relationship between uncertainty management and support in the lives of organ transplant patients. We conducted in-depth interviews with 8 pretransplant and 30 posttransplant patients, including individuals who were waiting for or had received a kidney, liver, heart, or pancreas. Interview transcripts were analyzed using a grounded theory approach, which involved two levels of thematic analysis. Participants reported that others provide assistance in various ways, and that this social support entailed a number of challenges. Participants also described several strategies for handling these support dilemmas. These findings suggest that the effectiveness of support is related to how well multiple goals (including uncertainty-related goals) are managed in the supportive interaction.
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Affiliation(s)
- Allison M Scott
- Department of Communication, University of Kentucky, 236 Grehan Building, Lexington, KY 40506, USA.
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Nilsson M, Forsberg A, Bäckman L, Lennerling A, Persson LO. The perceived threat of the risk for graft rejection and health-related quality of life among organ transplant recipients. J Clin Nurs 2010; 20:274-82. [PMID: 20964748 DOI: 10.1111/j.1365-2702.2010.03388.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This study was primarily aimed for developing and testing a valid and reliable instrument that measures perceived threat of the risk for graft rejection after organ transplantation. A second aim was to report descriptive data regarding graft rejection and Health-Related Quality of Life. BACKGROUND The most serious risk connected with transplantations besides infection is graft rejection. DESIGN Non experimental, descriptive involving instrument development and psychometric assessment. METHOD Questionnaires about perceived threat of the risk for graft rejection and Health-Related Quality of Life were mailed to 229 OTRs between 19-65 years old. The items were formed from a previous interview study. Patients were transplanted with a kidney, a liver or a heart and/or a lung. All patients with follow-up time of one year ± three months and three years ± three months were included. RESULTS With an 81% response rate, the study comprised of 185 OTRs, who had received either a kidney (n = 117), a liver (n = 39) or heart or lung (n = 29). Three homogenous factors of perceived threat for graft rejection were revealed, labelled 'intrusive anxiety', 'graft-related threat' and 'lack of control'. Tests of internal consistency showed good item-scale convergent and discriminatory validity. A majority of the OTRs scored low levels for 'intrusive anxiety'. The kidney transplant recipients experienced more 'graft-related threat' by acute graft rejection than those transplanted with a liver, heart or lung. CONCLUSION In conclusion, this study suggests that it is possible to measure the perceived threat of the risk for graft rejection in three homogenous factors. Relevance to clinical practice. The instrument perceived threat of the risk for graft rejection, might be usable to measure the impact of fear of graft rejection, to predict needs of pedagogical intervention strategies to reduce fear and to improve Health-Related Quality of Life related to graft rejection.
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Affiliation(s)
- Madeleine Nilsson
- The Sahlgrenska Academy at University of Gothenburg, Institute of Health and Care Sciences and Sahlgrenska University Hospital, Gothenburg, Sweden.
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Martin SC, Stone AM, Scott AM, Brashers DE. Medical, personal, and social forms of uncertainty across the transplantation trajectory. QUALITATIVE HEALTH RESEARCH 2010; 20:182-196. [PMID: 19955227 DOI: 10.1177/1049732309356284] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We designed this study to identify sources of uncertainty across the transplantation trajectory. We interviewed 38 transplant patients, who reported medical, personal, and social forms of uncertainty. Prior to transplantation, they reported uncertainty related to insufficient information about diagnosis, complex decisions about transplantation, unknown/unknowable organ availability, unclear expectations about medical procedures/outcomes, ambiguity in meaning of life, complex role and identity challenges, unclear financial consequences, questioning from others, and unclear relational implications. They reported that uncertainty experienced after transplantation was related to complex medication regimens, unpredictable future health/prognosis, complex role and identity challenges, unclear financial consequences, possible stigmatizing reactions, unclear relational implications, and complex interactions with the deceased donor's family. These findings lay the groundwork for additional research on uncertainty management for transplant patients, and suggest that health care professionals and supportive others cannot apply a one-size-fits-all solution when aiding in uncertainty management.
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Ouellette A, Achille M, Pâquet M. The experience of kidney graft failure: patients' perspectives. QUALITATIVE HEALTH RESEARCH 2009; 19:1131-1138. [PMID: 19638605 DOI: 10.1177/1049732309341733] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
In this article we describe the phenomenon of kidney graft failure from the unique perspective of patients. Fifteen patients took part in semistructured interviews. We analyzed interviews using interpretative phenomenological analysis. The content analysis yielded five main emergent themes: life disruption, suffering, meaning making, resistance/acceptance, and social comparison. These results are discussed within the theoretical framework of psychosocial transition put forward by Parkes. A comprehensive description of the experience of kidney graft failure emerging from the patients' perspectives can provide a better understanding of the psychosocial aspects- not only the body aspects-of the phenomenon. It can help health care professionals better address patients' suffering, which is experienced by a person as a whole, and to offer support that promotes adaptation to kidney graft failure.
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