Recently accepted for the waiting list for heart or lung transplantation - patients' experiences of information and support

Patient Experiences and Perspectives of Their Decision-Making to Accept Lung Transplantation Referral: A Qualitative Study

Providing early lung transplantation referral services should be considered to reduce pre-transplant mortality in patients with advanced disease. This study aimed to explore the reasons for lung transplantation referral decisions in patients and provide evidence for the development of transplantation referral services. This was a qualitative, retrospective, and descriptive study involving conventional content analysis. Patients in evaluation, listing, and post-transplant stages were interviewed. A total of 35 participants (25 male and 10 female) were interviewed. Four main themes were defined: (1) expectations for lung transplantation leading to the decision (a gamble for a silver lining, a return to normal life, and occupation); (2) facing uncertain outcomes (personal luck arranging everything; belief in success; incidents leading to "It's decided then"; hesitation when making a decision due to fear); (3) facing various information from peers, doctors, and so on; (4) complex policy and societal support (providing transplantation referral services earlier, family attachment and oral approval responses contribute to the referral decision, and so on). The findings of this study might enrich existing referral services, including training for family members and healthcare providers, a checklist and package of critical events in the patient lung transplantation referral decision-making process, precision services based on behavioral personas, and a curriculum to enhance patient decision self-efficacy.

Following-up midwives after adverse incidents: How front-line management practices help second victims

OBJECTIVE

To describe how front-line managers of maternity wards provide support to midwives as second victims in the aftermath of an adverse incident.

DESIGN

A qualitative study using critical incident technique and a content analytic approach of semi-structured in-depth interviews.

SETTING

Maternity wards in 10 Norwegian hospitals with more than 200 registered births annually were included in the study.

PARTICIPANTS

A purposeful sample of 33 midwives with more than two years' working experience described 57 adverse incidents.

FINDINGS

Maternity ward managers utilised four types of practices to support midwives after critical incidents: management, transformational leadership, distributed leadership and laissez-faire leadership.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The study shows that proactive managers who planned for how to handle critical incidents provided midwives with needed individual support and learning. Proactive transformational leadership and delegating roles for individual support should be promoted when assisting second victims after critical incidents. Managers can limit the potential harm to second victims by preparing for the eventuality of a crisis and institute follow-up practices.

Experiences of supportive care when waiting for a lung re-transplantation

Objectives:

Lung transplant patients and their next of kin share the experiences of illness but little is known in the face of a lung re-transplantation. To describe patients’ and next of kin’s experiences of supportive care while awaiting lung re-transplantation and the objective was to highlight a small group with special circumstances and needs.

Methods:

Using qualitative content analysis, seven adult patients and seven next of kin were consecutively selected from a regional lung transplantation centre and individually interviewed shortly after decision about lung re-transplantation.

Results:

The experiences of supportive care were captured in one main category: ‘once again haunted by death’ and three sub-categories: ‘when life turns and death once again snorts down your neck’, ‘the importance of information’, and ‘perceptions of support’. A complex interaction between the experience of waiting, and communication patterns, emotional states, and social support was shown.

Conclusion:

This study provides insights into the complex interaction between the experience of waiting for a second lung transplant and communication patterns, emotional states, social support and social roles between patients, next of kin, healthcare professionals, and the health and social welfare system. There is a need for developing supportive care programme to achieve the best possible care.

Psychosocial aspects before and up to 2 years after heart or lung transplantation: Experience of patients and their next of kin

BACKGROUND

Psychosocial factors are important for patients undergoing heart (HTx) or lung (LTx) transplantation and for their next of kin (NoK).

AIM

To describe health-related quality of life (HRQoL; patients only), anxiety, depression, stress, coping ability, and burden (NoK only) for patients and their NoK before and up to 2 years after HTx or LTx.

DESIGN

Adult patients (28 hearts and 26 lungs) and their appointed NoK were surveyed with questionnaires about specific psychosocial topics when they were accepted for the transplantation waiting list and 6 months, 1 year, and 2 years after transplantation.

FINDINGS

Patients' coping ability and self-perceived health were low at baseline and improved over time after transplantation. However, lung patients took longer time to recover in terms of HRQoL, depression, and stress than heart patients. Similarly, NoK of lung patients experienced a higher burden and more stress 1 year after transplantation than NoK of heart patients.

CONCLUSIONS

Healthcare professionals should be aware of the psychosocial challenges patients and their NoK face in daily living and provide support both before and after heart or lung transplantation.

The Unsteady Mainstay of the Family: Now Adult Children's Retrospective View on Social Support in Relation to Their Parent's Heart Transplantation

The needs for support among children with a seriously ill parent, who is waiting for heart transplantation, are unknown today. The aim was to describe now adult children's experiences of social support in relation to a parent's heart transplant during childhood. Nine females and four males were interviewed. The median age for the children was 18 at the transplantation and their parents had been ill before for 18 months (median) and on waiting list for 161 days (mean). Three categories emerged: health care professionals' approaches, family and friends' approaches, and society approaches. Our results show that there was lack of support for children of heart transplantation patients. Support in the shape of information was in most cases provided by the sick or healthy parent. It is of great clinical importance to develop psychosocial support programs for children with a seriously ill parent waiting for heart transplantation (before, during, and after surgery).

Perceptions of received information, social support, and coping in patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension

Patients with a life-limiting diagnosis of pulmonary arterial hypertension (PAH) or chronic thromboembolic pulmonary hypertension (CTEPH) need disease-specific information, ability to cope, and functioning social networks. This cohort study investigated the experiences of PAH and CTEPH patients who received information about their diagnosis, treatment, and management, in addition to coping and social support. Sixty-eight adult patients (mean ± SD, age 67 ± 14; 66% women) were included. A total of 54% of the patients wanted more information. Patients received information mostly in areas concerning medical test procedures, the diagnosis, disease severity, possible disease causes, and how to manage their disease. Coping ability was significantly better in patients who were satisfied with the received information (P = 0.0045). The information given to PAH or CTEPH patients and their communication with healthcare professionals can be greatly improved. Gaps in information and misunderstandings can be avoided by working in cooperation with the patients, their relatives, and within the PAH team.

Waiting for a heart or lung transplant: Relatives' experience of information and support

OBJECTIVES

To describe the relatives' experiences of information and support while heart or lung transplant candidates were waiting for a transplantation.

METHODOLOGY/DESIGN

The critical incident technique was used. Incidents were collected via interviews with 18 relatives (28-73 years old) of heart or lung transplant patients within four weeks of the patients being accepted onto the transplant waiting list.

FINDINGS

A total of 286 important events, both positive and negative, were identified and divided into two main areas: "Experiencing information and support" and "Reflecting upon information and support." "Experiencing information and support" was associated with "dissatisfaction with the health-care system", "being relatively satisfied", "supporting patients" and "the role of social networks." "Reflecting upon information and support" was associated with "finding strength" and "uncomfortable with emotions". Relatives experiences suggest that needs can be met through specific targeted information and support for them as well as mediating contact to previously transplanted persons.

CONCLUSION

The findings indicate a gap between the information and support that relatives need and receive, and that more attention should be paid to information and support for this group. By increasing awareness among healthcare professionals and the community, interventions can be developed that benefit relatives.

Psychosocial issues facing lung transplant candidates, recipients and family caregivers

Although lung transplantation is an accepted treatment for many individuals with severe lung disease, transplant candidates and recipients experience a range of psychosocial stressors that begin at the initiation of the transplant evaluation and continue throughout patients' wait for donor lungs, their perioperative recovery, and their long-term adjustment to posttransplant life. Transplant programs should strive to incorporate evidence-based interventions that aim to improve physical functioning, psychological distress, global quality of life, and medical adherence as well as to integrate symptom management and palliative care strategies throughout the pre- and posttransplantation course.

Heart or lung transplanted patients' retrospective views on information and support while waiting for transplantation

AIMS AND OBJECTIVES

To describe the patients' retrospective experiences of the information and support they received while on the heart or lung transplant waiting list.

BACKGROUND

Patients differ in the way that they cope with the time spent waiting for a heart or lung transplant. Patients must already before the transplantation be taught about a new lifestyle, risk factors, medication, food restrictions and exercise, so they can take an active role and responsibility for disease management after transplantation. Little is known about patients' experiences of information and support in these situations.

DESIGN

Qualitative descriptive design.

METHODS

Sixteen patients (16-67 year) were strategically selected from one transplant centre in Sweden and interviewed six months after heart or lung transplantation. Using content analysis, transcribed data were organised into subcategories that reflected emerging categories.

RESULTS

Three categories that describe patients' experiences of information and support have been identified: 'Achieving confidence and trust by information and support', 'Experiencing a lack of input and understanding' and 'Struggling with a life-threatening illness and an insecure future'. Each category consists of different subcategories.

CONCLUSIONS

Information and support in connection to heart or lung transplantation are a complex and multifaceted issue involving patient-related, family-related, disease-related and treatment-related factors as well as experiences related to the social situation, the healthcare system and society. Transplant patients are very vulnerable, and a deeper understanding of patients' experiences should help healthcare providers in optimising the care for these very sick patients.

RELEVANCE TO CLINICAL PRACTICE

A holistic approach to the patient is necessary in meeting the needs of patients with chronic illness, especially patients with children at home, as well as the needs of their families. An important implication is the necessity to enhance awareness about transplant patients in society in general, in particular in other institutions, by sharing knowledge and by improving cooperation.