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Anthony SJ, Lin J, Selkirk EK, Liang M, Ajmera F, Seifert-Hansen M, Urschel S, Soto S, Boucher S, Gold A, Stinson JN, Kohut SA. The iPeer2Peer mentorship program for adolescent thoracic transplant recipients: An implementation-effectiveness evaluation. J Heart Lung Transplant 2024:S1053-2498(24)01832-1. [PMID: 39260753 DOI: 10.1016/j.healun.2024.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 08/30/2024] [Accepted: 09/03/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND An increase in self-management skills for adolescent thoracic transplant recipients may improve health outcomes and facilitate a successful transition to adulthood. The iPeer2Peer© program is an online peer mentorship program that has been successfully implemented as a self-management intervention in multiple chronic disease populations. This study aimed to determine the implementation and effectiveness outcomes of the iPeer2Peer program for adolescent thoracic transplant recipients. METHODS A type III, hybrid implementation-effectiveness pilot study that comprised a quasi-experimental single-arm pre-post design was used to evaluate the iPeer2Peer program. Participant mentees, ages 12 to 17, were recruited from two large Canadian transplant centres. Peer mentors, ages 18 to 25, were thoracic transplant recipients who had successfully transitioned to adult care and self-manage their condition. A mixed methods approach for data collection was used, including interviews, focus groups, and standardized questionnaires. RESULTS Twenty mentees (median 15.0 years, IQR 3.3 years; 65% female) completed the iPeer2Peer program with nine young adult mentors (median 21.0 years, IQR 3.0 years; 78% female). Implementation outcomes indicated that the iPeer2Peer intervention was perceived as feasible, adoptable, acceptable, and appropriate for adolescent thoracic transplant recipients. Significant findings were noted in mentees for increased self-management and a decrease in overall depression and anxiety symptoms. CONCLUSIONS The successful implementation of the pilot iPeer2Peer program offers support to evaluate the scalability, sustainability, and cost-effectiveness of the program for adolescents with chronic illness, specifically thoracic transplant recipients. Changes to the iPeer2Peer program that facilitate a flexible delivery may help implementation and acceptance.
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Affiliation(s)
- Samantha J Anthony
- Child Health Evaluative Sciences, Research Institute, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Social Work, The Hospital for Sick Children, Toronto, Ontario, Canada; Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada.
| | - Jia Lin
- Child Health Evaluative Sciences, Research Institute, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Enid K Selkirk
- Child Health Evaluative Sciences, Research Institute, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Megan Liang
- Child Health Evaluative Sciences, Research Institute, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Faye Ajmera
- Child Health Evaluative Sciences, Research Institute, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Mirna Seifert-Hansen
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Simon Urschel
- Department of Pediatrics, University of Alberta/Stollery Children's Hospital, Edmonton, Alberta, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Stephanie Soto
- Department of Pediatrics, University of Alberta/Stollery Children's Hospital, Edmonton, Alberta, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Suzanne Boucher
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Anna Gold
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, Research Institute, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Sara Ahola Kohut
- Child Health Evaluative Sciences, Research Institute, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada; Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Roberts R, Burdall O, Bohr C, Kennard H, Lewis S, Harris L, Cusick E. Are we informing our patients correctly? Evaluation of perioperative counselling for paediatric intestinal stoma formation: a national study. Pediatr Surg Int 2024; 40:189. [PMID: 39008127 DOI: 10.1007/s00383-024-05756-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE Adequate preoperative information is known to improve patient outcomes. We aimed to evaluate perioperative education for paediatric patients and families undergoing intestinal stoma formation. METHODS UK paediatric surgery centres were invited to recruit patients aged 6-16 years with a stoma in situ or reversed within the last 2 years. Patient and parent questionnaires were posted for potential participants. RESULTS Eighty-three patient/parent dyads returned questionnaires. Median age was 11.5 years (range 4.1-17.8), with 48% (n = 40) formed electively. Parents rated how well-informed they felt perioperatively out of 10 (0 poorly, 10 highly informed). Parents were better informed about surgical issues and stoma care than psychological and social impacts (7.45 vs 6.11; p < 0.0001). 54% reported surgical complications but significantly fewer patients listed these amongst the worst things about having a stoma (24.4%) when compared with psychosocial issues: distress from bag leaks (90.8%; p < 0.0001), self-consciousness (54.1%; p = 0.0001), and restricted activity (40.2%; p = 0.03). CONCLUSION Parents felt well-informed for medical and practical aspects but less well-informed of psychological and lifestyle impacts of having a stoma. Surgical complications were less important to patients than the impact on daily life. Increased psychosocial information would enable families to be better prepared for life with a stoma.
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Affiliation(s)
- Rebecca Roberts
- Department of Paediatric Surgery, Bristol Children's Hospital, Upper Maudlin Street, Bristol, BS2 8BJ, UK.
| | - Oliver Burdall
- Department of Paediatric Surgery, Bristol Children's Hospital, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Claire Bohr
- Department of Paediatric Surgery, Bristol Children's Hospital, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Hilary Kennard
- Department of Paediatric Surgery, Bristol Children's Hospital, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Sophie Lewis
- Department of Paediatric Surgery, Bristol Children's Hospital, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Lauren Harris
- Department of Paediatric Surgery, Bristol Children's Hospital, Upper Maudlin Street, Bristol, BS2 8BJ, UK
| | - Eleri Cusick
- Department of Paediatric Surgery, Bristol Children's Hospital, Upper Maudlin Street, Bristol, BS2 8BJ, UK
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Kaplan A, Korenjak M, Brown RS. Post-liver transplantation patient experience. J Hepatol 2023; 78:1234-1244. [PMID: 37208108 DOI: 10.1016/j.jhep.2023.01.008] [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: 09/29/2022] [Revised: 01/02/2023] [Accepted: 01/12/2023] [Indexed: 05/21/2023]
Abstract
Given improvements in post-transplant patient and graft survival, there is a growing need to focus on patient experience and health-related quality of life (HRQOL). Though liver transplantation can be life-saving, it can also be associated with significant morbidity and complications. Patient HRQOL improves after transplantation, but it may not improve to that of age-matched cohorts. Understanding patient experience and the factors that contribute to it, including physical and psychological health, immunosuppression and medication adherence, return to employment or school, financial burden, and expectations, helps when thinking creatively about potential interventions to improve HRQOL.
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Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA
| | | | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell School of Medicine, New York Presbyterian, New York, NY, USA.
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Anthony SJ, Nicholas DB, Regehr C, West LJ. 'My Transplanted Self': Adolescent recipients' experience of post-traumatic growth following thoracic transplantation. J Heart Lung Transplant 2023; 42:327-334. [PMID: 36543705 DOI: 10.1016/j.healun.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite heart and lung transplantation being life-saving therapies for children and adolescents, little research has focused on recipients' lived experience post-transplant. This study captures the subjective experiences of adolescent thoracic transplant recipients, providing insight into the impact of life changes following transplantation in this population. METHODS A grounded theory approach guided an iterative process of data collection and data analysis. Adolescent heart and lung transplant recipients were recruited from a large Canadian pediatric teaching hospital to participate in one-on-one semi-structured interviews. Analysis using line-by-line coding and constant comparison methods facilitated reflection and agreement on categories and emergent themes. RESULTS A total of 27 heart and 5 lung transplant recipients (66% female) participated at a median age of 15.9 years and a median time post-transplant of 2.7 years. Participant narratives illuminated three themes describing (1) personal growth - an awareness of personal strengths and coping abilities, (2) relationship growth - a greater appreciation for family and friends, and (3) introspective growth - a developing life philosophy. Findings suggest that adolescents experience an emergent 'transplanted self', positioning thoracic transplantation as a potential catalyst for positive growth and personal change. CONCLUSIONS The study findings describe pediatric thoracic transplantation as potentially transformative in nature and sheds light on the application of post-traumatic growth theory. Practitioners and researchers are encouraged to acknowledge the possibility of growth, transformation, and positive change that may be possible within the adolescent thoracic transplant experience and leverage such strengths in clinical care.
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Affiliation(s)
- Samantha J Anthony
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
| | - David B Nicholas
- Department of Social Work, University of Calgary, Edmonton, Alberta, Canada
| | - Cheryl Regehr
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Lori J West
- Departments of Pediatrics, Surgery, Medical Microbiology/Immunology and Laboratory Medicine/Pathology, Alberta Transplant Institute, University of Alberta, Edmonton, Alberta, Canada
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Laliberté Durish C, Lin J, Pol SJ, Damer A, Anthony SJ, Wray J, Gold A. Quality of life and psychosocial outcomes of adults who were pediatric solid organ transplant recipients: A systematic review. Pediatr Transplant 2022; 27:e14448. [PMID: 36510449 DOI: 10.1111/petr.14448] [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: 08/22/2022] [Revised: 10/27/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND The number of pediatric SOT recipients surviving into adulthood is increasing. Thus, understanding their psychosocial and QoL outcomes is important. We conducted a systematic review to collate existing literature examining QoL outcomes (physical functioning, psychological functioning, social functioning), as well as risk and protective factors associated with QoL, among adults who underwent SOT during childhood. METHODS A systematic search of five databases, from inception to January 6, 2021, was conducted to identify articles that reported on QoL outcomes for adults (≥18-year of age) who received a SOT during childhood (<19-year of age). RESULTS Twenty-five articles met inclusion criteria. Studies examined QoL across a range of SOT populations (liver, kidney, heart). QoL and psychosocial outcomes were variable; however, the majority of studies indicated QoL in this population to be similar to the general population, or at least similar to other chronic illness groups, with the exception of physical and social functioning. Factors related to a more optimal medical course, younger age at transplant and follow-up, and positive psychosocial functioning, were found to be predictive of better QoL outcomes. CONCLUSIONS While several studies indicated QoL to be similar to the general population, the literature is limited in both quantity and quality. No study employed prospective, longitudinal methodologies to systematically evaluate QoL over time and few studies utilized normative-based measures of QoL. Furthermore, several SOT groups were under-represented in the literature (e.g., lung, intestine, multi-visceral). Nonetheless, findings have implications for intervention and clinical decision-making.
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Affiliation(s)
| | - Jia Lin
- Child Health Evaluative Sciences (CHES), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah J Pol
- Child Health Evaluative Sciences (CHES), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alameen Damer
- Child Health Evaluative Sciences (CHES), The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Samantha J Anthony
- Child Health Evaluative Sciences (CHES), The Hospital for Sick Children, Toronto, Ontario, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Jo Wray
- Heart and Lung Directorate, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anna Gold
- The Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada.,Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, Ontario, Canada
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Criss SD, Dageforde LA, Coe TM, Brandes RA, Li S, Keegan-Pitts E, Ritter R, Luby B, Ladin K, Yeh H. Acceptability and utility of a virtual pediatric transplant peer mentoring program: A mixed-methods analysis of a novel quality improvement program. Pediatr Transplant 2022; 26:e14345. [PMID: 35751639 DOI: 10.1111/petr.14345] [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: 10/27/2021] [Revised: 05/13/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adolescent transplant patients are at increased risk for graft loss at a period when they also suffer from illness-related social isolation, which has been exacerbated by the COVID-19 pandemic. The Peer Mentoring Program (PMP), developed in 2018, was adapted to a virtual format in 2020 due to COVID-19. Our objective is to evaluate the acceptability, utility, and potential impact of the in-person and virtual versions of the PMP on participants. METHODS We performed convergent mixed-methods analysis of the experiences of patients participating in the PMP for quality improvement purposes. RESULTS Surveys and focus group invitations were sent to 18 current program participants, with 17 patients responding to the survey and 13 patients participating in focus groups. In this study, 82% were satisfied and 88% would recommend PMP; 76% identified other PMP members as people they would like to keep in touch with. Qualitative analysis revealed three themes: (1) a supportive community of peers, (2) reduced isolation, and (3) receiving accurate information from providers. CONCLUSIONS There is a prominent need for greater peer support among adolescent transplant patients transitioning to adulthood, especially with the increased isolation associated with COVID-19. The virtual adaptation could be an important, permanent supplement to in-person events.
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Affiliation(s)
| | - Leigh Anne Dageforde
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Taylor Makena Coe
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Sienna Li
- Harvard Medical School, Boston, Massachusetts, USA
| | - Eileen Keegan-Pitts
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rachel Ritter
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Barb Luby
- Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Keren Ladin
- Departments of Occupational Therapy and Community Health, Tufts University, Medford, Massachusetts, USA
| | - Heidi Yeh
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Transplantation, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
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Davis L, Iraheta YA, Ho EW, Murillo AL, Feinsinger A, Waterman AD. Living Kidney Donation Stories and Advice Shared Through a Digital Storytelling Library: A Qualitative Thematic Analysis. Kidney Med 2022; 4:100486. [PMID: 35755303 PMCID: PMC9218227 DOI: 10.1016/j.xkme.2022.100486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Rationale & Objective Despite the development of numerous educational interventions, there has been limited change in actual living donor kidney transplant (LDKT) rates over time. New strategies, such as the inclusion of patient stories in patient education, show promise to inspire more people to donate kidneys. This study identified the challenges faced, coping strategies used, and advice shared by transplant donors and recipients. Study Design Qualitative thematic analysis. Setting & Participants One hundred eighteen storytellers across the United States and Canada, including 82 living donors and 36 kidney recipients of living donor transplants who shared their stories on the Living Donation Storytelling Project (explorelivingdonation.org), an online digital storytelling platform and library. Analytical Approach A poststorytelling survey assessed participant demographics. Two coders conducted tool-assisted (Dedoose v.8.3.35) thematic analysis on narrative storytelling videos and transcripts. Results Storytellers were predominantly White (79/118, 66.95%), female (76/118, 64.41%), and non-Hispanic (109/118, 92.37%) with college/vocational education (50/118, 42.37%). Common themes were found related to living donation challenges for donors and recipients (eg, the fear of not being able to complete the LDKT process, of unsupportive family or rejected donation requests, and of unknown or adverse surgical outcomes and graft rejection) and recommended coping strategies (eg, seeking LDKT information, using prayer, and relying on a support network). Recipients provided advice that included being proactive and staying hopeful, whereas donors recommended seeking support, researching LDKT to comprehensively learn, and building a community of support. Limitations Limited representation of diverse demographics. Conclusions Although supplementary to traditional education about LDKT, digital storytelling provides a source of peer support that can enhance the experience of donors and recipients and encourage autonomy and self-management after transplant.
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Affiliation(s)
- LaShara Davis
- Center for Outcomes Research, Houston Methodist, Houston, TX
| | - Yaquelin Arevalo Iraheta
- Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Erica W. Ho
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA
| | | | - Ashley Feinsinger
- Department of Medicine and Philosophy, University of California, Los Angeles, Los Angeles, CA
| | - Amy D. Waterman
- Center for Outcomes Research, Houston Methodist, Houston, TX
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Sambucini D, Ciacchella C, Pellicano GR, Zingaretti G, Pierro L, Aceto P, Lai C. Psychosocial treatment on psychological symptoms, adherence, and physiological function on transplanted patients: A systematic review and metanalysis. J Psychosom Res 2022; 154:110717. [PMID: 35032913 DOI: 10.1016/j.jpsychores.2022.110717] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Transplantation represents an important source of hope for the candidates and produces an intense emotional effect. Psychosocial interventions can be helpful in all transplantation stages to better manage this extraordinarily stressful situation. Aim of the work is to verify the effects of the psychosocial interventions on recipients on psychological symptoms, medical adherence and transplanted solid organ functioning. METHODS This work adhered to PRISMA, STROBE, Cochrane and New Castle Ottawa bias scales and it is registered in PROSPERO. Inserting "Transplant" and "Psychological intervention" as key words in PubMed, Psycinfo, Cochrane database resulted 977 studies from 2001 to 2021. A systematic review and metanalyses were processed on nineteen randomized controlled trials and observative prospective cohort studies. The difference between pre- and post- psychosocial intervention assessment on the psychological variables, medical adherence, and organ functioning outcome was processed. RESULTS Main findings showed that the psychosocial interventions were effective on depression (0.62; CI: 0.32-0.92) and anxiety on kidney recipients (0.49; CI: 0.17-0.81), and on anxiety on heart recipients, mainly when administrated after the surgery (0.68; CI: 0.30-1.06). Moreover, the findings showed a lack of studies on the effectiveness of the psychosocial intervention on organ functioning. CONCLUSION The work highlighted the effectiveness of the psychosocial interventions on psychological outcome, particularly after the surgery and the need to address the research on the evaluation of the effectiveness of the psychosocial interventions on the organ functioning. The findings suggest to integrate the transplantation procedures with psychosocial interventions considering the different needs of recipients in relation to the specific transplanted organ.
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Affiliation(s)
- Daniela Sambucini
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Chiara Ciacchella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Gaia Romana Pellicano
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Giorgia Zingaretti
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Laura Pierro
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy
| | - Paola Aceto
- Department of Emergency, anesthesiological and reanimation sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Basic Biotechnological Sciences, Intensive Care and Perioperative Clinics, University of Sacred Heart, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University, Rome, Italy.
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