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Dalvindt M, Veungen HL, Kisch A, Nozohoor S, Lennerling A, Forsberg A. Symptom Distress Before and After Heart Transplantation - A Longitudinal 5-Year Follow-Up. Clin Transplant 2024; 38:e15385. [PMID: 38973775 DOI: 10.1111/ctr.15385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/20/2024] [Accepted: 06/06/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Symptom distress after heart transplantation (HTx) is a significant problem causing uncertainty, low self-efficacy, and psychological distress. Few studies have addressed self-reported symptoms. The aim was to explore self-reported symptom distress from time on the waiting list to 5 years after HTx and its association with self-reported psychological well-being, chronic pain, and fatigue in order to identify possible predictors of psychological or transplant specific well-being. METHODS This multicenter, longitudinal cohort study includes 48 heart recipients (HTRs), 12 women, and 36 men, with a median age of 57 years followed from pretransplant to 5 years post-transplant. Symptom distress was explored by means of four instruments measuring psychological general wellbeing, transplant specific wellbeing, pain, and fatigue. RESULTS Transplant specific well-being for the whole improved in a stepwise manner during the first 5 years compared to pretransplant. Heart transplant recipients with poor psychological wellbeing were significantly more burdened by symptom distress, in particular sleep problems and fatigue, for up to 5 years after HTx, and their transplant-specific well-being never improved compared to baseline. The prevalence of pain varied from 40% to 60% and explained a significant proportion of the variance in transplant-specific well-being, while psychological general well-being was mainly predicted by overall symptom distress. CONCLUSION The presence of distressing symptoms explains a significant proportion of poor psychological wellbeing both among HTRs reporting chronic pain and those without pain.
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Affiliation(s)
- Marita Dalvindt
- Institute of Health Sciences at Lund University, Lund, Sweden
- Education Unit, Ystad County Hospital, Ystad, Sweden
| | - Hannah Lindahl Veungen
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
| | - Annika Kisch
- Institute of Health Sciences at Lund University, Lund, Sweden
- Department of Haematology at Skåne University Hospital, Lund, Sweden
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Lund University, 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, Gothenburg, Sweden
| | - Anna Forsberg
- Institute of Health Sciences at Lund University, Lund, Sweden
- Department of Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
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Abtahi H, Safdari R, Gholamzadeh M. Pragmatic solutions to enhance self-management skills in solid organ transplant patients: systematic review and thematic analysis. BMC PRIMARY CARE 2022; 23:166. [PMID: 35773642 PMCID: PMC9247970 DOI: 10.1186/s12875-022-01766-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/06/2022] [Indexed: 02/07/2023]
Abstract
Background In organ transplantation, all patients must follow a complex treatment regimen for the rest of their lives. Hence, patients play an active role in the continuity of the care process in the form of self-management tasks. Thus, the main objective of our study was to investigate the pragmatic solutions applied by different studies to enhance adherence to self-management behaviors. Method A systematic review was conducted in five databases from 2010 to August 2021 using keywords. Eligible studies were all English papers that developed self-management programs to enhance patient care in solid organ transplantation. The interventions were analyzed using thematic analysis to determine the main descriptive areas. The quality of the included articles was evaluated using the research critical appraisal program (CASP) tool. Results Of the 691 retrieved articles, 40 met our inclusion criteria. Of these, 32 studies were devoted to the post-transplantation phase. Five main areas were determined (e-health programs for telemonitoring, non-electronic educational programs, non-electronic home-based symptom-monitoring programs, electronic educational plans for self-monitoring, and Telerehabilitation) according to thematic analysis. Most studies (72.5%) declared that developed programs and applied solutions had a statistically significant positive impact on self-management behavior enhancement in transplant patients. Conclusion The results showed that an effective solution for improving organ transplantation needs patient collaboration to address psychological, social, and clinical aspects of patient care. Such programs can be applied during candidate selection, waiting list, and after transplantation by putting the patient at the center of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01766-z.
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Affiliation(s)
- Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Marsa Gholamzadeh
- Ph.D. Candidate in Medical Informatics, Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Fardanesh Alley, 5th FloorQods Ave, Tehran, Iran.
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Integration Process With a Donated Heart: A Grounded Theory Study. Dimens Crit Care Nurs 2021; 41:10-17. [PMID: 34817955 DOI: 10.1097/dcc.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In the posttransplant period, recipients face a complex phenomenon called the new heart, which is a symbol of physical and emotional life. They use different methods to get used to the new heart. OBJECTIVE The aim of this study was to explore the integration process with a donated heart in heart transplant patients. METHODS A qualitative study design with a grounded theory approach following Corbin and Strauss was used. Purposive and then theoretical sampling led to the inclusion of 15 heart transplant patients with diverse characteristics. Observations and semistructured interviews were conducted during a 1-year period in 2019 to 2020. Data collection and analysis occurred simultaneously. RESULTS The process of integration with the new heart in the transplant patients or the core category in this study was "rebirth." The process involved thre3 sequential and overlapping phases, which over time led to toleration and management of the situation. Religious issues, emotional chaos, additional worries, and sense of duality in the early stages after transplantation form a cycle, and the person is moving in this cycle. DISCUSSION The results of this study indicated that the patients experienced several emotional and psychological changes after heart transplantation. It was also shown that the participants experienced a change in the emotions and feelings over time. On the basis of the findings of this study, it can be suggested that health care providers need to improve their knowledge about posttransplant changes, recipients' feelings, and adaptation strategies.
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Yoo HJ, Suh EE. Effects of a smartphone-based self-care health diary for heart transplant recipients: A mixed methods study. Appl Nurs Res 2021; 58:151408. [PMID: 33745556 DOI: 10.1016/j.apnr.2021.151408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 10/18/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022]
Abstract
AIM This study evaluated the effectiveness of a smartphone-based self-care health diary based on the Information-Motivation-Behavioral Skills model, designed to enable transplant recipients to self-manage their health and increase their adherence to medical advice. BACKGROUND Heart transplant recipients must take immunosuppressants to prevent rejection for the rest of their lives. As immunosuppressant drugs suppress the immune system, transplant recipients are like individuals battling chronic diseases and must be diligent about self-care to keep healthy. METHODS This was a quasi-experimental study using a nonequivalent control group pretest-posttest non-synchronized design and mixed methods. The sample comprised of 56 patients, with 28 each in the experimental and control groups. The control group was recruited from May 25-June 19, 2018, and the experimental group from September 1-13, 2018. Self-efficacy and self-care adherence were assessed via questionnaires; user experiences were assessed via interviews after the application was used for 4 weeks. RESULTS After four weeks of use, transplant recipients reported significantly higher self-efficacy (F = 55.87, p < 0.001) and self-care adherence (F = 9.68, p = 0.003). Five themes were derived for the user experiences: (1) taking initiative for self-care, (2) utilizing a novel tool for self-care, (3) experiencing obstacles in ongoing self-care, (4) focusing on self-care adherence through the tool, and (5) expecting the application to serve as a personal medical assistant. CONCLUSIONS The health diary application is expected to motivate heart transplant recipients to perform self-care and improve adherence to medical advice.
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Affiliation(s)
- Hye Jin Yoo
- College of Nursing, Dankook University, Republic of Korea
| | - Eunyoung E Suh
- College of Nursing, Seoul National University, Republic of Korea; Research Institute of Nursing Science, Seoul National University, Republic of Korea.
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Hou IC, Chung TY. The Acceptability Study of Heart Transplantation Self-Management Support mHealth Application (iHeart App) in Taiwan: Mix Method Approaches. (Preprint). JMIR Form Res 2020. [DOI: 10.2196/26087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Validation and Adaptation of the "Modified Transplant Symptom Occurrence and Symptom Distress Scale" for Kidney Transplant Recipients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197348. [PMID: 33050107 PMCID: PMC7579451 DOI: 10.3390/ijerph17197348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/05/2023]
Abstract
The aim was to adapt and validate the Modified Transplant Symptom Occurrence and Symptom Distress Scale (MTSOSD-59R) for kidney transplant recipients undergoing immunosuppressive therapy in Korea. The MTSOSD-59R has been used with solid organ transplant recipients globally to assess the adverse effects of immunosuppressive medication. A descriptive cross-sectional design was used. MTSOSD-59R was first translated, and pilot tested. Next, content validity was established with nine organ transplant experts. Then, from October 2017 to October 2018, the Korean MTOSOSD-59R was administered to a convenience sample of 122 kidney transplant recipients recruited from a single center. Ridit analysis was used to measure symptom occurrence and distress. The known-group approach was used to test the construct validity using Mann-Whitney U tests for between-group comparisons. The content validity index for MTSOSD-59R was 0.98, and known-group validity was confirmed. The split-half Spearman-Brown corrected reliability coefficient was 0.902 for symptom occurrence and 0.893 for symptom distress. The four most frequent and distressing symptoms were fatigue, lack of energy, thinning hair, and erectile dysfunction (male). Results suggest this Korean MTSOSD-59R adaptation has adequate language, construct validity, and reliability to gather meaningful information from kidney transplant recipients in Korea.
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Aladwan S, Harrison JJ, Blackburn DF, Taylor J, Blydt-Hansen TD, Mansell H. A Canadian Survey on Adverse Symptoms Experienced by Solid Organ Transplant Recipients. Prog Transplant 2020; 30:254-264. [PMID: 32597328 DOI: 10.1177/1526924820933821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Adverse symptoms experienced by solid organ transplant recipients remain largely unexplored despite their purported frequency. OBJECTIVE To characterize patient perspectives on adverse symptoms, identifying the most problematic symptoms and the perceived cause and treatability, and to evaluate their impact on quality of life (QoL) and medication adherence. METHODS An electronic survey was distributed to members of the Canadian Transplant Association, to characterize perceptions on symptom experience (Modified Transplant Symptom Occurrence and Distress Scale), and QoL (Short Form-12), medication adherence (Basel Assessment of Adherence to Immunosuppressive Medications Scale), demographics, and clinical situation. RESULTS The questionnaire was distributed to 249 solid organ transplant recipients and achieved a 51% response rate (N = 127). Respondents reported a mean of 25 (standard deviation 10) adverse symptoms each. In women, the most prevalent and distressing symptoms were tiredness, lack of energy, sleep difficulties, difficulty concentrating or memory problems, diarrhea, joint pain, and depression. In men, they were tiredness, flatulence, lack of energy, sleep difficulties, and erectile problems. With the exception of flatulence, these symptoms were more often perceived to be caused by medical conditions rather than by immunosuppressants or other medications. Quality of life was similar to the general public, with mean physical and mental component scores of 47.4 (9.9) and 52.1 (8.2), respectively (relative to a US average of 50 [10]). However, QoL scores inversely correlated to the number of symptoms reported and were higher in patients who perceived all symptoms to be treatable. CONCLUSION Adverse symptoms may impact patient well-being. Perceived cause and treatability should be further explored.
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Affiliation(s)
- Shirin Aladwan
- College of Pharmacy and Nutrition, 70398University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jennifer J Harrison
- Multi-Organ Transplant Program, Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada.,Department of Pharmacy Services, Toronto General Hospital, 7989University Health Network, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - David F Blackburn
- College of Pharmacy and Nutrition, 70398University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jeff Taylor
- College of Pharmacy and Nutrition, 70398University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tom D Blydt-Hansen
- Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, 8166University of British Columbia, Vancouver, British Columbia, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, 70398University of Saskatchewan, Saskatoon, Saskatchewan, Canada.,Saskatchewan Transplant Program, Saskatoon, Saskatchewan, Canada
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Cacchione PZ. Special Issue: Nursing Research Advancing Cardiac Care. Clin Nurs Res 2020; 28:127-129. [PMID: 30789030 DOI: 10.1177/1054773818822855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Milaniak I, Rużyczka EW, Dębska G, Król B, Wierzbicki K, Tomaszek L, Przybyłowski P. Level of Life Quality in Heart and Kidney Transplant Recipients: A Multicenter Study. Transplant Proc 2020; 52:2081-2086. [PMID: 32471630 DOI: 10.1016/j.transproceed.2020.03.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/04/2020] [Accepted: 03/30/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The main objective of the researchers was to determine the level of life quality among heart and kidney transplant recipients depending on the time and type of the transplant. METHODS The study was conducted using standardized questionnaires: the 36-Item Short-Form Health Survey, Life Orientation Test-Revised, and Hospital Anxiety and Depression Scale. The study included 146 recipients (109 heart transplant recipients and 37 kidney transplant recipients) from 1 to 26 years after the transplantation surgery (mean 9 years). RESULTS The mean age of the study group was 52 years. The mean time since organ transplantation was 10 years for heart transplantation and 4.3 years for kidney transplantation. The study group obtained a slightly lower score for quality of life compared to the general population. In the Physical Component Summary (PCS), the study participants obtained the highest mean for the domain bodily pain (47.6), while the lowest score was in the domain role physical (41.82). As for the Mental Component Summary (MCS), the highest mean was obtained for the domain vitality (50.57), whereas the lowest one was for the domain role emotional (43.38). In 33% of the participants, risk of depression was identified. Statistically significant differences were observed depending on the type of the transplanted organ in the PCS for the domains general health, physical functioning, and bodily pain and the MCS for role emotional and social functioning. The statistically significant predictors for the PCS domain were the type of transplanted organ, recipients' age, and occurrence of anxiety. In turn, the predictor for the MCS was the occurrence of depression. CONCLUSIONS The quality of life (QOL) assessment varies between kidney and heart transplant recipients. The QOL is determined by the recipients' age and the occurrence of anxiety and depression. The obtained QOL assessment results are slightly lower than those in the general population.
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Affiliation(s)
- Irena Milaniak
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland; Department of Cardiovascular and Transplantology, John Paul II Hospital, Krakow, Poland.
| | - Ewa Wilczek Rużyczka
- Faculty of Psychology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Grażyna Dębska
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Bogumiła Król
- Department of Cardiac Surgery, Transplantology, Vascular and Endovascular, Silesian Centre for Heart Diseases in Zabrze, Zabrze, Poland
| | - Karol Wierzbicki
- Department of Cardiovascular and Transplantology, John Paul II Hospital, Krakow, Poland; Collegium Medicum, Jagiellonian University Krakow, Poland
| | - Lucyna Tomaszek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Piotr Przybyłowski
- Department of Cardiac Surgery, Transplantology, Vascular and Endovascular, Silesian Centre for Heart Diseases in Zabrze, Zabrze, Poland; Collegium Medicum, Jagiellonian University Krakow, Poland
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