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Gaudet K, Corbiere M, Chen T, Cardinal H, Achille M. The Strategies Used to Balance Health and Work Across the Solid Organ Transplantation Trajectory. Prog Transplant 2024; 34:32-40. [PMID: 38576412 PMCID: PMC11080381 DOI: 10.1177/15269248241239245] [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] [Indexed: 04/06/2024]
Abstract
Introduction: Workers who undergo solid organ transplantation report frequent conflicts between the unpredictable demands of their health condition and the rigid requirements of their employer and of health services. The present study aimed to describe the self-management strategies adopted by workers while staying at work before transplantation and during sustainable return-to-work posttransplantation. Methods: Fifteen employed kidney, liver, and lung transplant recipients were recruited from 2 large urban university health centers in Montreal, Canada. Three focus groups were held, and thematic analysis was performed. Findings: Seven strategies were identified: responding promptly and consistently to fatigue-related needs, planning ahead with immediate supervisors while remaining strategic about when to disclose transplantation, requesting work accommodations, requesting flexibility in healthcare provision, consulting physicians about work-related issues, informing co-workers about work limitations and immunosuppression and asking not to be treated differently in the workplace. Conclusion: Access to work accommodations, support from physicians and flexibility in treatment and appointment schedules supported workers' ability to manage their health while staying at work before and after undergoing solid organ transplantation. In light of findings, it may be useful for healthcare professionals to address workers' concerns about work limitations and work accommodation implementation, especially when the illness-management burden increases before transplantation and during posttransplantation sick leave. Future studies could describe the strategies used by other important stakeholders when attempting to provide support to workers.
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Affiliation(s)
- Keira Gaudet
- Department of Psychology, Universite de Montreal, Montreal, Quebec, Canada
| | - Marc Corbiere
- Department of Education, Career Counselling, Universite du Quebec a Montreal (UQAM), Montreal, Quebec, Canada
| | - Tianyan Chen
- Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Division of Gastroenterology and Hepatology, McGill University Health Center (MUHC), Montreal, Quebec, Canada
| | - Heloise Cardinal
- Department of Medicine, Universite de Montreal, Montreal, Quebec, Canada
- Department of Nephrology, Centre hospitalier de l'Universite de Montreal (CHUM), Montreal, Quebec, Canada
| | - Marie Achille
- Department of Psychology, Universite de Montreal, Montreal, Quebec, Canada
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Rupp S, Fair C, Korycinski H, Ferris M. "It's What I Have, It's Not Who I Am": A Qualitative Study of Social Support in Education/Employment Settings and Transition Readiness of Young Adults with End-Stage Renal Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126596. [PMID: 34205273 PMCID: PMC8296423 DOI: 10.3390/ijerph18126596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 11/16/2022]
Abstract
This study investigated the role of social support in self-management within education/employment settings for young adults (YA) with end-stage renal disease (ESRD) as well as barriers and facilitators to social support formation. Nineteen YA with ESRD (mean age 24 years, 10 males, 9 African American) recruited from a pediatric nephrology clinic in the Southeast United States completed in-person semi-structured interviews. The grounded theory was used to analyze transcribed interviews to identify emergent themes. Absences hindered participants' school/work attendance and performance. Social support was necessary for illness management and success in academic/vocational settings. Facilitators to establishing support included self-awareness and view of disclosure as a way to access accommodations. Barriers included fear of judgment, job loss, and the belief that the condition was too personal to disclose. Educators and employers must acknowledge the needs of YA with ESRD to promote development and educational/vocational success. Fear of disclosure and poor disease self-management interferes with accessing social support. Communication skills and autonomy in patients' medical and personal lives can promote success in education and employment settings.
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Affiliation(s)
- Sophie Rupp
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA; (S.R.); (H.K.)
| | - Cynthia Fair
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA; (S.R.); (H.K.)
- Correspondence: ; Tel.: +1-336-278-6547
| | - Hannah Korycinski
- Department of Public Health Studies, Elon University, Elon, NC 27244, USA; (S.R.); (H.K.)
| | - Maria Ferris
- UNC Self-Management and Transitions (STARx) Program, UNC-Chapel Hill, Chapel Hill, NC 27599, USA;
- The UNC Pediatric Diagnostic and Complex Care Program, UNC-Chapel Hill, Chapel Hill, NC 27599, USA
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Wong K, Owen-Smith A, Caskey F, MacNeill S, Tomson CR, Dor FJ, Ben-Shlomo Y, Bouacida S, Idowu D, Bailey P. Investigating Ethnic Disparity in Living-Donor Kidney Transplantation in the UK: Patient-Identified Reasons for Non-Donation among Family Members. J Clin Med 2020; 9:E3751. [PMID: 33233422 PMCID: PMC7700269 DOI: 10.3390/jcm9113751] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 12/11/2022] Open
Abstract
There is ethnic inequity in access to living-donor kidney transplants in the UK. This study asked kidney patients from Black, Asian and minority ethnic groups why members of their family were not able to be living kidney donors. Responses were compared with responses from White individuals. This questionnaire-based mixed-methods study included adults transplanted between 1/4/13-31/3/17 at 14 UK hospitals. Participants were asked to indicate why relatives could not donate, selecting all options applicable from: Age; Health; Weight; Location; Financial/Cost; Job; Blood group; No-one to care for them after donation. A box entitled 'Other-please give details' was provided for free-text entries. Multivariable logistic regression was used to analyse the association between the likelihood of selecting each reason for non-donation and the participant's self-reported ethnicity. Qualitative responses were analysed using inductive thematic analysis. In total, 1240 questionnaires were returned (40% response). There was strong evidence that Black, Asian and minority ethnic group individuals were more likely than White people to indicate that family members lived too far away to donate (adjusted odds ratio (aOR) = 3.25, 95% Confidence Interval (CI) 2.30-4.58), were prevented from donating by financial concerns (aOR = 2.95, 95% CI 2.02-4.29), were unable to take time off work (aOR = 1.88, 95% CI 1.18-3.02), were "not the right blood group" (aOR = 1.65, 95% CI 1.35-2.01), or had no-one to care for them post-donation (aOR = 3.73, 95% CI 2.60-5.35). Four qualitative themes were identified from responses from Black, Asian and minority ethnic group participants: 'Burden of disease within the family'; 'Differing religious interpretations'; 'Geographical concerns'; and 'A culture of silence'. Patients perceive barriers to living kidney donation in the UK Black, Asian and minority ethnic population. If confirmed, these could be targeted by interventions to redress the observed ethnic inequity.
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Affiliation(s)
- Katie Wong
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - Amanda Owen-Smith
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
| | - Fergus Caskey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
| | - Stephanie MacNeill
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
| | - Charles R.V. Tomson
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE7 7DN, UK;
| | | | - Yoav Ben-Shlomo
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
| | - Soumeya Bouacida
- Bristol Health Partners’ Chronic Kidney Disease Health Integration Team, Bristol BS1 2NT, UK
| | - Dela Idowu
- Gift of Living Donation (GOLD), London NW10 0NS, UK
| | - Pippa Bailey
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol BS8 2PS, UK; (A.O.-S.); (F.C.); (S.M.); (Y.B.-S.); (P.B.)
- Southmead Hospital, North Bristol NHS Trust, Bristol BS10 5NB, UK
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Employment Status and Associations with Workability, Quality of Life and Mental Health after Kidney Transplantation in Austria. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041254. [PMID: 32075277 PMCID: PMC7068411 DOI: 10.3390/ijerph17041254] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/20/2022]
Abstract
Kidney transplantation (KTx) in end-stage renal disease is associated with a significant increase in quality of life (QoL) and self-perceived health, optimally leading to the maintenance of employment or return to work (RTW) in working-age patients. The aim of this study was to assess individual factors including the QoL and mental health of kidney transplant recipients (KTRs) associated with employment after transplantation. A cross-sectional study including working-age patients with a history of KTx after 2012 was conducted at two Austrian study centers (Vienna and Graz). Brief Symptom Inventory (BSI-18), World Health Organization Quality of Life (WHOQOL-Bref) and Workability Index (WAI) were assessed along with detailed questionnaires on employment status. Out of n = 139 KTRs (43.2 ± 9.07 years; 57.6% male), 72 (51.8%) were employed. Employed patients were more frequently in a partnership (p = 0.018) and had higher education levels (p = 0.01) and QoL scores (<0.001). Unemployed KTRs reported fatigue and mental health issues more often (p < 0.001), and had significantly higher anxiety, depression and somatization scores (BSI-18). In unadjusted logistical regression, workability score (WAS; odds ratio (OR) = 3.39; 95% confidence interval (CI) = 1.97–5.82; p < 0.001), partnership (OR = 5.47; 95% CI 1.43–20.91; p = 0.013) and no psychological counseling after KTx (OR = 0.06; 95% CI = 0.003–0.969; p = 0.048) were independently associated with employment. Self-assessed mental health, workability and QoL were significantly associated with employment status after KTx. Thus, in order to facilitate RTW after KTx in Austria, vocational rehabilitation and RTW programs addressing KTRs should focus on increasing social support and care for their mental health.
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Davis LA, Grogan TM, Cox J, Weng FL. Inter- and Intrapersonal Barriers to Living Donor Kidney Transplant among Black Recipients and Donors. J Racial Ethn Health Disparities 2016; 4:671-679. [PMID: 27519479 DOI: 10.1007/s40615-016-0270-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/15/2016] [Accepted: 07/20/2016] [Indexed: 11/24/2022]
Abstract
CONTEXT End-stage renal disease (ESRD) is more common among Blacks, but Blacks are less likely to receive a live donor kidney transplant (LDKT). OBJECTIVE The objective of this study is to identify barriers and coping mechanisms that Black LDKT recipients and donors experienced while receiving or donating a kidney. DESIGN A qualitative study was conducted using structured interviews. Thematic analysis was used for data interpretation. PARTICIPANTS All 20 participants identified as Black, with two participants identifying themselves as multiracial. The mean age for the 14 recipients was 60, and the average age for the 6 living donors was 47. RESULTS Themes emerging from the data suggest both recipients and donors faced barriers in the LDKT experience. Recipients faced barriers associated with their denial and avoidance of the severity of their ESRD, their desire to maintain the privacy of their health status, and their refusal to approach potential donors. Donors encountered negative responses from others about the donors' desire to donate and the initial refusal of recipients to accept a LDKT offer. Recipients identified faith as a coping mechanism, while donors identified normalization of donation as their method of coping. Various types of social support helped donors and recipients navigate the transplant process. CONCLUSION Black LDKT recipients and donors must overcome barriers prior to receiving or donating a kidney. Most of these barriers arise from communication and interactions with others that are either lacking or undesirable. Future interventions to promote LDKT among Blacks may benefit by specifically targeting these barriers.
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Affiliation(s)
- LaShara A Davis
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ, 07039, USA. .,School of Communication and Information, Rutgers University, 4 Huntington St, New Brunswick, NJ, 08901, USA.
| | - Tracy M Grogan
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ, 07039, USA
| | - Joy Cox
- School of Communication and Information, Rutgers University, 4 Huntington St, New Brunswick, NJ, 08901, USA
| | - Francis L Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ, 07039, USA.,Rutgers School of Public Health, Rutgers University, 683 Hoes Lane West, Piscataway, NJ, 08854, USA
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