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Lieber SR, Baldelli L, Kim HP, Nash RP, Noriega Ramirez A, Magee G, Barritt AS, Evon DM, Singal AG. Active coping, resilience, post-traumatic growth, and psychiatric symptoms among early and late liver transplant survivors. Liver Transpl 2023; 29:290-306. [PMID: 36811878 PMCID: PMC10197865 DOI: 10.1097/lvt.0000000000000009] [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] [Received: 07/08/2022] [Accepted: 10/10/2022] [Indexed: 02/24/2023]
Abstract
Understanding survivorship experiences at different stages postliver transplantation (poat-LT) is essential to improving care. Patient-reported concepts including coping, resilience, post-traumatic growth (PTG), and anxiety/depression, have been implicated as important predictors of quality of life and health behaviors after LT. We aimed to descriptively characterize these concepts at different post-LT survivorship stages. This cross-sectional study featured self-reported surveys measuring sociodemographic, clinical characteristics, and patient-reported concepts including coping, resilience, PTG, anxiety, and depression. Survivorship periods were categorized as early (1 y or below), mid (1-5 y), late (5-10 y), and advanced (10 y or above). Univariable and multivariable logistic and linear regression modeling examined factors associated with patient-reported concepts. Among 191 adult LT survivors, the median survivorship stage was 7.7 years (interquartile range: 3.1-14.4) and median age was 63 years (range: 28-83); most were male (64.2%) and Caucasian (84.0%). High PTG was more prevalent in the early survivorship period (85.0%) than late survivorship (15.2%). High trait resilience was only reported by 33% of survivors and associated with higher income. Lower resilience was seen among patients with longer LT hospitalization stays and late survivorship stages. About 25% of survivors had clinically significant anxiety and depression, which was more frequent among early survivors and females with pre-LT mental health disorders. In multivariable analysis, factors associated with lower active coping included survivors ≥65 years, non-Caucasian race, lower levels of education, and nonviral liver disease. In a heterogeneous cohort including early and late LT survivors, there was variation in levels of PTG, resilience, anxiety, and depression at different survivorship stages. Factors associated with positive psychological traits were identified. Understanding determinants of LT survivorship has important implications for how we should monitor and support LT survivors.
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Affiliation(s)
- Sarah R Lieber
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Luke Baldelli
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Hannah P Kim
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rebekah P Nash
- Department of Psychiatry, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Alvaro Noriega Ramirez
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Gabrielle Magee
- Center for Gastrointestinal Biology and Disease, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Alfred S Barritt
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Donna M Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina (UNC), Chapel Hill, North Carolina, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
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Lieber SR, Kim HP, Baldelli L, Nash R, Teal R, Magee G, Desai CS, Loiselle MM, Lee SC, Singal AG, Marrero JA, Barritt AS, Evon DM. Early Survivorship After Liver Transplantation: A Qualitative Study Identifying Challenges in Recovery From the Patient and Caregiver Perspective. Liver Transpl 2022; 28:422-436. [PMID: 34529886 PMCID: PMC10548343 DOI: 10.1002/lt.26303] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/06/2021] [Accepted: 09/11/2021] [Indexed: 02/04/2023]
Abstract
Survivorship after liver transplantation (LT) is a novel concept providing a holistic view of the arduous recovery experienced after transplantation. We explored components of early survivorship including physical, emotional, and psychological challenges to identify intervention targets for improving the recovery process of LT recipients and caregivers. A total of 20 in-person interviews were conducted among adults 3 to 6 months after LT. Trained qualitative research experts conducted interviews, coded, and analyzed transcripts to identify relevant themes and representative quotes. Early survivorship comprises overcoming (1) physical challenges, with the most challenging experiences involving mobility, driving, dietary modifications, and medication adherence, and (2) emotional and psychological challenges, including new health concerns, financial worries, body image/identity struggles, social isolation, dependency issues, and concerns about never returning to normal. Etiology of liver disease informed survivorship experiences including some patients with hepatocellular carcinoma expressing decisional regret or uncertainty in light of their post-LT experiences. Important topics were identified that framed LT recovery including setting expectations about waitlist experiences, hospital recovery, and ongoing medication requirements. Early survivorship after LT within the first 6 months involves a wide array of physical, emotional, and psychological challenges. Patients and caregivers identified what they wish they had known prior to LT and strategies for recovery, which can inform targeted LT survivorship interventions.
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Affiliation(s)
- Sarah R. Lieber
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern, Dallas, TX
| | - Hannah P. Kim
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Luke Baldelli
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Rebekah Nash
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Randall Teal
- Connected Health Applications and Interventions, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gabrielle Magee
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Chirag S. Desai
- Division of Transplantation, Department of Surgery, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Marci M. Loiselle
- Division of Behavioral Medicine, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - Simon C. Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical, Dallas, TX
| | - Amit G. Singal
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern, Dallas, TX
| | - Jorge A. Marrero
- Division of Digestive and Liver Diseases, Department of Medicine, University of Texas Southwestern, Dallas, TX
| | - A. Sidney Barritt
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Donna M. Evon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
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Lieber SR, Kim HP, Baldelli L, Nash R, Teal R, Magee G, Loiselle MM, Desai CS, Lee SC, Singal AG, Marrero JA, Barritt AS, Evon DM. What Survivorship Means to Liver Transplant Recipients: Qualitative Groundwork for a Survivorship Conceptual Model. Liver Transpl 2021; 27:1454-1467. [PMID: 33942480 PMCID: PMC10576568 DOI: 10.1002/lt.26088] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/05/2021] [Accepted: 04/19/2021] [Indexed: 12/22/2022]
Abstract
Survivorship is a well-established concept in the cancer care continuum with a focus on disease recurrence, quality of life, and the minimization of competing risks for mortality; however, survivorship has not been well studied in liver transplantation (LT). We investigated what survivorship means to LT patients and identified motivations and coping strategies for overcoming challenges after LT. A total of 20 in-depth home interviews were conducted among adults 3 to 6 months after LT. Interviews were conducted by trained qualitative research experts and coded and analyzed using an inductive approach. A majority of LT recipients (75%) identified themselves as survivors. Integral to the definition of survivorship was overcoming hardship (including experiences on the waiting list) and the unique experience of being given a "second chance" at life. Motivations to survive included a new chance at life (55%), family (40%), spirituality/faith (30%), and fear of rejection (15%). LT recipients and caregivers identified multiple strategies to cope with post-LT challenges, including relying on a large network of community, spiritual, and virtual support. These findings informed a conceptual model of LT survivorship based on socioecological theory, which identified the following variables influencing survivorship: (1) pretransplant experiences, (2) individual attributes and challenges, (3) interpersonal relationships with caregivers and other social support, (4) community relationships, and (5) large-scale factors including neighborhood and financial issues. LT recipients identified themselves as survivors, and post-LT identities were greatly influenced by pre-LT experiences. These perspectives informed an in-depth conceptual model of survivorship after transplantation. We identified sources of motivation and coping strategies used in LT recovery that could be targets of survivorship interventions aimed at improving post-LT outcomes.
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Affiliation(s)
- Sarah R. Lieber
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Dallas, TX, United States
| | - Hannah P. Kim
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC, United States
| | - Luke Baldelli
- Department of Medicine, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC, United States
| | - Rebekah Nash
- Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Randall Teal
- Connected Health Applications and Interventions (CHAI-Core), Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Gabrielle Magee
- Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Marci M. Loiselle
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine, Duke University Medical Center, Durham, NC, United States
| | - Chirag S. Desai
- Department of Surgery, Division of Transplantation, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Simon C. Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Dallas, TX, United States
| | - Amit G. Singal
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Dallas, TX, United States
| | - Jorge A. Marrero
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Dallas, TX, United States
| | - A. Sidney Barritt
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC, United States
| | - Donna M. Evon
- Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina (UNC) School of Medicine, Chapel Hill, NC, United States
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Swanson A, Geller J, DeMartini K, Fernandez A, Fehon D. Active Coping and Perceived Social Support Mediate the Relationship Between Physical Health and Resilience in Liver Transplant Candidates. J Clin Psychol Med Settings 2019; 25:485-496. [PMID: 29546621 DOI: 10.1007/s10880-018-9559-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Without a transplant, end-stage liver disease is associated with significant morbidity and mortality. Transplant candidates endure physical and psychological stress while awaiting surgery, yet little is known about the relationship between physical health and psychological resilience during the wait-list period. This study examined predictors of psychological resilience and mediators of the relationship between physical health and psychological resilience in liver transplant candidates. Wait-listed candidates (N = 120) from a single Northeast transplant center completed assessments of physical functioning, coping, perceived social support, and resilience. Findings revealed that physical functioning, active coping, and perceived social support were positively associated with resilience; maladaptive coping was negatively associated with resilience. Perceived social support and active coping partially mediated the relationship between physical functioning and resilience. Transplant center care providers should promote active coping skills and reinforce the importance of effective social support networks. These interventions could increase psychological resilience among liver transplant candidates.
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Affiliation(s)
- Amelia Swanson
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
| | - Jessica Geller
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Department of Veterans Affairs, Denver-Seattle Center of Innovation, Aurora, CO, USA
| | - Kelly DeMartini
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Smilow Cancer Hospital at Yale-New Haven, New Haven, CT, USA.,Yale-New Haven Transplantation Center, New Haven, CT, USA
| | - Anne Fernandez
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Dwain Fehon
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.,Smilow Cancer Hospital at Yale-New Haven, New Haven, CT, USA.,Yale-New Haven Transplantation Center, New Haven, CT, USA
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Psychological profile and disease-coping strategies of patients on the waiting list for liver transplantation. Cir Esp 2019; 97:320-328. [PMID: 30948212 DOI: 10.1016/j.ciresp.2019.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 11/23/2022]
Abstract
AIM To determine the psychological characteristics of patients on the liver transplant waiting list; to analye the implications of the patient's psychological profile on coping with the disease. MATERIAL AND METHODS Study population: patients on the liver transplant waiting list. Psychological-profile: Socio-personal history; Mini Mental State Examination; Brief-Symptom Inventory of psychopathological problems; International Neuropsychiatric Interview; Family APGAR questionnaire; Social Support Questionnaire. Coping with the disease: A questionnaire about mental adaptation to the disease. Patients were recruited for the study at the time when they were included on the waiting list. RESULTS The patients (n=112) had the following characteristics: 68% of the patients had symptoms of emotional psychopathology, with 48% being of a depressive, anxious and obsessive-compulsive type, respectively. In terms of social and family support, 27% had the perception of being in a dysfunctional family (slight-23%; serious-4%). What is more, according to the Global Support Index, 21% had non-functional social and family support. Coping with the disease: 8% were well-adapted to the disease, the remaining 92% were poorly adapted; of which, 79% had a weaker fighting spirit, 51% expressed anxiety and concern about coping with the disease, 34% found they resorted to fatalism, 29% were in denial and 27% felt helpless. CONCLUSIONS Once liver patients are included on the transplant waiting list, they poorly adapt to the disease, with important emotional implications that result in psychological alterations.
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Oral health-related quality of life depending on dental and periodontal health in different patients before and after liver transplantation. Clin Oral Investig 2017; 22:2039-2045. [DOI: 10.1007/s00784-017-2298-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 12/06/2017] [Indexed: 12/12/2022]
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Amoyal N, Fernandez AC, Ng R, Fehon DC. Measuring Coping Behavior in Liver Transplant Candidates: A Psychometric Analysis of the Brief COPE. Prog Transplant 2016; 26:277-85. [PMID: 27358343 DOI: 10.1177/1526924816655253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Liver transplant candidates must cope with significant physiological and psychological challenges. The Brief COPE is a frequently used measure of coping behavior; however, knowledge of the scale's factor structure and construct validity is limited with regard to liver transplant candidates. This study assessed the validity of the Brief COPE in 120 liver transplant candidates using exploratory factor analysis. Results revealed a 6-factor solution, only 2 of which were consistent with the original scale assignments. Construct validity of the 6 Brief COPE scales yielded in this study was demonstrated. The results indicate that the Brief COPE is valid, reliable, and can be meaningfully interpreted in liver transplant patients. Future research should confirm this factor structure and examine its predictive validity prior to widespread use among liver transplant patients. Suggestions are presented for enhancing the care of transplant candidates by promoting the use of adaptive coping mechanisms to manage distress.
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Affiliation(s)
- Nicole Amoyal
- Division of General Internal Medicine, University of Colorado Anschutz Medical Center, Boulder, CO, USA
| | - Anne C Fernandez
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Reuben Ng
- Nanyang Technological University & National University of Singapore, Singapore
| | - Dwain C Fehon
- Yale School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA
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Denny B, Kienhuis M, Gavidia-Payne S. Explaining the quality of life of organ transplant patients by using crisis theory. Prog Transplant 2015; 25:324-31. [PMID: 26645927 DOI: 10.7182/pit2015904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Ubiquitous findings regarding the quality of life (QOL) of transplant patients have yet to be explained from a theoretical perspective. OBJECTIVE To investigate transplant patients' QOL by using the conceptual framework of crisis theory. DESIGN Cross-sectional study to explore differences in transplant patients' experiences of stress, coping, and QOL. Regression analysis was used to test crisis theory in relation to QOL, stress, and coping. PARTICIPANTS A total of 226 participants representing transplant candidates, transplant recipients, and nontransplant individuals participated via survey-based data collection. RESULTS Results showed that transplant candidates experience lower QOL than transplant recipients and nontransplant individuals. No significant differences were detected regarding stress levels or coping styles. Stress made a significant contribution to patients' QOL. CONCLUSIONS Current findings suggest important QOL benefits of organ transplant. Using a theoretical model is an effective way to investigate the QOL of people experiencing chronic illness such as end-stage organ failure. Further investigation is required to reach a conclusive understanding of the complex interaction between transplant patients' QOL, stress, and coping.
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Mohamed S, Sabki ZA, Zainal NZ. Depression and psychosocial correlates of liver transplant candidates: a systematic review. Asia Pac Psychiatry 2014; 6:447-53. [PMID: 25132651 DOI: 10.1111/appy.12145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 06/09/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Liver transplant candidates are vulnerable to develop depression. This paper aims to ascertain the prevalence of depression in liver transplant candidates and its psychosocial factors in a systematic review. METHODS An extensive review via electronic databases (PubMed, EMBASE, CINAHL) and hand search were carried out to retrieve published articles up to December 15, 2013, using (Incidence OR Prevalence) AND Depress* AND liver transplant as the keywords. Information on the study design, patient characteristics, prevalence of depression, and its associated risk factors were extracted from included studies. RESULTS There were 22 studies included in this review with a total of 3055 patients. The prevalence of depression in the liver transplant candidates ranges between 2% and 80%. Studies that used diagnostic tools found a narrower range of prevalence (4.5-43%) as compared to the self-administered questionnaires (2-80%). Studies that used Beck Depression Inventory reported a higher prevalence than those studies which used Hospital Anxiety and Depression Scale (median = 28%, range = 2-80% versus median 17%, range 6.1-25.8%). A number of socio-demographic factors, illness-related and psychosocial factors were found to be associated with depression. CONCLUSION Prevalence of depression in liver transplant candidates is high, and early detection will improve survival and quality of life.
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Affiliation(s)
- Salina Mohamed
- Department of Psychological and Behavioural Medicine, Faculty of Medicine, University of Technology MARA (UITM), Batu Caves, Selangor, Malaysia
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Yagil D, Cohen M, Beer JD. Older Adults' Coping With the Stress Involved in the Use of Everyday Technologies. J Appl Gerontol 2013; 35:131-49. [PMID: 24652919 DOI: 10.1177/0733464813515089] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 11/04/2013] [Indexed: 11/17/2022] Open
Abstract
PURPOSE This study was conducted to examine the frequency of reported use of everyday technologies (EDT) and its associations with self-efficacy, stress appraisal, and coping strategies. DESIGN AND METHODS Cross-sectional data were collected from 150 participants (aged ≥ 65 years), measuring use of EDT by means of self-report questionnaires and a computerized simulator of an automatic teller machine (ATM), and EDT-related self-efficacy, stress appraisal, and coping strategies questionnaires. RESULTS Structured equation modeling analysis showed that EDT-related self-efficacy was related to higher use of EDT, through the mediation of EDT-related stress and coping strategies. Logistic regression showed that use of ATM simulator was predicted by self-efficacy, younger age, and female gender. IMPLICATIONS Enhancing EDT-self efficacy is suggested to increase the use of EDT among elder adults. The use of simulators may be an efficient mean to promote EDT self-efficacy and use.
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Weng LC, Huang HL, Wang YW, Lee WC, Chen KH, Yang TY. The effect of self-efficacy, depression and symptom distress on employment status and leisure activities of liver transplant recipients. J Adv Nurs 2013; 70:1573-83. [PMID: 24237349 DOI: 10.1111/jan.12315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2013] [Indexed: 01/01/2023]
Abstract
AIM To examine the effect of self-efficacy, subjective work ability, depression and symptom distress on and to provide a description of, the employment and leisure activities of liver transplant recipients. BACKGROUND Return to work and leisure activities have become an important aspect of life for liver transplant recipients worldwide. An investigation of the factors that influence the employment status and leisure activities has been recommended as a means to help transplant recipients restore their productivity. DESIGN This was a cross-sectional, descriptive and correlational study in 2010. METHODS A convenience sampling method was used. Data were collected using a set of questionnaires that were administered retrospectively. A total of 106 liver transplant patients were included in this study. RESULTS The post-transplantation employment rate was 45.2%. The positive predictors of employment were higher subjective work ability and higher symptom distress. Gender (female), monthly family income (<US $2,000), depression and unemployment pre-transplantation were negatively associated with employment status. Of the 106 patients, 62 (58.5%) were in the low-diversity group (score of less than 3) of leisure activities. Monthly family income of <US $2,000 was associated with a low diversity of participation in leisure activities. CONCLUSION Subjective work ability and symptom distress were positive predictors of employment, while depression was a negative predictor. Nurses in the transplant team should focus on increasing a sense of confidence, decreasing depressive symptoms and monitoring the severity of symptoms to improve the employment status of liver transplant recipients.
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Affiliation(s)
- Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Denny B, Kienhuis M. Using Crisis Theory to Explain the Quality of Life of Organ Transplant Patients. Prog Transplant 2011; 21:182-8; quiz 189. [DOI: 10.1177/152692481102100302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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