[Psychosomatic medicine as a scientific approach for the 21st century]

[Living donor liver transplantation from the perspective of the donor: results of a psychosomatic investigation]

OBJECTIVES

Living donor liver transplantation (LDLT) has been gaining importance in the treatment of endstage liver disease in adults. Thus far, only few empirical studies have been published on the psychosocial situation of donors who are faced with the risk of medical complications after resection of the right hepatic lobe. The aims were to describe the clinical problems before and after transplantation and to contribute to the discussion of ethical issues based on empirical findings.

METHODS

In the present overview, the pre-/post-transplant and follow-up periods are characterized from a psychosocial point of view using actual psychosocial and medical findings in living donors of the right hepatic lobe.

RESULTS

Before LDLT, 11 % of potential donors were not recommended for the transplantation due to marked ambivalence about the operation. After donation 26 % of donors showed high values for anxious depression and physical complaints despite low rates of surgical complications.

CONCLUSIONS

For clinical psychosomatic evaluations of potential donors it is important to provide donors an opportunity to report any misgivings and anxieties as openly as possible. The psychosocial impairment and physical complaints of some donors after transplantation are yet not clearly understood. More psychosocial studies in this field will be necessary to investigate ethical questions and to develop criteria for an evidence-based medical care of living donors.

[Illness perceptions of patients suffering from acute leukaemia one week after diagnosis]

OBJECTIVES

To investigate illness perceptions, treatment expectations, and treatment experiences of patients suffering from acute leukaemia in the initial stage of their disease.

METHODS

In the first week of treatment we interviewed twelve patients with acute leukaemia using a detailed semi-structured interview guide. To investigate the transcribed interviews we applied methods of qualitative research. Case analyses were assigned to interindividual comparison tables representing the following subject areas: complaints, diagnostics, causes, controllability, treatment experiences, and prognosis. This allowed us to describe similarities and contrasts.

RESULTS

Dramatic narrations of overwhelming threat in younger patients are in contrast to downplaying, rationalizing, and factual descriptions especially in elderly patients. Feelings of helplessness and efforts of normalization become apparent. Experiences of visible and sensible physical injury are perceived as threatening. Prognosis is estimated as too positive. Mortal fears are only indirectly indicated.

CONCLUSIONS

Our results have practical consequences for both patient education and psycho-oncological training.