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Teh L, Henderson D, Hage C, Chernyak Y. Interitem Psychometric Validation of the Stanford Integrated Assessment for Transplant Scale Among Thoracic Transplant Candidates. J Acad Consult Liaison Psychiatry 2023; 64:418-428. [PMID: 36521680 DOI: 10.1016/j.jaclp.2022.12.004] [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: 04/14/2022] [Revised: 10/14/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Psychosocial evaluations are mandatory for transplant listing, however the methodology for creating psychosocial risk stratifications is unclear. The Standford Psychosocial Integrated Psychosocial Assessment for Transplant Scale is the most commonly used instrument, however its interitem validity has never been examined. OBJECTIVE To investigate the interitem validity of a psychosocial assessment tool for transplant candidates among a sample of thoracic transplant candidates. METHODS Clinic data consisting of Stanford Integrated Psychosocial Assessment for Transplant administrations from 173 heart and lung transplant candidates were fit to a partial credit model. Data were subsequently fit to 4 separate partial credit models based on subscale categories, demonstrating the discrimination parameter estimate of each item. Differential item functioning analyses were conducted on the data within each subscale by sex to investigate potential bias produced by each item. RESULTS The initial partial credit model using the full scale did not converge, indicating the subscales possibly did not measure the same underlying construct. Subscale discrimination parameter estimates demonstrated that most items were adequately or highly discriminative. The item measuring history of substance use demonstrated poor fit and differential item functioning. CONCLUSIONS While the Stanford Integrated Psychosocial Assessment for Transplant has demonstrated strong potential as a standardized framework for psychosocial assessments in transplant, this study identified some areas for improvement in the scoring system. The subscale scores appeared to show greater construct validity when utilized individually than when aggregated to form a total score. The substance use/abuse/dependence item did not fit well into its respective subscale. Future studies should aim to optimize the scoring system and re-asses its construct validity to improve its accuracy in discriminating between high-risk candidates and those needing psychosocial assistance.
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Affiliation(s)
- Lisa Teh
- Montefiore Medical Center, Department of Psychiatry and Behavioral Sciences, Bronx, NY; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN.
| | - Danielle Henderson
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Chadi Hage
- Department of Pulmonology, Allergy, and Critical Care, Indiana University, Indianapolis, IN
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
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Hand BN, Hyer JM, Schenk A, Coyne A, Gilmore D, Wang L, Ejaz A. Comparing Kidney Transplant Rates and Outcomes Among Adults With and Without Intellectual and Developmental Disabilities. JAMA Surg 2023; 158:386-392. [PMID: 36790769 PMCID: PMC9932938 DOI: 10.1001/jamasurg.2022.7753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Importance Improving equity in organ transplant access for people with intellectual and developmental disabilities (IDD) is a topic of social discourse in mainstream media, state legislation, and national legislation. However, few studies have compared evaluation rates, transplant rates, and outcomes among adults with and without IDD. Objective To compare rates of kidney transplant and transplant-specific outcomes between propensity-score matched groups of adults with end-stage kidney disease (ESKD [also referred to as end-stage renal disease (ESRD)]) with and without co-occurring IDD. Design, Setting, and Participants This retrospective cohort study included all Medicare inpatient and outpatient standard analytical files from 2013 through 2020. A total of 1 413 655 adult Medicare beneficiaries with ESKD were identified. Propensity-score matching was used to balance cohorts based on age, sex, race, follow-up duration, and Charlson Comorbidity Index. The matched cohorts consisted of 21 384 adults with ESKD (10 692 of whom had IDD) and 1258 kidney transplant recipients (629 of whom had IDD). Data were analyzed between June 1, 2022, and August 1, 2022. Exposure IDD. Main Outcomes and Measures Evaluation for kidney transplant, receipt of kidney transplant, perioperative complications, readmission, mortality, graft rejection, and graft failure. Results Of the 21 384 propensity-score matched adults with ESKD, the median (IQR) age was 55 (43-65) years, 39.2% were male, 27.4% were Black, 64.1% were White, and 8.5% identified as another race or ethnicity. After propensity score matching within the ESKD cohort, 633 patients with IDD (5.9%) received a kidney transplant compared with 1367 of adults without IDD (12.8%). Adults with IDD were 54% less likely than matched peers without IDD to be evaluated for transplant (odds ratio, 0.46; 95% CI, 0.43-0.50) and 62% less likely to receive a kidney transplant (odds ratio, 0.38; 95% CI, 0.34-0.42). Among matched cohorts of kidney transplant recipients, rates of perioperative complications, readmission, and graft failure were similar for adults with and without IDD. Conclusions and Relevance Using the largest cohort of adult kidney transplant recipients with IDD to date, the study team found that rates of evaluation and transplant were lower despite yielding equivalent outcomes. These data support consideration of adults with IDD for kidney transplant and underscore the urgent need for antidiscrimination initiatives to promote the receipt of equitable care for this population.
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Affiliation(s)
- Brittany N. Hand
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - J. Madison Hyer
- Center for Biostatistics, The Ohio State University, Columbus
| | - Austin Schenk
- Department of Surgery, The Ohio State University, Columbus
| | - Alex Coyne
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Daniel Gilmore
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus
| | - Lauren Wang
- Timothy Freeman Center for Intellectual and Developmental Disabilities, University of Cincinnati, Cincinnati, Ohio
| | - Aslam Ejaz
- Department of Surgery, The Ohio State University, Columbus
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The art of lung transplantation—lessons learnt from one thousand lung transplants. Indian J Thorac Cardiovasc Surg 2022; 38:207-208. [DOI: 10.1007/s12055-021-01314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022] Open
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Sandal S, Chen T, Cantarovich M. Evaluation of Transplant Candidates With a History of Nonadherence: An Opinion Piece. Can J Kidney Health Dis 2021; 8:2054358121990137. [PMID: 33598301 PMCID: PMC7863559 DOI: 10.1177/2054358121990137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/03/2021] [Indexed: 12/18/2022] Open
Affiliation(s)
- Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Tianyan Chen
- Division of Hepatology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Pennington KM, Benzo RP, Schneekloth TD, Budev M, Chandrashekaran S, Erasmus DB, Lease ED, Levine DJ, Thompson K, Stevens E, Novotny PJ, Kennedy CC. Impact of Affect on Lung Transplant Candidate Outcomes. Prog Transplant 2019; 30:13-21. [PMID: 31838950 DOI: 10.1177/1526924819892921] [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] [Indexed: 01/06/2023]
Abstract
BACKGROUND We examined the association of adult lung transplant candidates' self-reported affect with transplant-related outcomes, evaluating whether a positive (vs negative) frame of mind might be protective. METHOD Consenting waitlisted candidates from 6 centers completed the questionnaires including the Positive and Negative Affect Schedule annually and posttransplant. Univariate logistic regression analysis was performed to determine the association of baseline affect with outcomes of death or delisting. Models were subsequently adjusted for age, marital status, and education. RESULTS Questionnaires were completed by 169 candidates (77.9% participation). Mean positive affect, negative affect, and positive-to-negative affect ratio (positivity ratio) were similar to expected norms. The scores of the questionnaire did not change significantly over time. Fifteen (8.9%) waitlisted participants died. Candidates who died while waiting had lower positivity ratios compared to those who survived (1.82 vs 2.45; P = .02). A more negative affect was associated with increased death on the waiting list (adjusted odds ratio [OR] 1.10; P = .021). Conversely, a higher positivity ratio was associated with decreased death while waiting (adjusted OR: 0.45; P = .027). CONCLUSION Negative affect may represent a novel risk factor for death on the waitlist. Enhancing positive affect may represent a useful target for psychological optimization in lung transplant candidates.
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Affiliation(s)
- Kelly M Pennington
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic Rochester, MN, USA
| | - Roberto P Benzo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - Terry D Schneekloth
- Department of Psychiatry and Psychology, Mayo Clinic Rochester, MN, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic Rochester, MN, USA
| | - Marie Budev
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cleveland Clinic Foundation Cleveland, OH, USA
| | - Satish Chandrashekaran
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - David B Erasmus
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Jacksonville, FL, USA
| | - Erika D Lease
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington Seattle, WA, USA
| | - Deborah J Levine
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Texas Health Sciences Center San Antonio, TX, USA
| | - Karin Thompson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - Elizabeth Stevens
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA
| | - Paul J Novotny
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Cassie C Kennedy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic Rochester, MN, USA.,William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic Rochester, MN, USA
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Hong S, Rybicki L, Corrigan D, Dabney J, Hamilton BK, Kalaycio M, Lawrence C, McLellan L, Sobecks R, Lee SJ, Majhail NS. Psychosocial Assessment of Candidates for Transplant (PACT) as a tool for psychological and social evaluation of allogeneic hematopoietic cell transplantation recipients. Bone Marrow Transplant 2019; 54:1443-1452. [PMID: 30696998 PMCID: PMC6663643 DOI: 10.1038/s41409-019-0455-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/29/2018] [Accepted: 01/07/2019] [Indexed: 01/22/2023]
Abstract
Psychosocial Assessment of Candidates for Transplant (PACT) is a tool originally developed to address psychosocial risks in solid organ transplant recipients and has the potential for application to hematopoietic cell transplantation (HCT) recipients. In a retrospective cohort study, we reviewed 404 adult allogeneic HCT cases from 2003 to 2014 to identify predictors of adverse psychosocial status as determined by PACT. Final PACT rating was poor/borderline (score 0-1) in 5%, acceptable (score 2) in 22%, good (score 3) in 44%, and excellent (score 4) in 29% recipients. In multivariable regression, higher PACT score was associated with White race (odds ratio [OR] 2.95, P < 0.001), having a related donor (OR 1.61, P = 0.015), and a higher quality of life score (OR 1.22/ 10-point increase in FACT-BMT total score, P < 0.001). PACT score correlated with all quality of life subscales. The final PACT score was associated with non-relapse mortality (HR 0.82/ 1-point increase, p = 0.03) in multivariable analysis that considered patient and disease factors, but not in models that also included transplant-related factors and performance status. PACT score was not associated with overall survival. PACT can be considered as part of a comprehensive psychosocial assessment for identifying patients who may require additional resources around allogeneic HCT.
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Affiliation(s)
- Sanghee Hong
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | - Lisa Rybicki
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Donna Corrigan
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jane Dabney
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Betty K Hamilton
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Matt Kalaycio
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Christine Lawrence
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Linda McLellan
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ronald Sobecks
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Navneet S Majhail
- Blood & Marrow Transplant Program, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, OH, USA
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