Caregivers of lung transplant candidates: do they benefit when the patient is receiving psychological services?

Non-pharmacological interventions engaging organ transplant caregivers: A systematic review

Lay-caregivers in organ transplantation (to candidates, recipients, and donors) are essential to pre- and post-operative care, but report significant caregiving-related stressors. This review aims to summarize studies testing non-pharmacological interventions aimed at improving organ transplant caregiver-reported outcomes.

METHODS

In accordance with PRISMA, we conducted a systematic review (searched PubMed, Embase, Cochrane Central, PsycInfo, and CINAHL, no start-date restriction through 7/1/2021). Quality of comparative studies assessed by ROBS-2 or ROBINS.

RESULTS

Twelve studies met inclusion. Study designs, interventions, and outcomes varied. Sample sizes were small across caregivers to adult (nine studies, five with caregiver samples ns≤50) and pediatric patients (three studies, caregiver samples ns≤16). Study designs included seven single-arm interventions, two pre-post with comparison cohorts, and three randomized-controlled trials. Eight studies included transplant-specific education as the intervention, an interventional component, or as the comparison group. Outcomes included transplant specific knowledge, mental health, and intervention acceptability. Of the nine pre-post caregiver assessments and/or comparison groups, four studies demonstrated no statistically significant intervention effects.

CONCLUSION

Few interventions addressing the needs of organ transplant caregivers have been empirically evaluated. Existing interventions were well-received by caregivers. Given complexities of care in transplantation, research is needed evaluating interventions using rigorous trial methodology with adequate samples. This article is protected by copyright. All rights reserved.

Positive Psychotherapy to Improve Autonomic Function and Mood in ICD Patients (PAM-ICD): Rationale and Design of an RCT Currently Underway

BACKGROUND

Improving mental and physical health of patients with implantable cardioverter defibrillators (ICD) is critical because this group is at high risk for ventricular arrhythmias and sudden death and depressed or anxious cardiovascular disease (CVD) patients appear to be at even higher risk for mortality compared to nondepressed or nonanxious CVD patients. Further, autonomic dysfunction is present in these patients, and negative emotions and arrhythmias form a downward spiral further worsening mood, well-being, and cardiovascular health. Much research demonstrates that positive emotion is related to health benefits, improved physiology, and increased survival.

METHODS AND RESULTS

This is a two-arm randomized controlled trial aiming to recruit 60 adult ICD patients comparing 12 individually delivered, weekly sessions of: (1) a positive emotion-focused cognitive-behavioral therapy (Quality of Life Therapy [QOLT]), and (2) Heart Healthy Education. Autonomic functioning, heart rhythm indices, and psychosocial health are measured at baseline, 3 months, and 9 months. The first goal is feasibility and acceptability, with the primary outcome being arrhythmic event frequency data.

CONCLUSION

This study is designed to test whether QOLT produces changes in mood, quality of life/well-being, autonomic function, and arrhythmic and ICD therapy event rates. This feasibility trial is a foundational step for the next trial of QOLT to help determine whether a 3-month QOLT trial can reduce arrhythmias occurrences among ICD patients, and examine a mechanism of autonomic functioning. This study may help to develop and implement new medical or psychological therapies for ICD patients.

Psychosocial issues facing lung transplant candidates, recipients and family caregivers

Although lung transplantation is an accepted treatment for many individuals with severe lung disease, transplant candidates and recipients experience a range of psychosocial stressors that begin at the initiation of the transplant evaluation and continue throughout patients' wait for donor lungs, their perioperative recovery, and their long-term adjustment to posttransplant life. Transplant programs should strive to incorporate evidence-based interventions that aim to improve physical functioning, psychological distress, global quality of life, and medical adherence as well as to integrate symptom management and palliative care strategies throughout the pre- and posttransplantation course.

Quality of life and psychosocial functioning of spouse/partner caregivers before and after liver transplantation

Spouse/partner caregivers of liver transplant (LTx) patients play an important role both before and after transplantation. However, very little research has examined the quality of life (QOL), caregiving strain, and psychological functioning of these caregivers. In this study, we examined these outcomes and their correlates in 86 (49 pre-LTx, 38 post-LTx) spouse/partner caregivers. The physical QOL of caregivers was not impaired, and numerous caregiving benefits were identified (e.g., realizing what is important in life, discovering one's own inner strength, giving emotional support to the patient). However, a relatively high proportion of both pre-LTx and post-LTx caregivers had clinically low mental QOL (29% and 35%, respectively), low life satisfaction (45% and 32%, respectively), and high caregiving strain (59% and 81%, respectively). Both pre- and post-LTx caregivers, particularly women, had more total mood disturbance than a normative sample. Higher caregiving strain was significantly correlated with lower mental QOL, lower life satisfaction, and more mood disturbance. Overall, findings suggest that caregiving strain is prominent through the LTx spectrum. There is a need for prospective research to identify the patterns of caregiver outcomes over time and to examine the benefits of clinical interventions for caregivers.

A psychological intervention to improve quality of life and reduce psychological distress in adults awaiting kidney transplantation

BACKGROUND

Adults with end-stage renal disease who are awaiting kidney transplantation are at risk for low quality of life, high psychological disturbance and relationship distress. Effective psychological interventions to improve functioning in these areas are lacking.

METHODS

Sixty-two adults approved for kidney transplantation at one centre in the USA were randomized to quality of life therapy (QOLT), supportive therapy (ST) or standard care (SC) with repeated assessments of quality of life, psychological distress, and social intimacy at pre-intervention (T1), 1 week post-intervention (T2) and 12-week follow-up (T3).

RESULTS

QOLT patients had higher quality of life scores than ST and SC patients at T2 and T3, and higher social intimacy scores compared with SC patients at T3. Both QOLT and ST patients had lower psychological distress scores compared with SC patients at T2, although only QOLT continued to show reductions in psychological distress scores relative to SC patients at T3.

CONCLUSIONS

The findings show that it is possible to improve quality of life, psychological functioning and social intimacy with QOLT while patients await kidney transplantation. Study limitations include small sample size, single-centre study and possible patient self-selection biases. Future research will examine whether QOLT effectiveness is affected by treatment modality (face-to-face vs. telephone) and timing (pre- vs. post-transplantation).

The influence of clinical variables on the psychological adaptation of adolescents after solid organ transplantation

This study assessed the influence of clinical and socio-demographic variables on the psychological adaptation of transplanted adolescents. Twenty-six transplanted adolescents and 25 healthy adolescents, aged 13-17, and their parents participated in the study. The following domains were measured: social competence, emotional/behavioral problems, self-concept, self-esteem and subjective well-being. The findings revealed that transplanted boys presented significantly less social competence (U = 26,000, p < .05) and more externalizing problems (U = 25,000, p < .05), social problems (U = 25,000, p < .05) and attention problems (U = 17,500, p < .01) than healthy boys. In contrast, transplanted girls displayed significantly more internalizing problems (U = 47,000, p < .05) and lower physical self-concept (U = 49,500, p < .05) than healthy girls. Hierarchical regression analysis showed clinical variables, especially waiting-list time, significantly predicted attention problems (beta = .364, p < .05) and negative affect (beta = .632, p < .05) in transplanted adolescents. Also, male (beta = -0.554, p < .01) and younger (beta = -0.444, p < .01) transplanted adolescents were at risk for attention problems. Our data suggest the importance of the waiting-list time for transplanted adolescents. Efforts to reduce the pretransplant phase would help adolescents achieve better psychological adaptation at long-term posttransplant.