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van Buren MC, Beck DK, Lely AT, van de Wetering J, Massey EK. EXPloring attitudes and factors influencing reproductive Choices in kidney Transplant patients (The EXPECT-study). Clin Transplant 2021; 35:e14473. [PMID: 34453355 PMCID: PMC9285546 DOI: 10.1111/ctr.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022]
Abstract
Pregnancy can have risks after kidney transplantation (KT). This mixed‐methods study aimed to identify the percentage of women getting pregnant after KT and explore motives for and against pregnancy together with psychosocial and medical factors involved in decision making. Furthermore, experiences of pregnancy and child‐raising were explored. Women who got pregnant after KT were matched with women who had not been pregnant after KT. Semi‐structured interviews were conducted, transcribed verbatim and analyzed using directed content analysis. After KT, only 12% of women got pregnant. Eight women with pregnancies after KT were included (P‐group) and matched with 12 women who had not been pregnant after KT (NP‐group). Women after KT experienced a high threshold to discuss their pregnancy wish with their nephrologist. The nephrologists’ advice played an important role in decision‐making, but differed between the groups. In the P‐group, a desire for autonomy and positive role models were decisive factors in proceeding with their pregnancy wish. In the NP‐group, disease burden and risk perception were decisive factors in not proceeding with their pregnancy. Nephrologists need to be proactive in broaching this subject and aware of factors influencing the decision and outcomes. Standardized preconception guidelines on pregnancy counseling are recommended.
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Affiliation(s)
- Marleen C van Buren
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands
| | - Denise K Beck
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands
| | - A Titia Lely
- Department of Obstetrics, Wilhelmina Children's Hospital Birth Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacqueline van de Wetering
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands
| | - Emma K Massey
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Center, Rotterdam, The Netherlands
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Been-Dahmen JMJ, Beck DK, Peeters MAC, van der Stege H, Tielen M, van Buren MC, Ista E, van Staa A, Massey EK. Evaluating the feasibility of a nurse-led self-management support intervention for kidney transplant recipients: a pilot study. BMC Nephrol 2019; 20:143. [PMID: 31029107 PMCID: PMC6486974 DOI: 10.1186/s12882-019-1300-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 03/18/2019] [Indexed: 12/14/2022] Open
Abstract
Background To support effective self-management after kidney transplantation, a holistic nurse-led self-management support intervention was developed using the Intervention Mapping approach. The primary aim was to evaluate the feasibility, acceptability and fidelity of the intervention for kidney transplant recipients and professionals. The secondary aim was to explore preliminary effects on outcomes. Methods A pilot study was conducted in 2015–2017 to evaluate the intervention. Nurse Practitioners (NP) guided recipients in assessing 14 life areas using the Self-Management Web. Participants were supported in developing self-regulation skills which can be applied to self-management of the illness. Strategies included goal setting, action planning, and promotion of motivation and self-efficacy. Adult recipients from an outpatient clinic of a Dutch University Hospital who underwent their transplant at least 1 month ago, were invited to participate. NPs, nephrologists and recipients were interviewed to assess feasibility, fidelity and implementation experience. Consultations were videoed and analysed to assess fidelity. To assess the preliminary effects, the intervention group completed baseline (T0) and follow-up (T1) questionnaires on self-management behavior, self-efficacy, quality of life and quality of care. A historical control group of kidney transplant recipients completed the same questionnaires at T1. Results Twenty-seven recipients agreed to participate in the intervention group, of which 24 completed the intervention and 16 completed baseline and follow-up surveys. The control group consisted of 33 recipients. Professionals and recipients appraised the open, holistic focus of the intervention as a welcome addition to standard care and felt that this helped to build a relationship of trust. Recipients also felt they became more competent in problem-solving skills. The within-group analysis showed no significant increase in patients’ self-management skills. The between-groups analysis showed significantly higher medication adherence among the intervention group (P = 0.03; G = 0.81). The within-groups analysis showed a significantly higher perceived quality of care (P = 0.02) in the intervention group. Conclusion This holistic nurse-led self-management support intervention was found to be feasible and acceptable by professionals and recipients alike. This pilot had a small sample therefore further research is needed into the potential effects on self-management behavior and well-being of transplant recipients. ISRCTN Trial Registry: ISRCTN15057632 (registered retrospectively on 20-07-2018). Electronic supplementary material The online version of this article (10.1186/s12882-019-1300-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Janet M J Been-Dahmen
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Denise K Beck
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Mariëlle A C Peeters
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, the Netherlands
| | - Heleen van der Stege
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands
| | - Mirjam Tielen
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Marleen C van Buren
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands
| | - Erwin Ista
- Department of Internal Medicine - Section Nursing Science, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands.,Intensive Care Unit, Erasmus MC University Medical Center-Sophia Children's Hospital, P.O. Box 2060, 3000, Rotterdam, DR, the Netherlands
| | - AnneLoes van Staa
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, P.O. Box 25035, 3001, Rotterdam, HA, the Netherlands.,Erasmus School of Health Policy & Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, Rotterdam, DR, the Netherlands
| | - Emma K Massey
- Department of Internal Medicine - Section Nephrology & Transplantation, Erasmus MC University Medical Center, P.O. Box 2040, 3000, Rotterdam, CA, the Netherlands.
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Timmerman L, Laging M, Timman R, Zuidema WC, Beck DK, IJzermans JN, Betjes MG, Busschbach JJ, Weimar W, Massey EK. The impact of the donors' and recipients' medical complications on living kidney donors' mental health. Transpl Int 2016; 29:589-602. [DOI: 10.1111/tri.12760] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/28/2015] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Lotte Timmerman
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Mirjam Laging
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Reinier Timman
- Department of Psychiatry; Section Medical Psychology and Psychotherapy; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Willij C. Zuidema
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Denise K. Beck
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Jan N.M. IJzermans
- Department of General Surgery; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Michiel G.H. Betjes
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Jan J.V. Busschbach
- Department of Psychiatry; Section Medical Psychology and Psychotherapy; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Willem Weimar
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Emma K. Massey
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
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Timmerman L, Timman R, Laging M, Zuidema WC, Beck DK, IJzermans JNM, Busschbach JJV, Weimar W, Massey EK. Predicting mental health after living kidney donation: The importance of psychological factors. Br J Health Psychol 2016; 21:533-54. [DOI: 10.1111/bjhp.12184] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/22/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Lotte Timmerman
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
| | - Reinier Timman
- Department of Psychiatry; Section Medical Psychology and Psychotherapy; Erasmus Medical Center; Rotterdam The Netherlands
| | - Mirjam Laging
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
| | - Willij C. Zuidema
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
| | - Denise K. Beck
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
| | - Jan N. M. IJzermans
- Department of General Surgery; Erasmus Medical Center; Rotterdam The Netherlands
| | - Jan J. V. Busschbach
- Department of Psychiatry; Section Medical Psychology and Psychotherapy; Erasmus Medical Center; Rotterdam The Netherlands
| | - Willem Weimar
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
| | - Emma K. Massey
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
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Timmerman L, Laging M, Westerhof GJ, Timman R, Zuidema WC, Beck DK, IJzermans JNM, Betjes MGH, Busschbach JJV, Weimar W, Massey EK. Mental health among living kidney donors: a prospective comparison with matched controls from the general population. Am J Transplant 2015; 15:508-17. [PMID: 25582231 DOI: 10.1111/ajt.13046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 01/25/2023]
Abstract
The impact of living kidney donation on donors' mental health has not been sufficiently nor comprehensively studied. Earlier studies demonstrated that mental health did not change in the majority of donors, however they often lacked a suitable control group and/or had other methodological limitations. Consequently, it remains unclear whether changes in mental health found among a minority of donors reflect normal fluctuations. In this study we matched 135 donors with individuals from the general Dutch population on gender and baseline mental health and compared changes in mental health over time. Mental health was measured using the Brief Symptom Inventory and Mental Health Continuum Short Form. Primary analyses compared baseline and 6 months follow-up. Secondary analyses compared baseline and 9 (controls) or 15 months (donors) follow-up. Primary multilevel regression analyses showed that there was no change in psychological complaints (p = 0.20) and wellbeing (p = 0.10) over time and donors and controls did not differ from one another in changes in psychological complaints (p = 0.48) and wellbeing (p = 0.85). Secondary analyses also revealed no difference in changes between the groups. We concluded that changes in mental health in the short term after donation do not significantly differ from normal fluctuations found in the Dutch general population.
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Affiliation(s)
- L Timmerman
- Department of Internal Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
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Massey EK, Tielen M, Laging M, Beck DK, Khemai R, van Gelder T, Weimar W. The role of goal cognitions, illness perceptions and treatment beliefs in self-reported adherence after kidney transplantation: a cohort study. J Psychosom Res 2013; 75:229-34. [PMID: 23972411 DOI: 10.1016/j.jpsychores.2013.07.006] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 07/02/2013] [Accepted: 07/09/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Nonadherence to immunosuppressive medication (IM) after kidney transplantation is related to poorer patient and graft outcomes; therefore research into modifiable factors associated with nonadherence is a priority. In this prospective cohort study we investigated whether changes in goal cognitions, illness perceptions, and treatment beliefs were related to self-reported medication adherence six months after kidney transplantation. METHODS Interviews were conducted with patients in the out-patient clinic six weeks (T1: n=113) and six months (T2: n=106) after transplantation. Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS© Interview). The Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire and questions on goal cognitions were also administered at both time points. RESULTS Self-reported nonadherence increased significantly between 6 weeks and 6 months after transplantation from 17% to 27%. Importance of medication adherence as a personal goal and self-efficacy to successfully carry out this goal decreased significantly over time. Perceived necessity of immunosuppressive medication was high but significantly decreased over time. Concerns about the medicines were low. There were no significant changes in illness perceptions or concerns over time. An increase in perceived graft longevity (timeline) was related to higher likelihood of nonadherence six months post-transplant. Furthermore, younger adult patients were more likely to be nonadherent six months after transplantation. CONCLUSION The self-reported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes. Changes in (unrealistic) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients.
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Affiliation(s)
- Emma K Massey
- Department of Internal Medicine, Nephrology & Transplantation, Erasmus MC, Rotterdam, The Netherlands
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