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Solbu A, Cadzow RB, Pullano T, Brinser-Day S, Tumiel-Berhalter L, Kayler LK. Interviews With Lay Caregivers About Their Experiences Supporting Patients Throughout Kidney Transplantation. Prog Transplant 2024; 34:21-31. [PMID: 38449375 DOI: 10.1177/15269248241237820] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Introduction: Lay caregivers provide essential support to patients throughout the kidney transplant process, pretransplant through discharge. Sparse data exists about kidney transplant caregiver experience and facilitators of caregiver engagement. The aim of this study was to explore and describe lay caregivers' accounts of supporting a patient before and early after kidney transplantation. Methods: Caregivers of recent kidney transplant recipients were individually interviewed about their experiences, coping strategies, and perspectives of center-specific support approaches for patients and caregivers in a single transplant center. Results: Inductive content analysis of transcribed interviews with 23 caregivers revealed 6 domain areas: visit preparation, initial evaluation, caregiver role discussion, exposure to support resources, transplant preparedness, and coping styles. Caregivers used and appreciated information offered by the transplant center, including materials directed to the patient. They recommended repeating information, online access, and adding video to complement print resources. They valued and requested information directed to them, both within passive materials and communication with providers. Social network interactions were helpful for practical, emotional, and informational support. Support group reminders and connection pathways to peers were suggested for both patients and caregivers. Conclusion: Findings highlight steps that can be taken by transplant centers and may stimulate caregiver engagement. Featuring caregiver-focused information and communication more prominently may support caregivers to improve patient progress in navigating kidney transplantation.
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Affiliation(s)
- Anne Solbu
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
| | - Renee B Cadzow
- Center for Doctoral Studies and Research, D'Youville University, Buffalo, NY, USA
- University at Buffalo's Clinical and Translational Science Institute, Buffalo, NY, USA
| | - Teresa Pullano
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
| | | | - Laurene Tumiel-Berhalter
- University at Buffalo's Clinical and Translational Science Institute, Buffalo, NY, USA
- Department of Family Medicine, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Liise K Kayler
- Transplant and Kidney Care Regional Center of Excellence, Erie County Medical Center, Buffalo, NY, USA
- Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, Buffalo, NY, USA
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2
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Vankova H, Schmalz M, Andel R, Rajnochova Bloudickova S. Frailty and depressive symptoms in older kidney transplant recipients: opportunities for collaboration between transplant nephrologists and geriatricians. BMC Geriatr 2024; 24:423. [PMID: 38741066 DOI: 10.1186/s12877-024-04972-9] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Frailty is one of the key syndromes in geriatric medicine and an important factor for post-transplant outcomes. We aimed to describe the prevalence of frailty and examine the correlates of frailty and depressive symptoms in older kidney transplant recipients (KTRs). METHODS This cross-sectional study involved 112 kidney transplant recipients (KTRs) aged 70 and above. Frailty syndrome was assessed using the Fried frailty criteria, and patients were categorized as frail, pre-frail, or non-frail based on five frailty components: muscle weakness, slow walking speed, low physical activity, self-reported exhaustion, and unintentional weight loss. Depressive symptoms were measured using the 15-item Geriatric Depression Scale (GDS). The relationship between frailty and depressive symptoms was evaluated using multinomial logistic regression, with the three frailty categories as the dependent variable and the severity of depressive symptoms as the independent variable, while controlling for age, gender, renal graft function, and time since transplant surgery. RESULTS The participants had a mean age of 73.3 ± 3.3 years, and 49% were female. The prevalence of frailty syndrome was 25% (n = 28), pre-frailty was 46% (n = 52), and 29% (n = 32) of the KTRs were non-frail. The mean score for depressive symptoms was 3.1 ± 2.4 points, with 18% scoring above the clinical depression cutoff. Depressive symptoms were positively correlated with frailty (r = .46, p < .001). Among the frailty components, self-reported exhaustion (r = .43, p < .001), slow walking speed (r = .26, p < .01), and low physical activity (r = .44, p < .001) were significantly positively correlated with depressive symptoms, while muscle strength (p = .068) and unintentional weight loss (p = .050) were not. A multinomial logistic regression adjusted for covariates indicated that, compared to being non-frail, each additional point on the GDS increased the odds of being pre-frail by 39% (odds ratio [OR] = 1.39, 95% confidence interval [CI] 1.01-1.96) and roughly doubled the odds of being frail (OR = 2.01, 95% CI 1.39-2.89). CONCLUSION There is a strong association between frailty and depression in KTRs aged 70 years and older. Targeted detection has opened up a new avenue for collaboration between geriatricians and transplant nephrologists.
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Affiliation(s)
- Hana Vankova
- Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruska 87, 10000 Praha 10, Prague, Czech Republic.
| | - Michal Schmalz
- Department of Internal Medicine, Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Ruska 87, 10000 Praha 10, Prague, Czech Republic
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ross Andel
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
- Memory Clinic, Department of Neurology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
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3
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Min K, Hwang Y. Factors associated with the quality of life of living kidney donors in Korea: A cross-sectional study. Medicine (Baltimore) 2024; 103:e38068. [PMID: 38728517 PMCID: PMC11081590 DOI: 10.1097/md.0000000000038068] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
This study investigated the relationship between self-determination, physical health status, and Health related Quality of Life (=HRQoL) among living kidney donors. A descriptive survey was conducted between 2019 and 2020 and included 111 kidney donors. Data were collected using a self-report questionnaire on general and donation-related characteristics, self-determination, and HRQoL. The data also included medical records reflecting the physical health status at the time of the survey. Data were analyzed using a multiple regression model. Factors associated with HRQoL were perceived health recovery after donation (β = 0.42, P < .001), up to 1 year since donation (β = 0.33, P = .008), more than 1 up to 5 years since donation (β = 0.52, P < .001), more than 5 up to 10 years since donation (β = 0.53, P < .001), and competence of self-determination (β = 0.23, P = .033). The explanatory power of these variables was 43.3%. HRQoL of living kidney donors can be affected by subjective and psychological factors. Therefore, health care providers should help living kidney donors have high self-determination during pre and post donation and concentrate on the subjective and psychological factors as well as objective health status.
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Affiliation(s)
- Kyungok Min
- Transplantation Center, Seoul National University Hospital, Seoul, South Korea
| | - Younghui Hwang
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju, South Korea
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4
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Hu N, Yang Z, Wang A. Early Post-Transplant Adaptation Experience in Young and Middle-Aged People With Kidney Transplant in China: A Qualitative Study. West J Nurs Res 2024; 46:356-365. [PMID: 38500353 DOI: 10.1177/01939459241238683] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Successful adaptation to post-transplantation life in patients who have undergone kidney transplants is crucial. The psychosocial needs of people with kidney transplants are closely related to the health of the transplanted kidney. If transplant recipients cannot adapt to the effects of the transplant, their physical and mental health will be seriously impaired. OBJECTIVE The purpose of this study was to explore the early post-transplant adaptation experience of young and middle-aged persons with kidney transplants in China based on the Roy adaptation model. METHODS A qualitative descriptive study was conducted using semi-structured interviews. Fifteen young and middle-aged persons with kidney transplant were recruited from a tertiary hospital in China between September 2022 and March 2023 through purposive sampling. Data were analyzed using a thematic analysis approach. RESULTS This study identified 4 themes: (1) "two-sided" changes in physiological functioning, (2) "dawn and darkness" (conflicting perceived emotions about the future), (3) role functioning adaptation conflict and impairment, and (4) social isolation and the challenges of coping. CONCLUSIONS This study found that early post-transplant adaptation in young and middle-aged people with kidney transplant included both positive and negative experiences, and these findings can provide new insights into research related to successful post-operative adaptation.
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Affiliation(s)
- Na Hu
- Department of Transplantation, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Zhen Yang
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Aiping Wang
- Department of Public Service, The First Affiliated Hospital of China Medical University, Shenyang, China
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Calvelli H, Gardiner H, Gadegbeku C, Reese P, Obradovic Z, Fink E, Gillespie A. A Social Network Analysis of Hemodialysis Clinics: Attitudes Toward Living Donor Kidney Transplant among Influential Patients. Kidney360 2024; 5:577-588. [PMID: 38324254 DOI: 10.34067/kid.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
Key Points
Hemodialysis clinic social networks spread attitudes and behaviors toward kidney transplants.Identifying and characterizing influential patients is a first step in future hemodialysis clinic social network interventions to promote kidney transplantation.
Background
Hemodialysis clinics help develop patient social networks that may spread kidney transplant (KT) attitudes and behaviors. Identifying influential social network members is an important first step to increase KT rates. We mapped the social networks of two hemodialysis facilities to identify which patients were influential using in-degree centrality as a proxy for popularity and influence.
Methods
In this cross-sectional study, we performed a sociocentric social network analysis of patients on hemodialysis in two geographically and demographically different hemodialysis facilities. Statistical and social network analyses were performed using R statistical software.
Results
More patients at facility 1 (N=71) were waitlisted/evaluating living donor KT (50.7% versus 20.0%, P = 0.021), considered KT as very important (70.4% versus 45.0%, P = 0.019), and knew people who received a successful KT (1.0 versus 0.0, P = 0.003). Variables predicting relationship formation at facility 1 were the same shift (β=1.87, 95% confidence interval [CI] [1.19 to 2.55]; P < 0.0001), same sex (β=0.51, 95% CI [0.01 to 1.00]; P = 0.045), younger age (β=−0.03, 95% CI [−0.05 to −0.01]; P = 0.004), different lengths of time on hemodialysis (β=−0.49, 95% CI [−0.86 to −0.12]; P = 0.009), and knowing more people who received a successful KT (β=0.12, 95% CI [0.03 to 0.21]; P = 0.009). Predictive variables at facility 2 (N=40) were the same race (β=2.52, 95% CI [0.39 to 4.65]; P = 0.021) and knowing fewer people with successful KT (β=−0.92, 95% CI [−1.82 to −0.02]; P = 0.045). In-degree centrality was higher at facility 1 (1.1±1.2) compared with facility 2 (0.6±0.9).
Conclusions
Social networks differed between the hemodialysis clinics in structure and prevalent transplant attitudes. Influential patients at facility 1 (measured by in-degree centrality) had positive attitudes toward KT, whereas influential patients at facility 2 had negative attitudes.
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Affiliation(s)
- Hannah Calvelli
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Heather Gardiner
- Temple University College of Public Health, Philadelphia, Pennsylvania
| | - Crystal Gadegbeku
- Cleveland Clinic Glickman Urological and Kidney Institute, Cleveland, Ohio
| | - Peter Reese
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zoran Obradovic
- Temple University Center for Data Analytics and Biomedical Informatics, Philadelphia, Pennsylvania
| | - Edward Fink
- Temple University School of Media and Communication, Philadelphia, Pennsylvania
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Loor JM, Ford CG, Leyva Y, Swift S, Ng YH, Zhu Y, Dew MA, Peipert JD, Unruh ML, Croswell E, Kendall K, Puttarajappa C, Shapiro R, Myaskovsky L. Do pre-transplant cultural factors predict health-related quality of life after kidney transplantation? Clin Transplant 2024; 38:e15256. [PMID: 38400674 DOI: 10.1111/ctr.15256] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/16/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Post-transplant health-related quality of life (HRQOL) is associated with health outcomes for kidney transplant (KT) recipients. However, pretransplant predictors of improvements in post-transplant HRQOL remain incompletely understood. Namely, important pretransplant cultural factors, such as experience of discrimination, perceived racism in healthcare, or mistrust of the healthcare system, have not been examined as potential HRQOL predictors. Also, few have examined predictors of decline in HRQOL post-transplant. METHODS Using data from a prospective cohort study, we examined HRQOL change pre- to post-transplant, and novel cultural predictors of the change. We measured physical, mental, and kidney-specific HRQOL as outcomes, and used cultural factors as predictors, controlling for demographic, clinical, psychosocial, and transplant knowledge covariates. RESULTS Among 166 KT recipients (57% male; mean age 50.6 years; 61.4% > high school graduates; 80% non-Hispanic White), we found mental and physical, but not kidney-specific, HRQOL significantly improved post-transplant. No culturally related factors outside of medical mistrust significantly predicted change in any HRQOL outcome. Instead, demographic, knowledge, and clinical factors significantly predicted decline in each HRQOL domain: physical HRQOL-older age, more post-KT complications, higher pre-KT physical HRQOL; mental HRQOL-having less information pre-KT, greater pre-KT mental HRQOL; and, kidney-specific HRQOL-poorer kidney functioning post-KT, lower expectations for physical condition to improve, and higher pre-KT kidney-specific HRQOL. CONCLUSIONS Instead of cultural factors, predictors of HRQOL decline included demographic, knowledge, and clinical factors. These findings are useful for identifying patient groups that may be at greater risk of poorer post-transplant outcomes, in order to target individualized support to patients.
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Affiliation(s)
- Jamie M Loor
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
| | - C Graham Ford
- Durham VA Medical Center, Durham, North Carolina, USA
| | - Yuridia Leyva
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
| | - Samuel Swift
- College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA
| | - Yue Harn Ng
- Department of Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Yiliang Zhu
- Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - J Devin Peipert
- Department of Medical Social Sciences and Transplant Outcomes Research Collaboration, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mark L Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Chethan Puttarajappa
- Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine, New York, USA
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
- Department of Internal Medicine, University of New Mexico, School of Medicine, Albuquerque, New Mexico, USA
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7
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Temür BN, Aksoy N. Psychosocial Problems in Recipients of Kidney Transplant. EXP CLIN TRANSPLANT 2024; 22:187-191. [PMID: 38385395 DOI: 10.6002/ect.mesot2023.p18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
OBJECTIVES The purpose of kidney transplant is to improve the quality of life of recipients. Improving quality of life of transplant recipients is crucial for their treatment adherence and transplant success. However, it is known that psychosocial problems experienced by kidney transplant recipients after transplant can threaten quality of life and increase mortality and morbidity rates. Therefore, in this study, we examined up-to-date literature and recommendations on psychological problems experienced by recipients after kidney transplant. MATERIALS AND METHODS Studies were identified by searching PubMed, ScienceDirect, and Web of Science databases for the past 5 years. The search terms used included "depression, anxiety," "kidney transplant recipients," "kidney transplantation," psychosocial problems," and "psychosocial issues." RESULTS Our search of relevant databases resulted in 1663 articles imported into EndNote: 243 from PubMed, 1198 from ScienceDirect, and 222 from Web of Science. Twenty-one studies that met the inclusion criteria were included. CONCLUSIONS Recent studies have indicated that kidney transplant recipients experience depression, anxiety, and stress during the posttransplant period. Support is recommended for recipients after kidney transplant, and interventions aimed at reducing depression, anxiety, and stress are needed.
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Affiliation(s)
- Büşra Nur Temür
- From Faculty of Nursing, Akdeniz University, Antalya, Turkey
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8
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Loban K, Morgan R, Kute V, Bhalla AK, Sandal S. Are Differences in Living Kidney Donation Rates a Sex or a Gender Disparity? EXP CLIN TRANSPLANT 2024; 22:28-36. [PMID: 38385370 DOI: 10.6002/ect.mesot2023.l21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Sex-disaggregated data reveal significant disparities in living kidney donation, with more female than male living kidney donors in most countries and proportions over 60% in some countries. We summarize the present state of knowledge with respect to the potential drivers of this disparity and argue that it is primarily driven by gender-related factors. First, we present the differences between sex and gender and then proceed to summarize the potential medical reasons that have been proposed to explain why males are less likely to be living kidney donors than females, such as the higher prevalence of kidney failure in males. We then present counterarguments as to why biological sex differences are not enough to explain lower living kidney donation among males, such as a higher prevalence of chronic kidney disease among females, which could affect donation rates. We argue that gender differences likely provide a better explanation as to why there are more women than men living kidney donors and explore the role of economic and social factors, as well as gender roles and expectations, in affecting living kidney donation among both men and women. We conclude with the need for a gender analysis to explain this complex psychosocial phenomenon in living kidney donation.
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Affiliation(s)
- Katya Loban
- From the Research Institute of the McGill University Health Centre and the Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
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9
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Harding CC, Ephraim PL, Davenport CA, McElroy LM, Mohottige D, DePasquale N, Lunyera J, Strigo TS, Pounds IA, Riley J, Alkon A, Ellis M, Boulware LE. Association of Age and Gender With Concerns About Live Donor Kidney Transplantation Among Black Individuals. Transplant Proc 2023; 55:2403-2409. [PMID: 37945446 PMCID: PMC10872540 DOI: 10.1016/j.transproceed.2023.10.001] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/04/2023] [Indexed: 11/12/2023]
Abstract
Black individuals are less likely to receive live donor kidney transplantation (LDKT) compared to others. This may be partly related to their concerns about LDKT, which can vary based on age and gender. We conducted a cross-sectional, secondary analysis of the baseline enrollment data from the Talking about Living Kidney Donation Support trial, which studied the effectiveness of social workers and financial interventions on activation towards LDKT among 300 Black individuals from a deceased donor waiting list. We assessed concerns regarding the LDKT process, including their potential need for postoperative social support, future reproductive potential, recipient and donor money matters, recipient and donor safety, and interpersonal concerns. Answers ranged from 0 ("not at all concerned") to 10 ("extremely concerned"). We described and compared participants' concerns both overall and stratified by age (≥45 years old vs <45 years old) and self-reported gender ("male" versus "female"). The participants' top concerns were donor safety (median [IQR] score 10 [5-10]), recipient safety (5 [0-10]), money matters (5 [0-9]), and guilt/indebtedness (5 [0-9]). Younger females had statistically significantly higher odds of being concerned about future reproductive potential (odds ratio [OR] 3.77, 95% CI 2.77, 4.77), and older males had statistically higher mean concern about postoperative social support (OR 1.79, 95% CI 0.19, 3.38). Interventions to improve rates of LDKT among Black individuals should include education and counseling about the safety of LDKT for both recipients and donors, reproductive counseling for female LDKT candidates of childbearing age, and addressing older males' needs for increased social support.
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Affiliation(s)
- Ceshae C Harding
- General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Patti L Ephraim
- Institute of Health System Science, Feinstein Institute for Medical Research, Northwell Health, New York, New York
| | - Clemontina A Davenport
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Lisa M McElroy
- Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Dinushika Mohottige
- Institute for Health Equity Research, Department of Population Health, Icahn School of Medicine at Mount Sinai, New York, New York; Barbara T. Murphy Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Nicole DePasquale
- General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Joseph Lunyera
- General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Tara S Strigo
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Iris A Pounds
- General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Jennie Riley
- General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Aviel Alkon
- General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Matthew Ellis
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - L Ebony Boulware
- Wake Forest University School of Medicine, Winston-Salem, North Carolina.
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10
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Rodger D, Venter B. A fair exchange: why living kidney donors in England should be financially compensated. Med Health Care Philos 2023; 26:625-634. [PMID: 37620641 PMCID: PMC10725849 DOI: 10.1007/s11019-023-10171-x] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/04/2023] [Indexed: 08/26/2023]
Abstract
Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one 'buyer'-in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the 'crowding out' of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England.
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Affiliation(s)
- Daniel Rodger
- Institute of Health and Social Care, School of Allied and Community Health, London South Bank University, London, UK.
- Department of Psychological Sciences, University of London, Birkbeck, UK.
| | - Bonnie Venter
- Centre for Health, Law, and Society, Bristol Law School, University of Bristol, Bristol, UK
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11
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Cazauvieilh V, Moal V, Prudhomme T, Pecoraro A, Piana A, Campi R, Hevia V, Territo A, Boissier R. Psychological Impact of Living Kidney Donation: A Systematic Review by the EAU-YAU Kidney Transplant Working Group. Transpl Int 2023; 36:11827. [PMID: 38076226 PMCID: PMC10703979 DOI: 10.3389/ti.2023.11827] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023]
Abstract
We performed a systematic literature review of the psychological impact on donors of living kidney donation. We conducted a literature review in PubMed/Medline according to PRISMA guidelines which included both qualitative (based on interviews) and quantitative studies (based on standardized questionnaire). There were 15 quantitative studies and 8 qualitative studies with 2,732 donors. Given that the methodologies of qualitative and quantitative studies are fundamentally different, we narratively synthetized results of studies according to four axes: quality of life, anxiety/depression, consequences of donation on the donor/recipient relationship, overall satisfaction and regret. The quantitative studies reported that donor quality of life remained unchanged or improved. Donor regret rates were very low and donor-recipient relationships also remained unchanged or improved. Qualitative studies reported more complex donation experiences: one can regret donation and still decide to recommend it as in a social desirability bias. In both study types, donor-recipient relationships were closer but qualitative studies reported that post-donation rebonding was required. The qualitative studies therefore highlighted the psychological complexity of donation for donors, showing that living donation impacts the donor's life whether it is successful or not. A better understanding of the impact of donation on donors could provide better care for donors.
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Affiliation(s)
- Valentine Cazauvieilh
- Department of Nephrology, La Conception University Hospital, Assistance Publique – Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Valérie Moal
- Department of Nephrology, La Conception University Hospital, Assistance Publique – Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Thomas Prudhomme
- Department of Urology, Rangueil University Hospital, Toulouse, France
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Vital Hevia
- Urology Department, Hospital Universitario Ramón y Cajal, Alcalá University, Madrid, Spain
| | - Angelo Territo
- Oncology and Renal Transplant Units, Puigvert’s Foundation, Barcelona, Spain
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Assistance Publique – Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
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12
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Yoshikawa Y, Maeda K, Kosoku A, Uchida J. Male Renal Transplant Recipients' Experiences From Their Wives' Pregnancy and Childbirth. Transplant Proc 2023; 55:2046-2052. [PMID: 37783591 DOI: 10.1016/j.transproceed.2023.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/21/2023] [Indexed: 10/04/2023]
Abstract
This study aimed to analyze male renal transplant recipients' experience with their partners' pregnancy and childbirth and to investigate their methods of nursing their condition. We performed semistructured interviews and collected data from 6 Japanese males who underwent a kidney transplant after their partner had given birth. The data were analyzed using the Qualitative Synthesis Method (KJ Method). The mean age of the participants at data collection was 40.3 ± 4.7 years, whereas it was 34.7 ± 5.8 years when the transplant was performed. The Qualitative Synthesis Method revealed 7 symbols related to the pregnancy and childbirth experience of the partners of male kidney transplant recipients. Males who received a kidney transplant struggled with severe renal disease before the transplant. They also experienced indecisiveness about whether they should go through with the transplant. However, their lives changed because of the transplant and having children. This situation resulted in a sense of responsibility and a reason to live robustly for the male kidney transplant recipients. Nevertheless, they faced distress as kidney transplant patients. Their wives supported them through this experience. They communicated to their children what they learned from the experience while effectively dealing with their condition. The improvement in their sexual function resulting from the transplant influenced their determination to get married. It is necessary to offer information about the recovery of fertility and the possibility of having a child when choosing renal replacement therapy, give explanations based on evidence, and construct a counseling system.
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Affiliation(s)
- Yuki Yoshikawa
- Faculty of Nursing, Shitennoji University, Habikino, Osaka, Japan.
| | - Keiko Maeda
- Department of Nursing, Osaka Metropolitan University Hospital, Abeno-ku, Osaka-City, Japan
| | - Akihiro Kosoku
- Department of Urology, Osaka Metropolitan University Graduate School of Medicine, Abeno-ku, Osaka-City, Japan
| | - Junji Uchida
- Department of Urology, Osaka Metropolitan University Graduate School of Medicine, Abeno-ku, Osaka-City, Japan
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13
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Skaczkowski G, Barrett A, Olver I, Dollman J, Gunn KM. 'It is a life changing experience': The experiences of living kidney donors who live in rural Australia. Aust J Rural Health 2023; 31:866-877. [PMID: 37335838 DOI: 10.1111/ajr.13008] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/19/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations. OBJECTIVE To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs. DESIGN/SETTING/PARTICIPANTS Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis. FINDINGS Eight themes were identified: (1) donor's emotional well-being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well-being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall. CONCLUSION Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group.
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Affiliation(s)
- Gemma Skaczkowski
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Alison Barrett
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - James Dollman
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kate M Gunn
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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14
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Shi Y, Zhang H, Nie Z, Fu Y. Quality of life, anxiety and depression symptoms in living related kidney donors: a cross‑sectional study. Int Urol Nephrol 2023; 55:2335-2343. [PMID: 36881268 DOI: 10.1007/s11255-023-03542-z] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Few studies have examined the quality of life of living kidney donors in mainland China. The data on anxiety and depression of living kidney donors was also scant. This study aimed to investigate quality of life, anxiety, and depression and identify their influencing factors among living kidney donors in mainland China. METHODS A cross-sectional study included 122 living kidney donors from a kidney transplantation center in China. The abbreviated World Health Organization Quality of Life questionnaire, Generalized Anxiety Disorder 2-item and Patient Health Questionnaire 2-item were used to assess the quality of life, anxiety and depression symptoms, respectively. RESULTS Our study found that the physical related quality of life of our donors was poorer than that of the domestic general population. Among 122 donors, 43.4% and 29.5% of them were found to have anxiety and depression symptoms, respectively. Poor health condition of recipient was identified as not only negative factors affecting all domains of quality of life, but also closely related to anxiety and depression of kidney donors. Donors with proteinuria were more likely to have a poor psychological, social related quality of life, as well as anxiety and depression symptoms. CONCLUSIONS Living kidney donation has an impact on the physical and mental health of donors. Both the physical and mental health of living kidney donors should not be ignored. More attention and support should be given to donors with proteinuria and donors whose relative recipient suffering poor health condition.
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Affiliation(s)
- Yuexian Shi
- School of Nursing, Peking University, Beijing, 100191, China
| | - Haiming Zhang
- National Clinical Research Center for Digestive Diseases and Beijing Key Laboratory of Tolerance Induction and Organ Protection in Transplantation, Beijing Friendship Hospital, Capital Medical University, 100050, Beijing, People's Republic of China
| | - Zhaoling Nie
- Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin, 300192, China
| | - Yingxin Fu
- Kidney Transplant department (Liver transplant department), Transplant Center, National Clinical Research Center for Infectious Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China.
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15
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Leifeld S, de Zwaan M, Albayrak Ö, Einecke G, Nöhre M. Live Donor Assessment Tool (LDAT): Reliability and Validity of the German Version in Living Kidney Donor Candidates. J Acad Consult Liaison Psychiatry 2023; 64:429-435. [PMID: 36963466 DOI: 10.1016/j.jaclp.2023.03.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 03/09/2023] [Accepted: 03/14/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND The Live Donor Assessment Tool (LDAT) is a semi-structured psychosocial assessment tool for evaluating potential organ donors. It enables standardization of the psychosocial evaluation across institutions and allows the quantification of the evaluation result. OBJECTIVE To evaluate the validity and reliability of the German version of the LDAT in living kidney donors. METHODS We assessed the internal consistency and convergent validity (using known groups) of the German version of the LDAT in donor candidates who were evaluated at Hannover Medical School from May 2017 to December 2021. RESULTS One hundred fifty-two donor candidates were evaluated. The mean age was 50.9 (standard deviation, 12.0), 99 were female (65.1%) and 53 (34.9%) were male candidates. LDAT scores ranged from 39 to 78 (possible maximum score = 82). The mean and median LDAT scores in the entire sample were 69 (standard deviation, 6.4) and 71 (95% confidence interval, 68; 70), respectively. The LDAT items demonstrated good internal consistency (α = 0.737). LDAT scores were significantly lower in high and moderate risk donors compared to a low/no risk group as determined by clinical evaluation. We found a significant positive association of the LDAT total score with age and a negative correlation with levels of depression and anxiety. The best cutoff score in our sample was 66.5 with an area under the curve of 93%. CONCLUSIONS The German version of the LDAT was found to be a reliable and valid tool, which seems suitable to support psychosocial donor evaluation.
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Affiliation(s)
- Susan Leifeld
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.
| | - Özgür Albayrak
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Gunilla Einecke
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany; Department of Nephrology and Rheumatology, University Medical Center Goettingen, Goettingen, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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16
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Bourkas S, Achille M. The psychosocial adjustment of kidney recipients across donation contexts. J Health Psychol 2023; 28:1011-1023. [PMID: 36688379 PMCID: PMC10492421 DOI: 10.1177/13591053221149780] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The objective of this study was to investigate kidney recipients' experiences within deceased and living donation contexts and, in the latter, by donor relationship type, to identify differences by context and mechanisms by which the relationship with the donor may impact recipients' psychosocial well-being. Individual interviews were conducted with 12 participants and analyzed using Interpretative Phenomenological Analysis. Three themes emerged: (a) salience of and sensitivity toward sacrifice and loss, (b) honoring the sacrifice by honoring the gift, and (c) relational imbalance mirroring perceived burden of donation. Findings were contextualized in relation to the transplantation literature, and their clinical implications discussed.
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17
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Maple H, Gogalniceanu P, Gare R, Burnapp L, Draper H, Chilcot J, Norton S, Mamode N. Donating a Kidney to a Stranger: Are Healthcare Professionals Facilitating the Journey? Results From the BOUnD Study. Transpl Int 2023; 36:11257. [PMID: 37324220 PMCID: PMC10261699 DOI: 10.3389/ti.2023.11257] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
Unspecified kidney donors (UKDs) are approached cautiously by some transplant professionals. The aim of this study was to interrogate the views of UK transplant professionals towards UKDs and identify potential barriers. A purposely designed questionnaire was validated, piloted and distributed amongst transplant professionals at each of the 23 UK transplant centres. Data captured included personal experiences, attitudes towards organ donation, and specific concerns about UKD. 153 responses were obtained, with representation from all UK centres and professional groups. The majority reported a positive experience with UKDs (81.7%; p < 0.001) and were comfortable with UKDs undergoing major surgery (85.7%; p < 0.001). 43.8% reported UKDs to be more time consuming and 52% felt that a mental health assessment should take place before any medical tests. 77% indicated the need for a lower age limit. The suggested age range was broad (16-50 years). Adjusted mean acceptance scores did not differ by profession (p = 0.68) but higher volume centres were more accepting (46.2 vs. 52.9; p < 0.001). This is the first quantitative study of acceptance by transplant professionals to a large national UKD programme. Support is broad, however potential barriers to donation have been identified, including lack of training. Unified national guidance is needed to address these.
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Affiliation(s)
- Hannah Maple
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Petrut Gogalniceanu
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Rebecca Gare
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lisa Burnapp
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- UK and NHS Blood and Transplant, Bristol, United Kingdom
| | - Heather Draper
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Nizam Mamode
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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18
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Abstract
Sickness symptoms (depressive symptoms, anxiety, and fatigue) are common among people with chronic illness, often presenting as a symptom cluster. Sickness symptoms persist in many patients with chronic kidney disease, even after kidney transplantation (KT); however, little is known about sickness symptom-induced burden in KT recipients. This scoping review synthesizes available evidence for sickness symptoms in KT recipients, including findings on symptom prevalence, predictors, outcomes, interrelationships, and clustering. Among 38 reviewed studies, none identified sickness symptoms as a cluster, but we observed interrelationships among the symptoms examined. Fatigue was the most prevalent sickness symptom, followed by anxiety and depressive symptoms. Predictors of these symptoms included demographic, clinical, and psychosocial factors, and health-related quality of life was the most researched outcome. Future research should use common data elements to phenotype sickness symptoms, include biological markers, and employ sophisticated statistical methods to identify potential clustering of sickness symptoms in KT recipients.
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Affiliation(s)
- Choa Sung
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
| | | | - Mark B. Lockwood
- Department of Biobehavioral Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, IL, USA
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19
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Lim WH, Chan KE, Ng CH, Tan DJH, Tay PWL, Chin YH, Yong JN, Xiao J, Fu CE, Nah B, Tiong HY, Syn N, Devi K, Griva K, Mak LLY, Huang DQ, Fung J, Siddiqui MS, Muthiah M, Tan EXX. A qualitative systematic review of anonymous/unspecified living kidney and liver donors' perspectives. PLoS One 2022; 17:e0277792. [PMID: 36584032 PMCID: PMC9803135 DOI: 10.1371/journal.pone.0277792] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/03/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES & BACKGROUND Anonymous live organ donors or unspecified donors are individuals willing to be organ donors for any transplant recipient with whom they have no biological or antecedent emotional relationship. Despite excellent recipient outcomes and the potential to help address organ scarcity, controversy surrounds the unconditional act of gifting one's organs to an unrelated recipient. This qualitative systematic review provides insights into the first-hand experiences, motivations, and challenges that unspecified donors face. METHODS A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO, and Web of Science database for qualitative literature regarding unspecified living donors' motivations and experiences in liver and kidney transplantation. An inductive thematic analysis was conducted to generate themes and supportive subthemes. RESULTS 12 studies were included. The four major themes were (i) motivations, (ii) perception of risks, (iii) donor support, and (iv) benefits of donation. Unspecified donors demonstrated a deep sense of social responsibility but tended to underestimate health risks in favour of benefits for recipients. Despite the lack of emotional support from family and friends, the decision to donate was a resolute personal decision for donors. Majority benefitted emotionally and did not express regret. CONCLUSION This qualitative review bridges the gap in literature on unspecified living donor psychology and provides a comprehensive understanding of the decision-making matrix and experiences of donors.
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Affiliation(s)
- Wen Hui Lim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- * E-mail: (WHL); (EXXT)
| | - Kai En Chan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Cheng Han Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Darren Jun Hao Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Phoebe Wen Lin Tay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yip Han Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jie Ning Yong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jieling Xiao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Clarissa Elysia Fu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Benjamin Nah
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Ho Yee Tiong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
- Department of Urology, University Surgical Cluster, National University Hospital, Singapore, Singapore
| | - Nicholas Syn
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Kamala Devi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Konstadina Griva
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Loey Lung Yi Mak
- Division of Gastroenterology and Hepatology, Department of Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Daniel Q. Huang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - James Fung
- Division of Liver Transplantation, Department of Surgery at Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | - Mohammad Shadab Siddiqui
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, United States of America
| | - Mark Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
| | - Eunice X. X. Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore, Singapore
- National University Centre for Organ Transplantation, National University Health System, Singapore, Singapore
- * E-mail: (WHL); (EXXT)
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20
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Zimbrean PC. Depression in transplantation. Curr Opin Organ Transplant 2022; 27:535-545. [PMID: 36227755 DOI: 10.1097/mot.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To review and summarize the literature published between 1 January 2020 and 30 June 2022, on the prevalence, risk factors and impact of depression in transplant population. RECENT FINDINGS Depression is common in transplantation candidates and recipients, with a prevalence up to 85.8% in kidney recipients. Multiple studies have indicated after transplantation depression correlates with increased mortality and with higher healthcare utilization. Social risk factors for posttransplant depression include financial difficulties and unemployment, while less is understood about the biological substrate of depression in this population. There is evidence that dynamic psychotherapy is effective for depression in organ transplant recipients, while cognitive behavioral therapy or supportive therapy did not lead to improvement of depression in transplant recipients. For living organ donors, the rates of depression are similar to the general population, with financial factors and the clinical status of the recipient playing a significant role. SUMMARY Depression is a common finding in transplant population. More research is needed to understand the biological substrate and risk factors and to develop effective treatment interventions.
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Affiliation(s)
- Paula C Zimbrean
- Departments of Psychiatry and Surgery (Transplantation), Yale University School of Medicine, New Haven, Connecticut, USA
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21
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Swift SL, Leyva Y, Wang S, Chang CCH, Dew MA, Shapiro R, Unruh M, Kendall K, Croswell E, Peipert JD, Myaskovsky L. Are cultural or psychosocial factors associated with patient-reported outcomes at the conclusion of kidney transplant evaluation? Clin Transplant 2022; 36:e14796. [PMID: 35988025 PMCID: PMC9772103 DOI: 10.1111/ctr.14796] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/30/2022] [Accepted: 07/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Kidney transplant evaluation (KTE) is a period marked by many stressors for patients, which may lead to poorer patient-reported outcomes (PROs). Research on the association of cultural and psychosocial factors with PROs during KTE is lacking, even though cultural and psychosocial variables may mitigate the relationship between acceptance status and PROs. METHODS Using a prospective cohort study of 955 adults referred for KTE, we examined whether cultural factors and psychosocial characteristics, assessed at the initiation of KTE, are associated with PROs at KTE completion, controlling for demographics and medical factors. Also, we analyzed whether these factors moderate the relationship between transplant acceptance status and PROs. RESULTS In multivariable regression models, a stronger sense of mastery was associated with higher physical and mental QOL. A stronger sense of self-esteem was associated with higher kidney-specific QOL. Depression was associated with a lower mental QOL, but only in those who were accepted for transplant. Having low levels of external locus of control was associated with better mental QOL in those who were not accepted for transplant. Higher anxiety was associated with poorer kidney-specific QOL among those who were not accepted for KT, but trust in physician was only associated with greater satisfaction in transplant clinic service for those who were accepted for KT. CONCLUSIONS Targeting interventions to increase patient mastery and external locus of control, and reduce depression and anxiety in patients undergoing kidney transplant evaluation may be useful approaches to improve their experience during this stressful period.
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Affiliation(s)
- Samuel L. Swift
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center
- SS now at New Mexico Department of Health, Epidemiology
| | - Yuri Leyva
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center
| | - Shu Wang
- Department of Biostatistics, University of Florida
| | - Chung-Chou H. Chang
- Department of Biostatistics, University of Pittsburgh, Graduate School of Public Health
- Department of Medicine, University of Pittsburgh, School of Medicine
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, School of Medicine
| | - Ron Shapiro
- Mount Sinai Recanati/Miller Transplantation Institute, Icahn School of Medicine
| | - Mark Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine
| | | | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, School of Medicine
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
- Northwestern University Transplant Outcomes Research Collaboration (NUTORC), Feinberg School of Medicine, Northwestern University
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center
- Department of Internal Medicine, University of New Mexico, School of Medicine
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22
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Nilsson K, Westas M, Andersson G, Johansson P, Lundgren J. Waiting for kidney transplantation from deceased donors: Experiences and support needs during the waiting time -A qualitative study. Patient Educ Couns 2022; 105:2422-2428. [PMID: 35272905 DOI: 10.1016/j.pec.2022.02.016] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/28/2022] [Accepted: 02/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The study aimed to explore and describe patients' experiences of the transplantation process and the support they had received during the waiting time. METHOD Semi-structured interviews were conducted with 14 patients currently waiting for kidney transplantation from deceased donors (n = 7) or recently having received kidney transplantation (n = 7). Interviews were transcribed, anonymized and analysed inductively using thematic analysis. RESULTS Two themes and seven sub-themes were identified. The first theme, "Swaying between hope and despair" describes patients' perceptions of waiting for transplantation as a struggle, their expectations for life after the upcoming transplantation and experienced disappointments. The second theme, "Making your way through the waiting time", describes support, strategies and behaviours used to manage the waiting time. CONCLUSION Patients described life while waiting for kidney transplantation as challenging, involving unexpected events, not understanding the transplantation process and having unrealistic expectations on life after transplantation. They also described support, strategies and behaviours used, some of which led to unwanted consequences. PRACTICE IMPLICATIONS Patients waiting for kidney transplantation from deceased donors need continuous and easily available education, practical and emotional support to manage the waiting time. Transplantation specific education is also needed to facilitate preparation for transplantation and adjustment to life after transplantation.
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Affiliation(s)
- Kristina Nilsson
- Department of Internal Medicine in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden.
| | - Mats Westas
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden. Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Peter Johansson
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Department of Internal Medicine, Norrköping, Sweden
| | - Johan Lundgren
- Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden
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23
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Krajewski PK, Tyczyńska K, Bardowska K, Olczyk P, Krajewska M, Szepietowski JC. Psychosocial Burden of Itch among Renal Transplant Recipients. Toxins (Basel) 2022; 14:320. [PMID: 35622567 PMCID: PMC9145006 DOI: 10.3390/toxins14050320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 12/10/2022] Open
Abstract
Itch is the most common symptom of chronic dermatoses. Moreover, itch may be associated with systemic disorders. Chronic kidney disease—associated itch (CKD-aI) may affect up to 20% of renal transplant recipients (RTR). The aim of the study was to assess psychosocial burden of itch in RTR. The study was performed on a group of 129 RTR, out of which 54 (41.9%) experienced itch in the previous 3 days. A specially designed questionnaire assessing anxiety, depression, stigmatization, and quality of life was used. Results: Patients suffering from itch in the previous 3 days achieved significantly higher scores in GAD-7 (p < 0.001), BDI (p < 0.001), HADS total score (p < 0.001), HADS Depression (p = 0.004), and HADS Anxiety (p < 0.001). Severity of itch correlated positively with HADS, stigmatization scale, and GAD-7. Itch in RTR was associated with higher incidence of depression assessed with BDI (OR 3.7). Moreover, higher prevalence of anxiety was found among patients suffering from CKD-aI, assessed with HADS A and GAD-7 (OR 2.7 and OR 4.8, respectively) The results of our study clearly demonstrate that itch among RTR is a significant burden. Higher prevalence of depression and anxiety in this groups indicate the necessity of addressing itch relief as a part of holistic approach to patients after renal transplantation.
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Affiliation(s)
- Piotr K. Krajewski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (K.T.); (K.B.)
| | - Kinga Tyczyńska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (K.T.); (K.B.)
| | - Klaudia Bardowska
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (K.T.); (K.B.)
| | - Piotr Olczyk
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.O.); (M.K.)
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.O.); (M.K.)
| | - Jacek C. Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland; (P.K.K.); (K.T.); (K.B.)
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Memory KE, Wilkinson TJ, Smith AC, Lightfoot CJ. A qualitative exploration of the facilitators and barriers to self-management in kidney transplant recipients. J Nephrol 2022; 35:1863-1872. [PMID: 35467326 PMCID: PMC9035973 DOI: 10.1007/s40620-022-01325-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/27/2022] [Indexed: 11/26/2022]
Abstract
Background Understanding the behaviours that facilitate or impede one’s ability to self-manage is important to improve health-related outcomes in kidney transplant recipients (KTRs). Previous studies exploring the self-management experiences of KTRs have focused on specific tasks (e.g., medication adherence), age groups (e.g., adolescent or older recipients), or have been conducted outside of the UK where transferability of findings is unknown. Our study aimed to explore the perceptions and experiences of self-management in UK KTRs to identify facilitators and barriers associated with self-management tasks. Methods Semi-structured interviews were conducted with eleven KTRs. Topics explored included experiences of self-management tasks (diet, exercise, medications, stress management), perceived healthcare role, and future interventional approaches. Thematic analysis was used to identify and report themes. Results Eight themes were identified which were mapped onto the three self-management tasks described by Corbin and Strauss: medical, role and emotional management. Perceived facilitators to self-management were: gathering health-related knowledge, building relationships with healthcare professionals, creating routines within daily life, setting goals and identifying motivators, establishing support networks, and support from family and friends. Complexity of required treatment and adjusting to a new health status were perceived barriers to self-management. Conclusions Participants described the importance of collaborative consultations and continuity of care. Tailored interventions should identify individualised goals and motivators for participating in self-management. Education on effective strategies to manage symptoms and comorbidities could help alleviate KTRs’ perceived treatment burden. Family and peer support could emotionally support KTRs; however, managing the emotional burden of transplantation warrants more attention. Graphic abstract ![]()
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Affiliation(s)
- Katherine E Memory
- Leicester Medical School, University of Leicester, Leicester, UK
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Thomas J Wilkinson
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Alice C Smith
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Courtney J Lightfoot
- Leicester Kidney Lifestyle Team, Department of Health Sciences, University of Leicester, Leicester, UK.
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Waterman AD, Nair D, Purnajo I, Cavanaugh KL, Mittman BS, Peipert JD. The Knowledge Assessment of Renal Transplantation (KART) 2.0: Development and Validation of CKD and Transplant Knowledge Scales. Clin J Am Soc Nephrol 2022; 17:555-564. [PMID: 35332061 PMCID: PMC8993477 DOI: 10.2215/cjn.11490821] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Many individuals with kidney disease, particularly those belonging to racial and ethnic minority groups and whose primary language is not English, lack knowledge related to kidney disease symptoms, physiologic functions of the kidney, and benefits and risks of kidney transplantation. Valid instruments to assess patients' knowledge of CKD and kidney transplantation are needed. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using a sample of 977 patients with stages 3-5 CKD in the Kaiser Permanente health system, we developed the Knowledge Assessment of Renal Transplantation (KART) 2.0 instrument. We conducted cognitive interviews followed by item response theory (IRT) to reduce 48 candidate items. Construct validity was tested by examining differences in scores between patients who spent <1 and ≥1 hour receiving CKD and transplant education. RESULTS Cognitive interviews modified four items and omitted 11. IRT analyses resulted in two scales: the KART 2.0-Transplant Knowledge Scale (16 items; Cronbach's α=0.8) and the KART 2.0-CKD Knowledge Scale (nine items; Cronbach's α=0.79). Differential item functioning showed that the scales were unbiased to capture knowledge across self-identified race, primary language, CKD stage, and sex. Both scales distinguished patients who had spent <1 and ≥1 hour speaking with health professionals (effect size [ES]=0.33 [transplant], 0.54 [CKD]; P<0.001 for both), reading about kidney disease (ES=0.45 [transplant], 0.62 [CKD]; P<0.001), reading about kidney transplantation (ES=0.67 [transplant], 0.69 [CKD]; P<0.001), and reading about living donor kidney transplant (ES=0.76 [transplant], 0.62 [CKD]; P<0.001). CONCLUSIONS The KART 2.0 is a valid tool to assess patients' knowledge of CKD and kidney transplantation.
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Affiliation(s)
- Amy D Waterman
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas
| | - Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee
| | | | - Kerri L Cavanaugh
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt O'Brien Center for Kidney Disease, Nashville, Tennessee
- Center for Effective Health Communication, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Brian S Mittman
- Health Services Research and Implementation Science, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - John Devin Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Northwestern University Transplant Outcomes Research Collaborative, Comprehensive Transplant Center, Feinberg School of Medicine, Chicago, Illinois
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Tattoli L, Santovito D, Raciti IM, Scarmozzino A, Di Vella G. Risk Assessment and Management for Potential Living Kidney Donors: The Role of “Third-Party” Commission. Front Public Health 2022; 10:824048. [PMID: 35372186 PMCID: PMC8968079 DOI: 10.3389/fpubh.2022.824048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Abstract
Living kidney donation is the most common type of living-donor transplant. Italian guidelines allow the living donations from emotionally related donors only after clear and voluntary consent expressed by both the donor and the recipient involved. Living donation raises ethical and legal issues because donors voluntarily undergo a surgical procedure to remove a healthy kidney in order to help another person. According to the Italian standards, the assessment of living donor-recipient pair has to be conducted by a medical “third party”, completely independent from both the patients involved and the medical team treating the recipient. Starting from the Hospital “Città della Salute e della Scienza” of Turin (Italy) experience, including 116 living kidney donations, the Authors divided the evaluation process performed by the “Third-Party” Commission into four stages, with a particular attention to the potential donor. Living donation procedures should reflect fiduciary duties that healthcare providers have toward their patients, originating from the relationship of trust between physician and patient. In addition to that, the social implications are enormous if one considers the worldwide campaigns to promote public awareness about organ donation and transplantation, and to encourage people to register their organ donation decisions. The systematic process proposed here can be a tool that proactively reduces and controls the risks of coercion, organ trafficking, vitiated consent, insufficient weighting of donative choice, that could arise especially in donors involved in living kidney donation.
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Affiliation(s)
- Lucia Tattoli
- Section of Legal Medicine, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
- *Correspondence: Lucia Tattoli
| | - Davide Santovito
- Section of Legal Medicine, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Ida Marina Raciti
- Clinical Risk Management Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Antonio Scarmozzino
- Hospital Medical Direction, Ospedale Molinette, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - Giancarlo Di Vella
- Legal Medicine Unit, Department of Public Health and Pediatric Sciences, University of Turin, Turin, Italy
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Wirken L, van Middendorp H, Hooghof CW, Sanders JS, Dam R, van der Pant KAMI, Wierdsma J, Wellink H, Ulrichts P, Hoitsma AJ, Hilbrands LB, Evers AW. Combining transplant professional's psychosocial donor evaluation and donor self-report measures to optimise the prediction of HRQoL after kidney donation: an observational prospective multicentre study. BMJ Open 2022; 12:e045249. [PMID: 35236728 PMCID: PMC8895930 DOI: 10.1136/bmjopen-2020-045249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Living donor kidney transplantation is currently the preferred treatment for patients with end-stage renal disease. The psychosocial evaluation of kidney donor candidates relies mostly on the clinical viewpoint of transplant professionals because evidence-based guidelines for psychosocial donor eligibility are currently lacking. However, the accuracy of these clinical risk judgements and the potential added value of a systematic self-reported screening procedure are as yet unknown. The current study examined the effectiveness of the psychosocial evaluation by transplant professionals and the potential value of donor self-report measures in optimising the donor evaluation. Based on the stress-vulnerability model, the predictive value of predonation, intradonation and postdonation factors to impaired longer term health-related quality of life (HRQoL) of kidney donors was studied. DESIGN An observational prospective multicentre study. SETTING Seven Dutch transplantation centres. PARTICIPANTS 588 potential donors participated, of whom 361 donated. Complete prospective data of 230 donors were available. Also, 1048 risk estimation questionnaires were completed by healthcare professionals. METHODS Transplant professionals (nephrologists, coordinating nurses, social workers and psychologists) filled in risk estimation questionnaires on kidney donor candidates. Furthermore, 230 kidney donors completed questionnaires (eg, on HRQoL) before and 6 and 12 months after donation. PRIMARY AND SECONDARY OUTCOME MEASURES HRQoL, demographic and preoperative, intraoperative and postoperative health characteristics, perceived support, donor cognitions, recipient functioning and professionals risk estimation questionnaires. RESULTS On top of other predictors, such as the transplant professionals' risk assessments, donor self-report measures significantly predicted impaired longer term HRQoL after donation, particularly by poorer predonation physical (17%-28% explained variance) and psychological functioning (23%). CONCLUSIONS The current study endorses the effectiveness of the psychosocial donor evaluation by professionals and the additional value of donor self-report measures in optimising the psychosocial evaluation. Consequently, systematic screening of donors based on the most prominent risk factors provide ground for tailored interventions for donors at risk.
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Affiliation(s)
- Lieke Wirken
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
| | | | - Jan-Stephan Sanders
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Ruth Dam
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karlijn A M I van der Pant
- Department of Internal Medicine/Nephrology, Renal Transplant Unit, Amsterdam UMC, Amsterdam, The Netherlands
| | - Judith Wierdsma
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hiske Wellink
- Department of Nephrology, Amsterdam UMC VUMC Site, Amsterdam, The Netherlands
| | - Philip Ulrichts
- Department of Internal Medicine/Nephrology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Andrea W Evers
- Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands
- Department of Medical Psychology, Radboudumc, Nijmegen, The Netherlands
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Robiner WN, Petrik ML, Flaherty N, Fossum TA, Freese RL, Nevins TE. Depression, Quantified Medication Adherence, and Quality of Life in Renal Transplant Candidates and Recipients. J Clin Psychol Med Settings 2022; 29:168-184. [PMID: 34089133 PMCID: PMC8642472 DOI: 10.1007/s10880-021-09792-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 11/26/2022]
Abstract
Like patients with many chronic illnesses, ESRD patients experience psychological challenges with greater incidence of depression and reduced quality of life (QoL). A series of 139 transplant candidates' depression and QoL, and a subset of 82 candidates' medication adherence were monitored, revealing heterogenous patterns of depression and adherence and reduced QoL. Twenty-eight patients who received kidney transplants were re-evaluated 6 months post-transplant revealing mixed patterns. Mean depression and quantitated adherence decreased and QoL increased. Some patients improved whereas others declined in depression and adherence. Pre-transplant depression was negatively correlated with post-transplant adherence but positively correlated with post-transplant depression. Nevertheless, the ability to predict individuals' post-transplant adherence and depression, principal objectives of pre-transplant psychological evaluations, is limited. Consequently, it is important to provide periodic screening of ESRD patients for depression and adherence pre- and post-transplant as they reflect changing states, rather than static traits, with variable patterns across patients.
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Affiliation(s)
- William N Robiner
- Health Psychology, Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street, S.E, Minneapolis, MN, 55455, USA.
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Megan L Petrik
- Health Psychology, Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street, S.E, Minneapolis, MN, 55455, USA
| | - Nancy Flaherty
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Thyra A Fossum
- Health Psychology, Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, MMC 741, 420 Delaware Street, S.E, Minneapolis, MN, 55455, USA
| | - Rebecca L Freese
- Biostatistical Design and Analysis Center (BDAC), Clinical and Translational Science Institute (CTSI), University of Minnesota, Minneapolis, MN, USA
| | - Thomas E Nevins
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
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Birkefeld K, Bauer-Hohmann M, Klewitz F, Kyaw Tha Tun EM, Tegtbur U, Pape L, Schiffer L, Schiffer M, de Zwaan M, Nöhre M. Prevalence of Mental Disorders in a German Kidney Transplant Population: Results of a KTx360°-Substudy. J Clin Psychol Med Settings 2022; 29:963-976. [PMID: 35195827 DOI: 10.1007/s10880-022-09861-0] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/26/2022]
Abstract
In patients after kidney transplantation (KTx) an increased rate of affective and anxiety disorders has been observed. Repeatedly, a relationship between mental health issues and increased morbidity and mortality in KTx recipients has been reported. However, information on the prevalence of mental disorders in KTx patients is scarce. As part of the structured multimodal follow-up program (KTx360°), mental disorders were examined in 726 patients after KTx through structured diagnostic interviews using the Mini-DIPS Open Access. Overall, 27.5% had a current and 49.2% a lifetime mental disorder. Only 14.5% with a current mental disorder reported to be in treatment. Affected patients were younger, more often female, reported more symptoms of anxiety and depression and less perceived social support. While comparable to the rate in general population samples, the prevalence of mental disorders should attract attention. The low treatment rate requires an improved identification of afflicted patients and provision of specialist treatment.ISRCTN registry, https://doi.org/10.1186/ISRCTN29416382 , date of registry: 03.05.2017.
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Affiliation(s)
- Katrin Birkefeld
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Institute of Legal Medicine and Forensic Sciences, Charité-Universiätsmedizin, Berlin, Germany
| | - Maximilian Bauer-Hohmann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
| | - Felix Klewitz
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
| | - Eva-Marie Kyaw Tha Tun
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Uwe Tegtbur
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Sports Medicine, Hannover Medical School, Hannover, Germany
| | - Lars Pape
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
- Department of Pediatrics II, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
| | - Lena Schiffer
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Mario Schiffer
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
- Department of Nephrology and Hypertension, University Hospital Erlangen, Erlangen, Germany
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany
| | - Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
- Project Kidney Transplantation 360° (NTx360°), Hannover Medical School, Hannover, Germany.
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Grubman-Nowak M, DĘbska-ŚlizieŃ A, Renke M. Employment after renal transplantation vs. the health locus of control and the quality of life. Int J Occup Med Environ Health 2022; 35:53-62. [PMID: 34533137 PMCID: PMC10464777 DOI: 10.13075/ijomeh.1896.01765] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 05/12/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES The aim of the presented study was to compare the health locus of control (HLC) between employed and unemployed patients after kidney transplantation (KT), and to investigate the relationship between HLC and the quality of life (QoL). MATERIAL AND METHODS The study group consisted of 101 KT patients and the control group of 60 hemodialysis (HD) patients. The applied methods were: the Multidimensional Health Locus of Control Questionnaire (MHLC), the WHO Quality of Life Questionnaire (WHOQoL-BREF), and a survey collecting information on the socio-demographic status and work experience. RESULTS Overall, 57.5% of KT patients were employed and 42.5% were unemployed. In the HD group, 25% were employed and 71% were unemployed, while 4% did not disclose their employment status. The unemployed KT patients, in comparison with the employed ones, presented a higher feeling of the impact of chance on their health (unemployed M±SD 23.68±6.59; employed M±SD 21.02±4.57) and a lower level of QoL on the Somatic Scale (unemployed Me = 14.00, IQR = 3.00; employed Me = 1450, IQR = 3.00) and the Environmental Scale (unemployed M±SD 15.39±2.83; employed M±SD 16.85±3.24). In the employed KT group, the Internal Control Scale (MHLC) correlated with all QoL scales (the Somatic Scale: r = 0.292, p = 0.036; the Psychological Scale: r = 0.455, p = 0.001; the Social Scale: r = 0.304, p = 0.029; and the Environmental Scale: r = 0.307, p = 0.027). In the unemployed KT group, the Internal Control Scale (MHLC) correlated significantly with the Somatic Scale (r = 0.396, p = 0.013) and the Psychological Scale (r = 0.374, p = 0.019). CONCLUSIONS The employed KT patients have a higher level of independence, with results indicating a strong internal type. Additionally, the working patients assess their QoL better, both in terms of their health condition and the organization of satisfying environment. The obtained knowledge about the psychological characteristics of KT patients may be useful for the occupational activation programs and psycho-education for those with weaker predispositions. Int J Occup Med Environ Health. 2022;35(1):53-62.
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Affiliation(s)
- Marta Grubman-Nowak
- Medical University of Gdańsk, Clinic of Occupational, Metabolic and Internal Diseases, Gdańsk, Poland
| | - Alicja DĘbska-ŚlizieŃ
- Medical University of Gdańsk, Department of Nephrology, Transplantology and Internal Diseases, Gdańsk, Poland
| | - Marcin Renke
- Medical University of Gdańsk, Clinic of Occupational, Metabolic and Internal Diseases, Gdańsk, Poland
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The experiences of living with a transplanted kidney from a deceased donor. J Ren Care 2021; 47:E1. [PMID: 33625780 DOI: 10.1111/jorc.12370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Urstad KH, Wahl AK, Moum T, Engebretsen E, Andersen MH. Renal recipients' knowledge and self-efficacy during first year after implementing an evidence based educational intervention as routine care at the transplantation clinic. BMC Nephrol 2021; 22:265. [PMID: 34266414 PMCID: PMC8284003 DOI: 10.1186/s12882-021-02468-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/30/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Following an implementation plan based on dynamic dialogue between researchers and clinicians, this study implemented an evidence-based patient education program (tested in an RCT) into routine care at a clinical transplant center. The aim of this study was to investigate renal recipients' knowledge and self-efficacy during first year the after the intervention was provided in an everyday life setting. METHODS The study has a longitudinal design. The sample consisted of 196 renal recipients. Measurement points were 5 days (baseline), 2 months (T1), 6 months (T2), and one-year post transplantation (T3). Outcome measures were post-transplant knowledge, self-efficacy, and self-perceived general health. RESULTS No statistically significant changes were found from baseline to T1, T2, and T3. Participants' levels of knowledge and self-efficacy were high prior to the education program and did not change throughout the first year post transplantation. CONCLUSION Renal recipients self-efficacy and insight in post-transplant aspects seem to be more robust when admitted to the hospital for transplantation compared to baseline observations in the RCT study. This may explain why the implemented educational intervention did not lead to the same positive increase in outcome measures as in the RCT. This study supports that replicating clinical interventions in real-life settings may provide different results compared to results from RCT's. In order to gain a complete picture of the impacts of an implemented intervention, it is vital also to evaluate results after implementing findings from RCT-studies into everyday practice.
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Affiliation(s)
- Kristin Hjorthaug Urstad
- Faculty of Health Sciences, Department of Quality and Health Technology, University of Stavanger, 4036, Stavanger, Norway.
| | - Astrid Klopstad Wahl
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Moum
- Faculty of Medicine, Department of Behavioural Sciences in Medicine, University of Oslo, Oslo, Norway
| | - Eivind Engebretsen
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
| | - Marit Helen Andersen
- Faculty of Medicine, Department of Health Sciences, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
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Abstract
Health-related quality of life (HRQOL) of kidney transplant recipients is an outcome evaluation after kidney transplants. Therefore, we investigated the associations among perceived health status, social support, self-determination, post-traumatic growth, and kidney transplant recipients' HRQOL. This study involved a descriptive, self-report survey of 163 kidney transplant recipients visiting an outpatient solid organ transplant center in South Korea. Participants' general and transplant characteristics, perceived health status, post-traumatic growth, social support, self-determination, and HRQOL were collected. Data were statistically analyzed using the software SPSS version 25.0. HRQOL showed statistically significant positive correlation with perceived health status (r = .56, p < .001), post-traumatic growth (r = .18, p = .022), social support (r = .25, p = .002), and self-determination (r = .36, p < .001). The factors affecting HRQOL were perceived health status (β = 0.47, p < 0.001), post-transplant occupation (β = 0.17, p = 0.009), and income source (β = -0.13, p = 0.046). The explanatory power of these variables was 34.8% (F = 28.81, p < 0.001). In the subdomains of HRQOL, the factors influencing HRQOL of mental component summary were perceived health status (β = 0.45, p < 0.001), self-determination (β = 0.27, p < 0.001), and education level (β = 0.18, p = 0.006). The explanatory power of these variables was 34.8% (F = 28.81, p < 0.001). To promote the HRQOL of kidney transplant recipients, an institutional system to assist kidney transplant recipients in returning to work needs to be developed. Additionally, creating an environment that allows kidney transplant recipients to act with self-determination, and developing intervention programs that can enhance self-determination will contribute to enhancing the HRQOL of kidney transplant recipients.
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Affiliation(s)
- Younghui Hwang
- Department of Nursing, College of Medicine, University of Ulsan, Ulsan, Korea
| | - Misook Kim
- Department of Mental Health Nursing, Seoul National University, Seoul, Korea
| | - Kyoungok Min
- Transplant Center, Department of Nursing, Seoul National University Hospital, Seoul, South Korea
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Boima V, Agyabeng K, Ganu V, Dey D, Yorke E, Amissah-Arthur MB, Wilson AA, Yawson AE, Mate-Kole CC, Nonvignon J. Willingness to pay for kidney transplantation among chronic kidney disease patients in Ghana. PLoS One 2020; 15:e0244437. [PMID: 33378327 PMCID: PMC7773273 DOI: 10.1371/journal.pone.0244437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Kidney transplantation is the preferred treatment for patients with end stage renal disease. However, it is largely unavailable in many sub-Sahara African countries including Ghana. In Ghana, treatment for end stage renal disease including transplantation, is usually financed out-of-pocket. As efforts continue to be made to expand the kidney transplantation programme in Ghana, it remains unclear whether patients with Chronic Kidney Disease (CKD) would be willing to pay for a kidney transplant. AIM The aim of the study was to assess CKD patients' willingness to pay for kidney transplantation as a treatment option for end stage renal disease in Ghana. METHODS A facility based cross-sectional study conducted at the Renal Outpatient clinic and Dialysis Unit of Korle-Bu Teaching Hospital among 342 CKD patients 18 years and above including those receiving haemodialysis. A consecutive sampling approach was used to recruit patients. Structured questionnaires were administered to obtain information on demographic, socio-economic, knowledge about transplant, perception of transplantation and willingness to pay for transplant. In addition, the INSPIRIT questionnaire was used to assess patients' level of religiosity and spirituality. Contingent valuation method (CVM) method was used to assess willingness to pay (WTP) for kidney transplantation. Logistic regression model was used to determine the significant predictors of WTP. RESULTS The average age of respondents was 50.2 ± 17.1 years with most (56.7% (194/342) being male. Overall, 90 out of the 342 study participants (26.3%, 95%CI: 21.7-31.3%) were willing to pay for a kidney transplant at the current going price (≥ $ 17,550) or more. The median amount participants were willing to pay below the current price was $986 (IQR: $197 -$1972). Among those willing to accept (67.3%, 230/342), 29.1% (67/230) were willing to pay for kidney transplant at the prevailing price. Wealth quintile, social support in terms of number of family friends one could talk to about personal issues and number of family members one can call on for help were the only factors identified to be significantly predictive of willingness to pay (p-value < 0.05). CONCLUSION The overall willingness to pay for kidney transplant is low among chronic kidney disease patients attending Korle-Bu Teaching Hospital. Patients with higher socio-economic status and those with more family members one can call on for help were more likely to pay for kidney transplantation. The study's findings give policy makers an understanding of CKD patients circumstances regarding affordability of the medical management of CKD including kidney transplantation. This can help develop pricing models to attain an ideal poise between a cost effective but sustainable kidney transplant programme and improve patient access to this ultimate treatment option.
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Affiliation(s)
- V. Boima
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - K. Agyabeng
- Departments of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - V. Ganu
- Department of Medicine and therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana
| | - D. Dey
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - E. Yorke
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - M. B. Amissah-Arthur
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
| | - A. A. Wilson
- Departemnt of Public Health, Greater Accra regional Hospital, Ghana Health Service, Accra, Ghana
| | - A. E. Yawson
- Departments of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - C. C. Mate-Kole
- Department of Medicine and Therapeutics University of Ghana Medical School, College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Psychology/Center for ageing studies, College of Humanities, University of Ghana, Legon, Ghana
| | - J. Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Yang FC, Chen HM, Pong SC, Chen CH, Wang SS, Chen CM. Difficulties and Coping Strategies of Kidney-transplant Recipients During Their Dark Postoperative Recovery Stage After Returning Home. Transplant Proc 2020; 52:3226-3230. [PMID: 32636069 DOI: 10.1016/j.transproceed.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/12/2020] [Accepted: 05/12/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Kidney Transplantation (KT) is the best treatment for end-stage renal disease to prolong patients' lives. To improve patients' postoperative survival rate and quality of life, postoperative care at home is vital. We explored the difficulties faced and coping strategies used by KT recipients during their dark postoperative recovery stage at home. METHODS This qualitative, exploratory study used a purposive sample, which was obtained from a leading medical center in Taiwan. We used a semi-structured interview guide to collect data through in-depth, face-to-face interviews. Data were content analyzed. RESULTS Fifty individuals were approached and agreed to participate (30 men, 20 women). Participants' post-KT timeframe ranged from 2 to 28 years. Seven difficulties were reported: 1. physical discomfort and treatment side-effects; 2. concern about the impact of transplant failure; 3. uncertainty about the future; 4. unbearable economic pressure; 5. concerns about becoming a family burden; 6. feeling that life lacks a purpose; and 7. feeling isolated. Coping strategies included 1. seeking assistance from health care professionals, 2. thinking positively, 3. changing one's lifestyle, 4. setting goals to divert attention, 5. seeking psychological, and 6. seeking spiritual support. CONCLUSIONS By elucidating KT recipients' adaptability and coping strategies, we hope to improve their quality of life at home. Health care professionals should be aware of the difficulties faced by patients during their dark postoperative recovery stage and promote effective coping strategies. This study informs future research and has implications concerning the effective coordination of transplant medical teams.
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Affiliation(s)
- Fu-Chi Yang
- College of General Education, National Chin-Yi University of Technology, Taichung, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiao-Mei Chen
- Department of Nursing, Chung Shan Medical University, Taichung, Taiwan
| | - Su-Chen Pong
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Cheng-Hsu Chen
- Division of Nephrology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Life Science, Tunghai University, Taichung, Taiwan
| | - Shoei-Shen Wang
- Department of Surgery, National Taiwan University Hospital, and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Surgery, Fu Jen Catholic University Hospital, and School of Medicine, Fu Jen Catholic University College of Medicine, New Taipei City, Taiwan.
| | - Ching-Min Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Basiri A, Taheri M, Khoshdel A, Golshan S, Mohseni-rad H, Borumandnia N, Simforoosh N, Nafar M, Aliasgari M, Nourbala MH, Pourmand G, Farhangi S, Khalili N. Living or deceased-donor kidney transplant: the role of psycho-socioeconomic factors and outcomes associated with each type of transplant. Int J Equity Health 2020; 19:79. [PMID: 32487079 PMCID: PMC7268666 DOI: 10.1186/s12939-020-01200-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 05/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Kidney transplant improves patients' survival and quality of life. Worldwide, concern about the equality of access to the renal transplant wait-list is increasing. In Iran, patients have the choice to be placed on either the living or deceased-donor transplant wait-list. METHODS This was a prospective study performed on 416 kidney transplant recipients (n = 217 (52.2%) from living donors and n = 199 (47.8%) from deceased donors). Subjects were recruited from four referral kidney transplant centers across Tehran, Iran, during 2016-2017. The primary outcome was to identify the psycho-socioeconomic factors influencing the selection of type of donor (living versus deceased). Secondary objective was to compare the outcomes associated with each type of transplant. The impact of psycho-socioeconomic variables on selecting type of donor was evaluated by using multiple logistic regression and the effect of surgical and non-surgical variables on the early post-transplant creatinine trend was assessed by univariate repeated measure ANOVA. RESULTS Based on standardized coefficients, the main predictors for selecting living donor were academic educational level (adjusted OR = 3.25, 95% CI: 1.176-9.005, p = 0.023), psychological status based on general health questionnaire (GHQ) (adjusted OR = 2.46, 95% CI: 1.105-5.489, p = 0.028), and lower monthly income (adjusted OR = 2.20, 95% CI: 1.242-3.916, p = 0.007). The waiting time was substantially shorter in patients who received kidneys from living donors (p < 0.001). The early post-transplant creatinine trend was more desirable in recipients of living donors (β = 0.80, 95% CI: 0.16-1.44, p-value = 0.014), patients with an ICU stay of fewer than five days (β = - 0.583, 95% CI: - 0.643- -0.522, p-value = < 0.001), and those with less dialysis duration time (β = 0.016, 95% CI: 0.004-0.028, p-value = 0.012). Post-operative surgical outcomes were not different across the two groups of recipients (p = 0.08), however, medical complications occurred considerably less in the living-donor group (p = 0.04). CONCLUSION Kidney transplant from living donors was associated with shorter transplant wait-list period and better early outcome, however, inequality of access to living donors was observed. Patients with higher socioeconomic status and higher level of education and those suffering from anxiety and sleep disorders were significantly more likely to select living donors.
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Affiliation(s)
- Abbas Basiri
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Taheri
- Urology and Nephrology Research Center (UNRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khoshdel
- Modern Epidemiology Research Center, Aja University of Medical Sciences, Tehran, Iran
| | - Shabnam Golshan
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Mohseni-rad
- Department of Urology, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center (UNRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nasser Simforoosh
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Nafar
- Chronic Kidney Disease Research Center, Urology and Nephrology Research Center, Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Aliasgari
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Gholamreza Pourmand
- Urology Research Center, Ibin Sina Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Nastaran Khalili
- Urology and Nephrology Research Center (UNRC), Shahid Labbafinejad Medical Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Milaniak I, Rużyczka EW, Dębska G, Król B, Wierzbicki K, Tomaszek L, Przybyłowski P. Level of Life Quality in Heart and Kidney Transplant Recipients: A Multicenter Study. Transplant Proc 2020; 52:2081-2086. [PMID: 32471630 DOI: 10.1016/j.transproceed.2020.03.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 03/04/2020] [Accepted: 03/30/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The main objective of the researchers was to determine the level of life quality among heart and kidney transplant recipients depending on the time and type of the transplant. METHODS The study was conducted using standardized questionnaires: the 36-Item Short-Form Health Survey, Life Orientation Test-Revised, and Hospital Anxiety and Depression Scale. The study included 146 recipients (109 heart transplant recipients and 37 kidney transplant recipients) from 1 to 26 years after the transplantation surgery (mean 9 years). RESULTS The mean age of the study group was 52 years. The mean time since organ transplantation was 10 years for heart transplantation and 4.3 years for kidney transplantation. The study group obtained a slightly lower score for quality of life compared to the general population. In the Physical Component Summary (PCS), the study participants obtained the highest mean for the domain bodily pain (47.6), while the lowest score was in the domain role physical (41.82). As for the Mental Component Summary (MCS), the highest mean was obtained for the domain vitality (50.57), whereas the lowest one was for the domain role emotional (43.38). In 33% of the participants, risk of depression was identified. Statistically significant differences were observed depending on the type of the transplanted organ in the PCS for the domains general health, physical functioning, and bodily pain and the MCS for role emotional and social functioning. The statistically significant predictors for the PCS domain were the type of transplanted organ, recipients' age, and occurrence of anxiety. In turn, the predictor for the MCS was the occurrence of depression. CONCLUSIONS The quality of life (QOL) assessment varies between kidney and heart transplant recipients. The QOL is determined by the recipients' age and the occurrence of anxiety and depression. The obtained QOL assessment results are slightly lower than those in the general population.
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Affiliation(s)
- Irena Milaniak
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland; Department of Cardiovascular and Transplantology, John Paul II Hospital, Krakow, Poland.
| | - Ewa Wilczek Rużyczka
- Faculty of Psychology, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Grażyna Dębska
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Bogumiła Król
- Department of Cardiac Surgery, Transplantology, Vascular and Endovascular, Silesian Centre for Heart Diseases in Zabrze, Zabrze, Poland
| | - Karol Wierzbicki
- Department of Cardiovascular and Transplantology, John Paul II Hospital, Krakow, Poland; Collegium Medicum, Jagiellonian University Krakow, Poland
| | - Lucyna Tomaszek
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Piotr Przybyłowski
- Department of Cardiac Surgery, Transplantology, Vascular and Endovascular, Silesian Centre for Heart Diseases in Zabrze, Zabrze, Poland; Collegium Medicum, Jagiellonian University Krakow, Poland
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Nonterah CW, Gardiner HM. Pre-transplant evaluation completion for Black/African American renal patients: Two theoretical frameworks. Patient Educ Couns 2020; 103:988-998. [PMID: 31733984 DOI: 10.1016/j.pec.2019.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Black/African Americans (B/AA) are less likely to complete the pre-transplant evaluation for kidney transplantation despite higher prevalence rates of end-stage renal disease (ESRD). To better understand the barriers and motivators to completing the evaluation process, two qualitative studies were conducted to categorize and elucidate the relationships between these factors. METHODS In Phase I, semi-structured interviews were conducted with a stratified purposeful sample of transplant professionals (N = 23). Focus groups were conducted during Phase II with a purposeful sample of B/AA patients (N = 30). RESULTS Thematic analyses assessed using grounded theory revealed a multitude of factors at individual and systemic levels, including health and informational/educational-related factors. Two comprehensive theoretical frameworks, a socio-ecological model of barriers and a model of motivators are presented. Medical mistrust is an example of a community factor identified as impeding completion rates. Systemic motivators included compressed time for testing and fewer intervals between doctor's appointments. CONCLUSIONS This study offers a structure for understanding impediments to and facilitators of pre-transplant evaluation completion as seen through the eyes of both B/AA ESRD patients seeking transplant and the providers who work with them. PRACTICE IMPLICATIONS Recommendations for intervention and systemic changes to narrow health disparities are discussed.
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Affiliation(s)
- Camilla W Nonterah
- University of Richmond, 114 UR Drive, Richmond, 23173-0001, United States.
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Wesolowska-Gorniak K, Wojtowicz M, Gierus J, Czarkowska-Paczek B. The correlation of patients' anxiety after a liver or kidney transplantation with functional and self-reported work ability. Medicine (Baltimore) 2020; 99:e20108. [PMID: 32358401 PMCID: PMC7440135 DOI: 10.1097/md.0000000000020108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Organ transplantation has become the treatment of choice for end-stage organ failure, including renal and liver failure. The benefits of patient employment after transplantation are numerous, but factors determining the ability to work among these patients are not clearly defined. The growing interest in these factors has strong practical implications for organizations creating vocational rehabilitation programs. Given the interconnection between psychological and physical functioning in patients after transplantation, the present study examined the impact of anxiety on vocational rehabilitation and its relationship with functional tests. A total of 100 patients after liver or kidney transplantation underwent functional tests, including the 6-minute walking test and 30-second chair stand test (30"CST), and psychological tests, specifically the Inventory of Physical Activity Objectives, Work Ability Index, and State-Train Anxiety Inventory. Working ability was affected by psychological factors. State and trait anxiety exhibited inverse relationships with subjective readiness to occupational activity (P < .001, r = -.59 and P < .001, r = -.56, respectively). The level of anxiety was negatively related to the results of the 30"CST. State-Train Anxiety Inventory, State Anxiety subscale and State-Train Anxiety Inventory, State-Trait Anxiety subscale vs 30"CST: P < .001, r = -.43 P < .001, r = -.44). Thus, state and trait anxiety influence perceived work ability and partially functional status. These observations may indicate the potential benefits of including psychologists in interdisciplinary teams for physical and especially vocational rehabilitation of patients after liver or kidney transplantation.
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Affiliation(s)
| | - Monika Wojtowicz
- Department of Immunology, Transplantology, and Internal Diseases, Warsaw
| | - Jacek Gierus
- Clinic of Psychiatry, Medical University of Warsaw, Pruszkow, Poland
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Jones J, Damery S, Allen K, Nicholas J, Baharani J, Combes G. 'You have got a foreign body in there': renal transplantation, unexpected mild-to-moderate distress and patients' support needs: a qualitative study. BMJ Open 2020; 10:e035627. [PMID: 32234745 PMCID: PMC7170619 DOI: 10.1136/bmjopen-2019-035627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore why transplant patients experience unexpected mild-to-moderate distress and what support they may need. DESIGN Qualitative study using individual in-depth interviews. SETTING Four National Health Service (NHS) Trusts in the Midlands, UK. PARTICIPANTS Fifteen renal transplant patients meeting the criteria for mild-to-moderate distress from their responses to emotion thermometers. MAIN OUTCOME MEASURES Identification of the reasons for distress and support options acceptable to renal transplant patients. RESULTS Three themes were interpreted from the data: 'I am living with a "foreign body" inside me', 'why am I distressed?' and 'different patients want different support'. Following their transplant, participants felt that they should be happy and content, but this was often not the case. They described a range of feelings about their transplant, such as uncertainty about the lifespan of their new kidney, fear of transplant failure or fear of the donor having health conditions that may transfer to them. A few experienced survivors' guilt when others they had met at the dialysis unit had not received a transplant or because someone had died to enable them to receive the transplant. No longer having regular contact with the renal unit made participants feel isolated. Some participants did not initially attribute the source of their distress to their transplant. Participants' preferred support for their distress and their preferences about who should deliver it varied from peer support to seeing a psychologist. CONCLUSIONS Raising the issue of post-transplant mild-to-moderate distress with patients and encouraging them to think about and plan coping strategies pretransplant may prove beneficial for the patient and healthcare provider. Patients should be able to choose from a variety of support options.
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Affiliation(s)
- Janet Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Johann Nicholas
- Renal Unit, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, Shropshire, UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Liu KL, Wang HH, Hsieh CY, Huang XY, Lin CT, Lin KJ, Chiang YJ, Chien CH. Kidney Donation Withdrawal and Related Factors Among the Potential Donors of Living Kidney Transplant. Transplant Proc 2020; 52:73-77. [PMID: 31901327 DOI: 10.1016/j.transproceed.2019.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to discuss the reasons for kidney donation withdrawal and related factors among the potential donors of living kidney transplant. METHODS This study was conducted in outpatient departments with purposive sampling. Potential donors received relevant examinations and completed questionnaires when they would donate their kidneys for living related kidney transplant. Researchers tracked the final decision of potential donors. The structured questionnaire included basic data, psychosocial adjustment to illness scale, and decisional conflict scale. RESULTS A total of 53 potential donors participated in this study, 46 of whom completed the kidney donation surgery (86.6%). The factors related to the final decision of kidney donation or kidney donation withdrawal included self-ranking health condition, value clarity, feeling supported in decision making, and overall decisional conflict. CONCLUSION Organ transplant teams should conduct a complete physical and psychological assessment of potential donors, provide information and support, and assist potential donors to clarify their true values and willingness to undergo kidney donation. Thus, each potential donor can decide to donate in true accordance with their willingness.
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Affiliation(s)
- Kuan-Lin Liu
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Hsu-Han Wang
- Department of Urology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; Organ Transplantation Institute, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chin-Yi Hsieh
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
| | - Xuan-Yi Huang
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chih-Te Lin
- Department of Urology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
| | - Kuo-Jen Lin
- Department of Urology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; Organ Transplantation Institute, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yang-Jen Chiang
- Department of Urology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; Organ Transplantation Institute, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ching-Hui Chien
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Wang H, Du C, Liu H, Zhang S, Wu S, Fu Y, Zhao J. Exploration of symptom experience in kidney transplant recipients based on symptoms experience model. Qual Life Res 2020; 29:1281-1290. [PMID: 31898113 DOI: 10.1007/s11136-019-02404-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE Kidney transplant recipients suffer from a variety of symptoms, and symptom management is crucial in improving their quality of life (QOL). Accordingly, this study aims to identify the symptoms experienced by kidney transplant recipients and examine the relationship amongst antecedents, symptom experience and QOL of recipients in China. METHODS A total of 300 kidney transplant recipients were investigated in one of the most first-rate hospitals in China by asking them to fill out a self-designed general questionnaire, the Symptom Experience Scale, the Sense of Coherence Scale (Chinese version), the Revised Life Orientation Test (Chinese version) and the 36-item Short Form Health Survey (Chinese version). RESULTS Kidney transplant recipients experienced multiple symptoms that were frequent, severe and bothersome. The final model showed significant consistency with the data. In the QOL model, post-transplant time, complications, immunosuppressive agents and sense of coherence explained 30.7% of the variance of symptom experience. Moreover, habitual residence, economic burden, post-transplant time, kidney function, optimism and symptom experience accounted for 70.6% of the variance on QOL. CONCLUSIONS We can explain the relationship between antecedents, symptom experience and QOL amongst Chinese kidney transplant recipients by using Symptoms Experience Model. Clinicians and caregivers can manage the recipient's symptoms during follow-up from psychological, physical and medication management perspectives. Improving sense of coherence, maintaining optimism and managing symptoms are essential for enhancing QOL.
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Affiliation(s)
- Han Wang
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Chunyan Du
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Hongxia Liu
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China.
| | - Shuping Zhang
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Sisi Wu
- School of Nursing, Beijing University of Chinese Medicine, Intersection of Yangguang South Street and Baiyang East Road, Fang Shan District, Beijing, 102488, China
| | - Yingxin Fu
- Organ Transplant Centre, Tianjin First Central Hospital, Tianjin, China
| | - Jie Zhao
- Organ Transplant Centre, Tianjin First Central Hospital, Tianjin, China
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Leal-Costa C, Ramos-Morcillo AJ, Martínez Zaragoza F, Bernabeu Juan P, Rodríguez-Marín J, Ruzafa-Martínez M, van-der Hofstadt Román CJ. Personality and psychopathology in potential live kidney donors: A cluster analysis of personality features. PLoS One 2019; 14:e0221222. [PMID: 31412089 PMCID: PMC6693753 DOI: 10.1371/journal.pone.0221222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background The previous psychosocial evaluation of the potential living kidney donors (PLKD) requires a detailed understanding of the psychosocial benefits and the possible damages of the act of donation. Objective The aim was to create clusters by using the clinical patterns of personality and to evaluate their influence on psychopathological variables. Methods Observational, analytical and cross-sectional study that included the PLKD from February 2009 to March 2017. The patients were referred to the Hospital Psychology Unit by the Transplant Coordination Unit. The total sample was composed of 100 participants. The socio-demographic characteristics, the relationship with the recipient and the Millon Clinical Multiaxial Inventory were included. Results The final sample was composed by 100 PLKD. The mean age of the participants was 45.70, and most were women (70%). The analysis showed a final result of 3 personality clusters that best represented the data, in agreement with the DSM-5 classification. The PLKD from cluster 3 obtained greater scores in all the clinical syndromes. Conclusions The personality evaluation of the PLKD could help with the planning of monitoring protocols of the participants who were classified to cluster 3, in order to improve their post-transplant psychosocial adjustment. This result makes us consider the usefulness of the psychosocial evaluation to preserve the psychological health of the PLKD.
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Affiliation(s)
- César Leal-Costa
- Nursing Department, Faculty of Nursing, University of Murcia, Murcia, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL—Fundación FISABIO), Alicante, Spain
| | | | | | | | - Jesús Rodríguez-Marín
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL—Fundación FISABIO), Alicante, Spain
- Health Psychology Department, Miguel Hernandez University (UMH), Elche, Spain
- Hospital Psychology Unit, University Hospital of Alicante, Alicante, Spain
| | | | - Carlos Javier van-der Hofstadt Román
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL—Fundación FISABIO), Alicante, Spain
- Health Psychology Department, Miguel Hernandez University (UMH), Elche, Spain
- Hospital Psychology Unit, University Hospital of Alicante, Alicante, Spain
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Brito DCSD, Machado EL, Reis IA, Carmo LPDFD, Cherchiglia ML. Depression and anxiety among patients undergoing dialysis and kidney transplantation: a cross-sectional study. SAO PAULO MED J 2019; 137:137-147. [PMID: 31314874 PMCID: PMC9721231 DOI: 10.1590/1516-3180.2018.0272280119] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 01/28/2019] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Depression and anxiety are the most prevalent psychological disorders among end-stage renal disease patients and are associated with various conditions that result in poorer health outcomes, e.g. reduced quality of life and survival. We aimed to investigate the prevalences of depression and anxiety among patients undergoing renal replacement therapy. DESIGN AND SETTING Cross-sectional study in Belo Horizonte, Brazil. METHODS Patients' depression and anxiety levels were assessed using the Beck Inventory. The independent variables were the 36-Item Short-Form Health Survey (SF-36), Charlson Comorbidity Index and Global Subjective Assessment, along with sociodemographic and clinical characteristics. RESULTS 205 patients were included. Depression and anxiety symptoms were detected in 41.7% and 32.3% of dialysis patients and 13.3% and 20.3% of transplantation patients, respectively. Lower SF-36 mental summary scores were associated with depression among transplantation patients (odds ratio, OR: 0.923; 95% confidence interval, CI: 0.85-0.99; P = 0.03) and dialysis patients (OR: 0.882; 95% CI: 0.83-0.93; P ≤ 0.001). Physical component summary was associated with depression among dialysis patients (OR: 0.906; 95% CI: 0.85-0.96; P = 0.001). Loss of vascular access (OR: 3.672; 95% CI: 1.05-12.78; P = 0.04), comorbidities (OR: 1.578; 95% CI: 1.09-2.27; P = 0.01) and poorer SF-36 mental (OR: 0.928; 95% CI: 0.88-0.97; P = 0.002) and physical (OR: 0.943; 95% CI: 0.89-0.99; P = 0.03) summary scores were associated with anxiety among -dialysis patients. CONCLUSIONS Depression and anxiety symptoms occurred more frequently among patients undergoing dialysis. Quality of life, comorbidities and loss of vascular access were associated factors.
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Affiliation(s)
- Daniela Cristina Sampaio de Brito
- MSc. Psychologist and Doctoral Student, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Elaine Leandro Machado
- MD, PhD. Psychologist and Professor, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG); and Researcher, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Ilka Afonso Reis
- MD, PhD. Statistician and Professor, Department of Statistics, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG); and Researcher, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Lilian Pires de Freitas do Carmo
- MD, PhD. Doctor and Professor, Department of Internal Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
| | - Mariangela Leal Cherchiglia
- MD, PhD. Doctor and Professor, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG); and Coordinator, Research Group on Economy and Health, Department of Preventive and Social Medicine, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte (MG), Brazil
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Wesolowska-Gorniak K, Wojtowicz M, Gierus J, Wlodarczyk E, Federowicz M, Czarkowska-Paczek B. Multivariate analysis of biopsychosocial determinants of professional activity among patients after kidney or liver transplantation in Poland. BMJ Open 2019; 9:e029501. [PMID: 31292184 PMCID: PMC6624034 DOI: 10.1136/bmjopen-2019-029501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE The aim of the present study was to assess the employment rate among kidney and liver transplant recipients in Poland and identify the predictors of employment. SETTINGS The study was based on a self-prepared questionnaire containing five parts: demographic data and professional, medical, physical and psychological factors. This is a multicentre study involving four hospitals in Poland. PARTICIPANTS The investigated group consisted of 285 individuals (92 women and 185 men; 8 no sex given) aged between 18 and 45 years who underwent kidney or liver transplantation 1-5 years prior. Because of missing data, 279 questionnaires were considered regarding employment status after transplantation and 277 when sex differences were considered. RESULTS A total of 120 patients (43%) worked full-time, 42 (15%) part-time and 117 (42%) remained unemployed, with a higher employment rate post-transplantation among men than women (60% vs 55%, p=0.04). More women performed white collar work (74% vs 41%, p=0.0003) and had to modify their working position than men (22% vs 7%, p=0.0118). Factors determining employment after transplantation included higher level of education (OR=27.08; p=0.0096), employment 1 year prior to transplantation (OR=11.05; p<0.001) and good psychological adaptation (OR=4.23; p<0.001). Men working the year before transplantation had higher education (OR=9.66; p=0.0356). Among men, more kidney recipients worked compared with liver recipients (OR=3.567; p=0.0417). Among women, age determined employment status (OR=0.89; p=0.0234). CONCLUSION Higher education is the most important predictor of employment after transplantation. Therefore, rehabilitation programmes including vocational activity should be directed to increase the level of education, both pretransplantation and post-transplantation if possible.
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Affiliation(s)
| | - Monika Wojtowicz
- Department of Immunology, Transplantology, and Internal Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Gierus
- Clinic of Psychiatry, Medical University of Warsaw, Pruszkow, Poland
| | - Elzbieta Wlodarczyk
- Department of Geriatrics, Collegium Medicum, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
| | - Magdalena Federowicz
- Department of Rehabilitation, Central Teaching Clinical Hospital in Warsaw, Warsaw, Poland
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Senses Dinc G, Cak T, Cengel Kultur E, Bilginer Y, Kul M, Topaloglu R. Psychiatric morbidity and different treatment modalities in children with chronic kidney disease. Arch Pediatr 2019; 26:263-267. [PMID: 31278026 DOI: 10.1016/j.arcped.2019.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Revised: 01/15/2019] [Accepted: 05/30/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Chronic kidney disease (CKD) is a potentially life-threatening condition leading to various psychosocial problems associated with different treatment modalities in addition to their medical advantages and disadvantages. The aim of this study was to evaluate the psychiatric morbidity in children with CKD in terms of different treatment modalities in comparison to healthy peers. In addition, parental attitudes and psychiatric symptoms in this group of mothers were examined. POPULATION AND METHODS A matched cohort study including 66 children with CKD (21 renal transplantation, 27 dialysis, 18 conservative treatment) and 37 healthy age- and sex-matched controls were evaluated. Children filled out the Children's Depression Inventory, the State-Trait Anxiety Inventory, and the Parental Attitude Scale, and the mothers filled out the Symptom Checklist-90-R. The Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version was used for psychiatric diagnosis. RESULTS The overall depression scores in children and the mothers' overall symptom severity index were significantly higher in the CKD group: 40.9% of children in the CKD group were diagnosed with a psychiatric disorder, while the corresponding figure for the control group was 16.2%. The in-group comparison of the CKD group failed to detect any significant difference between the three treatment modalities. CONCLUSION The results support the findings of research showing that CKD has high psychiatric morbidity. It is important to include psychosocial and psychiatric assessments in the evaluation processes of different treatment modalities in CKD.
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Affiliation(s)
- G Senses Dinc
- Clinics of Child and Adolescent Psychiatry, Ministry of Health Ankara Children's Health and Pediatric Hematology- Oncology Training and Research Hospital, Ankara, Turkey.
| | - T Cak
- Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - E Cengel Kultur
- Department of Child and Adolescent Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Y Bilginer
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - M Kul
- Mersin Child Hospital, Clinic of Child and Adolescent Psychiatry, Mersin, Turkey
| | - R Topaloglu
- Division of Pediatric Nephrology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Adamczuk D, Roszkowska-Blaim M, Leszczyńska B, Pańczyk-Tomaszewska M. Life activity, disease acceptance and quality of life in patients treated with renal replacement therapy since childhood. ADV CLIN EXP MED 2019; 28:871-878. [PMID: 30968610 DOI: 10.17219/acem/94070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Advances in the treatment of chronic kidney disease (CKD) resulted in expanding therapy goals from simple prolongation of life to a return to normal social functioning and having an active and satisfactory life after reaching adulthood. OBJECTIVES The aim of the study was to evaluate life activity, disease acceptance (DA) and quality of life (QOL) in patients with end-stage renal disease (ESRD) treated with renal replacement therapy (RRT) since childhood. MATERIAL AND METHODS We surveyed 117 patients aged .16 years on RRT since childhood. The control group included 25 healthy subjects. We used questionnaires that included a sociodemographic questionnaire (questions regarding education, work, family, and offspring), Acceptance of Illness Scale (AIS), Satisfaction With Life Scale, and Kidney Disease Quality of Life (KDQOL). RESULTS A completed survey was returned by 45 respondents aged 27.16 }6.78 years, among whom 82.2% had a transplanted kidney and 17.8% were on hemodialysis (HD). Higher education was reported by 18.18% of respondents, secondary and primary by 63.64% and 18.18%, respectively. Employment was reported by 46.67% of the respondents. A family was started by 35% of women and 4% of men. Good DA was found in 28.9% of the respondents. Satisfaction with life was lower in the study group compared to the control group. We found statistically significant correlations between the age when the kidney disease was diagnosed and satisfaction with life (r = 0.33), and between the time since the last change of RRT modality and emotional well-being (r = 0.34). The number of kidney transplantations correlated negatively with emotional component of QOL (r = .0.66) and emotional well-being (r = .0.73). CONCLUSIONS Patients treated with RRT were quite well adapted to their chronic disease but showed less ability to live independently. Young age at the diagnosis of kidney disease, loss of kidney transplant and living on social security benefit had a negative effect on their emotional well-being.
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Affiliation(s)
- Dominika Adamczuk
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland
| | | | - Beata Leszczyńska
- Department of Pediatrics and Nephrology, Medical University of Warsaw, Poland
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Tucker EL, Smith AR, Daskin MS, Schapiro H, Cottrell SM, Gendron ES, Hill-Callahan P, Leichtman AB, Merion RM, Gill SJ, Maass KL. Life and expectations post-kidney transplant: a qualitative analysis of patient responses. BMC Nephrol 2019; 20:175. [PMID: 31096942 PMCID: PMC6524208 DOI: 10.1186/s12882-019-1368-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/01/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The effect of a kidney transplant on a recipient extends beyond the restoration of kidney function. However, there is limited qualitative analysis of recipient perspectives on life following transplantation, particularly in the United States. To understand the full patient experience, it is necessary to understand recipient views on life adjustments after kidney transplantation, medical management, and quality of life. This could lead to improvements in recipient care and sense of well-being. METHODS We conducted a paper-based survey from March 23 to October 1, 2015 of 476 kidney transplant recipients at the University of Michigan Health System in Ann Arbor, Michigan. We analyzed their open-ended responses using qualitative research methods. This is a companion analysis to a previous quantitative report on the closed-ended responses to that survey. RESULTS Common themes relating to changes following transplantation included: improvements in quality of life, a return to normalcy, better health and more energy. Concerns included: duration of graft survival, fears about one day returning to dialysis or needing to undergo another kidney transplant, comorbidities, future quality of life, and the cost and quality of their healthcare. Many recipients were grateful for their transplant, but some were anxious about the burdens transplantation placed on their loved ones. CONCLUSIONS While most recipients reported meaningful improvements in health and lifestyle after kidney transplantation, a minority of participants experienced declines in energy or health status. Worries about how long the transplant will function, future health, and cost and quality of healthcare are prevalent. Future research could study the effects of providing additional information, programs, and interventions following transplantation that target these concerns. This may better prepare and support kidney recipients and lead to improvements in the patient experience.
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Affiliation(s)
- Emily L. Tucker
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI USA
| | | | - Mark S. Daskin
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI USA
| | - Hannah Schapiro
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI USA
| | - Sabrina M. Cottrell
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI USA
| | - Evelyn S. Gendron
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI USA
| | | | - Alan B. Leichtman
- Arbor Research Collaborative for Health, Ann Arbor, MI USA
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Robert M. Merion
- Arbor Research Collaborative for Health, Ann Arbor, MI USA
- Department of Surgery, University of Michigan, Ann Arbor, MI USA
| | | | - Kayse Lee Maass
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, MI USA
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA USA
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Yoshikawa Y, Uchida J, Kosoku A, Akazawa C, Suganuma N. Childbirth and Care Difficulties of Female Kidney Transplantation Recipients. Transplant Proc 2019; 51:1415-1419. [PMID: 31076146 DOI: 10.1016/j.transproceed.2019.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/22/2019] [Accepted: 03/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND For mothers who experience transplants, pregnancy and childcare can have significant consequences on their quality of life. This study aims to investigate the childcare-related suffering faced by women who gave birth following kidney transplantation. METHODS Data were collected from 65 Japanese kidney transplant recipients from 21 hospitals who had given birth after transplant. The questionnaire included questions concerning the childcare-related suffering of the female kidney transplant recipients. The data were analyzed using KH Coder for the qualitative text mining analysis. RESULTS The results of the co-occurrence network of words and hierarchical cluster analysis revealed 6 categories that were identified regarding the difficulties in childcare experienced by mothers who gave birth after kidney transplantation: comparing themselves with healthy mothers, parenting priorities, getting tired, not being able to take medicine on time, carefully giving the child a hug, being unable to give breast milk, having regular doctor checkups, and having to leave the child. CONCLUSION Recipients experience suffering related to the lifestyle changes that occur as a matter of course during childcare. Recipients are exhausted because of how busy they are with childcare, and they sometimes forget to take their medicine. It is necessary to confirm the living situations of recipients after birth and provide support for their self-management based on their new lifestyles.
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Affiliation(s)
- Yuki Yoshikawa
- Faculty of Nursing, Shitennoji University, Osaka, Japan.
| | - Junji Uchida
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Akihiro Kosoku
- Department of Urology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | | | - Nobuhiko Suganuma
- Department of Nursing, Nagoya University of Arts and Sciences, Nagoya, Japan
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Maass KL, Smith AR, Tucker EL, Schapiro H, Cottrell SM, Gendron E, Hill-Callahan P, Gill SJ, Daskin MS, Merion RM, Leichtman AB. Comparison of patient and provider goals, expectations, and experiences following kidney transplantation. Patient Educ Couns 2019; 102:990-997. [PMID: 30591284 DOI: 10.1016/j.pec.2018.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 11/12/2018] [Accepted: 12/08/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE This study examined whether kidney transplant recipients' post-transplant goals and expectations align with those as perceived by their healthcare providers. METHODS Post-transplant goals and expectations across four domains were assessed via a descriptive survey of healthcare providers (N=72) and kidney transplant recipients (N=476) at the University of Michigan from March 23 - October 1, 2015. Demographic and transplant-related data were collected via a retrospective review of medical records, and survey responses were compared using Chi-square tests, Wilcoxon two-sample tests, and logistic regression. RESULTS Patients expressed higher quality of life (mean Neuro-QOL T-score 60.2 vs. 52.7), were less likely to report that they were currently experiencing complications (11% vs. 24%), and anticipated their transplants to last longer (median 25 vs. 15 years) and to live longer (median 80 vs. 71 years) than providers expected for their typical patient. However, provider perceptions of patients' future ability to feel well, perform daily activities and work were significantly higher than those expressed by patients (all p<0.05). CONCLUSION Kidney transplant patient and provider expectations differ in significant ways. PRACTICE IMPLICATIONS Identified areas of discordance may provide opportunities for patients and providers to better evaluate treatment option tradeoffs in post-transplant clinical interactions.
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Affiliation(s)
- Kayse Lee Maass
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, USA; Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, USA
| | - Abigail R Smith
- Department of Biostatistics, University of Michigan, Ann Arbor, USA; Arbor Research Collaborative for Health, Ann Arbor, USA
| | - Emily L Tucker
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, USA
| | - Hannah Schapiro
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, USA
| | - Sabrina M Cottrell
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, USA
| | - Evelyn Gendron
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, USA
| | | | | | - Mark S Daskin
- Department of Industrial and Operations Engineering, University of Michigan, Ann Arbor, USA
| | - Robert M Merion
- Arbor Research Collaborative for Health, Ann Arbor, USA; Department of Surgery, University of Michigan, Ann Arbor, USA
| | - Alan B Leichtman
- Arbor Research Collaborative for Health, Ann Arbor, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, USA.
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