Best practices in the pediatric pretransplant psychosocial evaluation

Abstract

Assessment of psychosocial functioning is an often-included component of the pretransplant evaluation process. This study reviews several domains of assessment that have been related to post-transplant outcomes across solid organ transplant populations. These include evaluation of patient and family past adherence, knowledge about the transplantation process, and their neurocognitive, psychological, and family functioning. To date, few comprehensive pretransplant evaluation measures have been standardized for use with children; however, several assessment measures used to evaluate the aforementioned domains are reviewed throughout the study. Additionally, this article discusses some developmental, illness-specific, and cultural considerations in conducting the psychosocial evaluation. We also discuss ethical issues specific to the pediatric psychosocial evaluation. Recommendations are advanced to promote a comprehensive evaluation that identifies family strengths and risk factors as they begin the transplant journey.

Psychosocial predictors of medication non‐adherence in pediatric organ transplantation: A systematic review

“…However, great inconsistency in the findings of studies and the current knowledge around predictors of non‐adherence greatly undermines efforts to develop an evidence‐based, standardized psychosocial assessment within pediatric organ transplantation. Development and refinement of standardized and evidenced psychosocial assessments may be an invaluable tool for transplant teams concerned about patient psychosocial problems . A quality assessment tool should be able to predict future adherence issues, and resulting ratings should correlate with health‐related quality‐of‐life, psychosocial, health, and transplant‐specific medical outcomes .…”

“…Thus, the pediatric transplant psychosocial team advocates for patients from early childhood through young adulthood and works with patients around important psychosocial challenges affecting their care. Continued assessment of psychosocial factors aims to identify barriers to successful outcomes over time and identify areas for intervention to reduce these barriers …”

Psychosocial predictors of medication adherence in pediatric heart and lung organ transplantation

“…The development of a pretransplant psychosocial assessment is difficult given the need to include aspects of the child, family, aspects of the medical care, and illness‐related factors in a multifaceted assessment. A recent review of best practice in pediatric transplant psychosocial assessment stressed the need for standardized assessment focusing on a number of domains surrounding the child and family . Best practices highlighted include not only assessment of the child and the parents but also that of the family as a system.…”

“…The items on the assessment cover knowledge about the transplant, motivation for transplantation, previous adherence problems, patient psychiatric problems, parental psychiatric concerns, substance abuse history, questions concerning the family environment, external support for the family, and the relationship with the medical team. Despite the support for these domains and their association with post‐transplant adherence, the instrument has found to have low inter‐rater reliability . Other psychometric properties of the instrument have not been tested including the ability of the scores to predict adherence and outcomes during the later post‐transplant period.…”

“…Significant questions remain concerning individual and family pretransplant predictors of post‐transplant adherence, especially with adolescent and heart and lung recipients . The aims of the current study were to identify pediatric recipient and family‐related demographic, psychosocial, and condition‐related characteristics predicting immunosuppressive medication adherence in a sample of children receiving either heart or lung transplants and their families.…”