How important is social support in determining patients’ suitability for transplantation? Results from a National Survey of Transplant Clinicians

Ladin, Keren; Emerson, Joanna; Butt, Zeeshan; Gordon, Elisa J.; Hanto, Douglas W.; Perloff, Jennifer; Daniels, Norman; Lavelle, Tara A.

doi:10.1136/medethics-2017-104695

Cited by 40 publications

(31 citation statements)

References 41 publications

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“…On the other hand, social support and good psychological functioning of caregivers of liver transplantation patients represent a valid protective factor (Goetzinger et al, 2012; Goetzmann et al, 2012; Malik et al, 2014). As a matter of fact, social support emerged as one of the most influential factors, among transplant providers, in determining patients’ suitability for transplantation (Ladin et al, 2018). In light of that, and because of the high involvement in the patients’ care and its potential impact on patients’ long-term outcomes (Nguyen et al, 2015), the caregivers’ health should also be taken into consideration and protected.…”

Section: Introductionmentioning

confidence: 99%

Psychosocial Support in Liver Transplantation: A Dyadic Study With Patients and Their Family Caregivers

et al. 2019

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Background and aims: Liver transplantation provides an opportunity of survival for patients with liver failure; however, this procedure is known to be psychologically and physically fatiguing for patients and their informal caregivers. The aim of this study was to investigate how perceived social support and the distribution of dependency were associated with the psychological wellbeing of patients waiting for liver transplantation and their caregivers, as a dyad.Methods: The present was a cross-sectional study. Ninety-five participants were recruited at a hospital in Northern Italy, during the psychological evaluation for inclusion in the transplantation list: 51 patients (19 with alcohol-related illness) and 44 family caregivers. Both patients and caregivers filled in a Symptom Checklist and Kelly’s Dependency Grids. Patients also compiled the Medical Outcome Study Social-Support Survey, and caregivers compiled the Family Strain Questionnaire Short-Form.Results: Caregivers reported important levels of strain and strongly related to a worsening of their own and patients’ symptoms. Patients with alcohol-related pathologies had a narrower social network, which corresponded to an increase in family strain. On the sample as a whole, regression analyses showed that perceived social support and dependency measures did not predict patients’ and caregivers’ symptoms. Nevertheless, cluster analysis identified a group of caregivers who distributed their dependency more and experienced lower levels of depression, anxiety, and strain.Conclusions: These results suggest the usefulness of a dyadic approach in the research, prevention, and care of liver diseases. A deeper comprehension of the functioning of dyads will help practitioners in the identification of situations at risk.

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Section: Introductionmentioning

confidence: 99%

Psychosocial Support in Liver Transplantation: A Dyadic Study With Patients and Their Family Caregivers

et al. 2019

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“…Specifically, Yeates et al have shown that the wait times are longer for Indigenous vs all other (living and deceased) transplant recipients in Australia (2.4 vs 1.5 years), Canada (2.1 vs 1.5 years), New Zealand (2.2 vs 1.2 years), and the United States (2.1 vs 1.1 years). Delayed referral for transplant evaluation by a nephrologist is a possible explanation for this discrepancy, an explanation that is associated with higher mortality, longer time on the waitlist, and decreased likelihood of receiving a transplant . Another possible explanation is that nephrologists are more likely to identify Indigenous patients as non‐adherent with dialysis and high‐risk transplantation candidates .…”

Section: Discussionmentioning

confidence: 99%

“…While not researched extensively, it is possible that poor social support networks may also impact postoperative outcomes. The adverse effects of longer wait times are well known and have been shown to impact a patient's psychological well‐being in a negative manner . Graft survival rates are considerably worse among patients on dialysis for more than 24 months when compared to those on dialysis for less than six months for patients who receive kidneys from both deceased (39% vs 69% survival rate, respectively) and living (49% vs 75% survival rate, respectively) donors at 10 years post‐transplant .…”

Section: Discussionmentioning

confidence: 99%

Patient survival following renal transplantation in Indigenous populations: A systematic review

McGuire

Kannathasan

Lowe

et al. 2019

Clinical Transplantation

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Background: Inequities in health care predispose Indigenous populations to poor health outcomes. The objective of this study was to examine patient survival and other post-transplant outcomes of kidney transplantation among Indigenous patients compared with non-Indigenous populations. Methods: A systematic review of MEDLINE, EMBASE, and Google Scholar was undertaken from inception to September 30, 2019, using a computerized search. Publication descriptors and methodological and statistical details were extracted. Articles were assessed using the methodological index for non-randomized studies (MINORS) scale. Results: Twelve studies were included. All studies were retrospective and published between 2004 and 2018. Mean Indigenous patient age was 40 (range: 8-76), while non-Indigenous was 41 (range: 6-74). Mean sample size for Indigenous populations was 398 (range: 24-1459), while for non-Indigenous patients was 1102 (range: 53-7555). Eight studies examined indigenous populations in Australia, two in Canada, one in the United States, and one in New Zealand. All studies were considered of high methodological quality and clinically homogenous. Results indicated that patient survival, graft survival, and delayed graft function were significantly reduced among Indigenous populations compared with non-Indigenous populations. Conclusions: Post-transplant outcomes among various Indigenous populations are significantly worse compared with non-Indigenous populations. The reasons for poor outcomes are likely multifactorial. Improved standardized reporting of transplant outcomes of Indigenous patients is necessary to better inform healthcare services and improve clinical outcomes. K E Y W O R D S epidemiology, health outcomes, indigenous, kidney transplantation

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“…Prior findings suggest that social support is one of the most important factors considered in transplant listing decisions, but what constitutes adequate social support is poorly understood. 8,9 Compared to physicians and surgeons, psychosocial clinicians were twice as likely to rely upon social support in listing decisions. 5 While transplant teams commonly rely on psychosocial clinicians to determine patients’ psychosocial eligibility for transplantation, questions remain about how these clinicians evaluate social support.…”

Section: Introductionmentioning

confidence: 99%

A Mixed-Methods Approach to Understanding Variation in Social Support Requirements and Implications for Access to Transplantation in the United States

et al. 2019

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Social support is a key component of transplantation evaluation in the United States. Social support definitions and evaluation procedures require examination to achieve clear, consistent implementation. We surveyed psychosocial clinicians from the Society for Transplant Social Workers and American Society of Transplant Surgeons about their definitions and evaluation procedures for using social support to determine transplant eligibility. Bivariate statistical analysis was used for quantitative data and content analysis for qualitative data. Among 276 psychosocial clinicians (50.2% response rate), 92% had ruled out patients from transplantation due to inadequate support. Social support definitions varied significantly: 10% of respondents indicated their center lacked a definition. Key domains of social support included informational, emotional, instrumental, motivational, paid support, and the patient’s importance to others. Almost half of clinicians (47%) rarely or never requested second opinions when excluding patients due to social support. Confidence and perceived clarity and consistency in center guidelines were significantly associated with informing patients when support contributed to negative wait-listing decisions ( P = .001). Clinicians who excluded fewer patients because of social support offered significantly more supportive health care ( P = .02). Clearer definitions and more supportive care may reduce the number of patients excluded from transplant candidacy due to inadequate social support.

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How important is social support in determining patients’ suitability for transplantation? Results from a National Survey of Transplant Clinicians

Abstract: Social support is highly influential in listing decisions and may exacerbate transplant disparities. Providers' beliefs and reliance on social support in determining suitability vary considerably, raising concerns about transparency and justice.

Cited by 40 publications

References 41 publications

Psychosocial Support in Liver Transplantation: A Dyadic Study With Patients and Their Family Caregivers

Psychosocial Support in Liver Transplantation: A Dyadic Study With Patients and Their Family Caregivers

Patient survival following renal transplantation in Indigenous populations: A systematic review

A Mixed-Methods Approach to Understanding Variation in Social Support Requirements and Implications for Access to Transplantation in the United States

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