Patients are pragmatic and physicians are perfectionists? Comparing success after liver transplantation among patients and physicians

Abstract

Although both patients and physicians are key stakeholders in health care outcomes, patients and physicians often define success differently. The purpose of this study was to compare patient and physician perceptions of success 1 year after liver transplantation. This was a single-institution, qualitative study. We conducted in-person, semi-structured interviews with liver transplant recipients 1 year after transplantation and virtual interviews with transplant surgeons and hepatologists. Transcripts were coded and iteratively analyzed for themes using the principles of phenomenology. Twenty patients, 8 caregivers, 5 transplant surgeons, and 4 hepatologists were interviewed. Subject interviews averaged 57 (patient) and 27 (physician) minutes. Overall, patients and physicians had significant agreement in their definitions of success, which included avoidance of death, restoration of physical and mental function, return to society, acquisition of new health care knowledge, and open communication between the patient and the physician. Patients highlighted relief from worry about their future health status, and physicians highlighted decreased health care costs. Patients noted that a liver transplant did not have to be perfect, that is free from complications, to be successful. Physicians had a more stringent view and felt that any deviation from an ideal course reduced the relative success of a transplant. Detailed assessment of patient and physician responses reveals similar overall goals of regaining physical, mental, and emotional function. Complications are perceived differently by patients and physicians. Awareness of this discordance may serve to enhance relationships between transplant patients and their providers.

Transplant selection simulation: Liver transplantation for alcohol-associated hepatitis

“…This suggests that on a case-by-case basis, particularly with borderline psychosocial profiles, there may be other factors or hidden biases that supersede providers’ general beliefs regarding “success” in LT for AH, which warrants further study. A recent qualitative study of defining successful outcomes in LT with various stakeholders demonstrated that beyond survival, restoration of function, relief from worry, and wellness allowing for meaningful contributions to society were truer measures of success for patients, with post-LT complications being “part of the process.” 24 This aligns with calls for more nuanced, indication-specific post-LT outcome measures 3,25 . In LT for AH, for example, rather than the dichotomous yes/no outcome of alcohol relapse post-LT, outcomes based on alcohol pattern types that include regaining of abstinence, composite end points like recurrent ALD and/or rejection from nonadherence, or patient-reported outcome measures could be reported and studied 26,27 .…”