Psychosocial predictors in upper-extremity vascularized composite allotransplantation: A qualitative study of multidimensional experiences including patients, healthcare professionals, and close relatives

Abstract

BackgroundThe impact of patient-specific psychosocial factors on functional outcomes after upper-extremity (UE) vascularized composite allotransplantation (VCA) is poorly understood. The objective of this study was to identify relevant psychosocial predictors for success or failure of UE VCA in an Austrian cohort.MethodsA qualitative study was undertaken consisting of semi-structured interviews with UE VCA staff, transplanted patients, and close relatives. Participants were asked about their perceptions of factors that either favored or hindered a successful transplant outcome, including functional status before surgery, preparation for transplant, decision-making, rehabilitation and functional outcome after surgery, and family and social support. Interviews were conducted online and recorded with the consent of interviewees.ResultsFour bilateral UE VCA patients, 7 healthcare professionals, and a sister of a patient participated in the study. Thematic analysis revealed the importance of an expert interdisciplinary team with adequate resources for patient selection. Psychosocial aspects of prospective candidates are crucial to evaluate as they contribute to success. Both patients and providers may be impacted by public perceptions of UE VCA. Functional outcomes are optimized with a life-long commitment to rehabilitation as well as close, ongoing provider involvement.ConclusionPsychosocial factors are important elements in the assessment and follow-up care for UE VCA. To best capture psychosocial elements of care, protocols must be individualized, patient-centered, and interdisciplinary. Investigating psychosocial predictors and collecting outcomes is, thus, critical to justifying UE VCA as a medical intervention and to providing accurate and salient information to prospective candidates.

Advancing vascularized composite allotransplantation: essential factors for upper extremity transplant program development

“…Unsurprisingly, the need for expert interdisciplinary collaboration permeates into the psychosocial domain as well. Hummel et al conducted semi-structured interviews among UE staff, transplant patients, and relatives and determined that interdisciplinary teams with adequate resources for patient selection as well as ongoing close provider involvement contribute to transplantation success ( 30 ).…”

“…Similarly, social work departments play a vital role in ensuring that a robust social support system is in place as patients work to regain a sense of self, body image, and identity ( 9 , 12 , 30 – 32 ). In particular, patients and their caregivers have identified community and caregiver support as crucial factors in VCA success ( 33 , 34 ).…”

Patient preferences of patient selection criteria for upper extremity vascularized composite allotransplantation: A qualitative study

“…8 In addition, consistent with our study, other research on UE VCA providers and recipients found that adherence to the transplant protocol and self-motivation during rehabilitation is essential to patient selection and pivotal to the success of hand transplantation. 24 A key finding was the importance participants placed on a "good social support system" in determining a patient's suitability for UE VCA. Other research with UE VCA recipients similarly identified the importance of a quality support system as recipients recounted the practical and emotional support provided to them by their networks.…”

“… 8 In addition, consistent with our study, other research on UE VCA providers and recipients found that adherence to the transplant protocol and self-motivation during rehabilitation is essential to patient selection and pivotal to the success of hand transplantation. 24 …”

Incorporating Trauma-informed Approaches to Care in Vascularized Composite Allotransplantation

“…After all, rapport between patients and their healthcare team have demonstrated improved patient outcomes. 36 If a loved one is verbally communicating on the patient’s behalf during the appointment, still addressing the patient first and foremost and understanding how the patient communicates their agreement or disagreement to what is being said will allow for the active involvement of the patient whose care is being discussed.…”