Standardized Semi-structured Psychosocial Evaluation before Hematopoietic Stem Cell Transplantation Predicts Patient Adherence to Post-Transplant Regimen

Abstract

In patients undergoing stem cell transplantation (SCT), nonadherence has potential for significant medical impact and potentially life-threatening complications. No study thus far has demonstrated an effective way to predict adherence in SCT recipients. A structured rating scale, the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), has been shown to predict psychosocial outcomes and medical morbidity in solid organ transplant recipients. We assessed the SIPAT in SCT recipients. We hypothesized that the SIPAT rating would be associated with nonadherence to the post-SCT regimen. We retrospectively studied SCT recipients who had psychiatric evaluations with the SIPAT before SCT. The primary outcome was nonadherence, defined a priori as at least 1 life-threatening nonadherence event in the first 6 months post-transplant. Association of the SIPAT with outcomes was evaluated by logistic regression, and an optimal cutoff score was determined using a receiver operating characteristic curve. Of 85 patients (mean age 47 years; range, 18 to 74 years), 56 (66%) were male, and 43 (50.5%) received autologous SCT. Eighteen (21%) patients were nonadherent. The SIPAT rating, treated as a continuous variable and controlling for autologous versus allogeneic SCT, was significantly associated with nonadherence (per 1 point; odds ratio [OR], 1.162; P< .0001). Allogeneic SCT also conferred a significantly increased risk of nonadherence (OR, 14.184; P= .005). Multivariate analysis stratifying for allogeneic versus autologous transplantation and controlling for age, sex, and disease confirmed an independent association between the SIPAT score and nonadherence. A cutoff score of 18 provided optimal specificity (89.6%) and sensitivity (55.6%) for nonadherence. Nonadherence rates were 58.8% and 11.8% for subjects with SIPAT ratings of 18 and above or 17 and below, respectively (relative risk = 4.98, P < .0001). Psychosocial risk as quantified by the SIPAT correlated with SCT recipients' adherence to the post-transplant regimen, suggesting that this instrument can contribute to medical risk stratification models. Further study should evaluate long-term mortality data and the effects of intervention on psychosocial risks.

Psychosocial Pre-Transplant Screening With the Transplant Evaluation Rating Scale Contributes to Prediction of Survival After Hematopoietic Stem Cell Transplantation

“…The SIPAT has been used to date in solid organ transplantations only and may provide extended insight into pre-transplant psychological risk. More recently, a retrospective study showed significant correlations using SIPAT in predicting non-adherence after HSCT for patients at high psychosocial risk, leading to medical morbidity (54). Further, intervention studies are needed to confirm the TERS' clinical efficacy and help establish systematic pre-transplant screenings with TERS.…”

Psychosocial and financial issues after hematopoietic cell transplantation

“…Psychosocial Assessment of Candidates for Transplant 41 Describes psy cho so cial func tion ing before organ and HCT Transplant Evaluation Rating Scale 42 Describes psy cho so cial func tion ing before organ and HCT Psychosocial Assessment Tool-Hematopoietic Cell Transplantation 43 Describes the fam ily psy cho so cial risk for fam i lies of a child under go ing HCT Stanford Integrated Psychosocial Assessment for Transplantation 44 Measures psy cho so cial read i ness for trans plant…”

Psychosocial considerations in the assessment of hand transplant candidates: A single‐center experience and brief literature review

“…Despite the widely acknowledged importance of psychosocial factors across transplant recipient groups, the psychosocial considerations within each (SOT, BMT, and VCA) vary in their importance. 7,12,13 Studies characterizing various approaches to psychosocial issues are, therefore, important in informing optimal patient management strategies.…”

“…In addition, for many transplant recipient groups, optimal engagement in their immediate transplant rehabilitation is a critical element of long‐term functional outcomes and “transplant success.” Psychosocial factors interfering with behavioral compliance may, therefore, adversely impact long‐term transplant outcomes, even with the best surgical and perioperative course. Despite the widely acknowledged importance of psychosocial factors across transplant recipient groups, the psychosocial considerations within each (SOT, BMT, and VCA) vary in their importance 7,12,13 . Studies characterizing various approaches to psychosocial issues are, therefore, important in informing optimal patient management strategies.…”