Team-Based Biopsychosocial Care in Solid Organ Transplantation

Skillings, Jared L.; Lewandowski, Amber N

doi:10.1007/s10880-015-9428-5

Cited by 14 publications

(7 citation statements)

References 25 publications

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“…There are no reported cases of solid organ transplant involving a patient with a previous diagnosis of anorexia nervosa, although there are reports of anorexia symptoms developing after renal transplant [15]. The contribution of mental health specialists to decision making in solid organ transplant teams has been a subject of investigation only rarely [16][17][18].…”

Section: Methodsmentioning

confidence: 99%

The Contribution of Psychotherapists to Patient Care in Multidisciplinary Heart Transplantation Care Teams

Tigges-Limmer¹,

Ensminger²,

Brocks³

et al. 2018

obm transplant

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Background: The participation of mental health professionals in multidisciplinary care teams for heart transplantation has become an international standard practice. The contribution of these professionals in this setting, which involves assessment and interventions, has not been the subject of systematic study. Methods: This paper explores how psychotherapists contribute to multidisciplinary decision making and care in transplant teams before, during, and after transplantation. To illustrate, it uses the case of a 19-year-old woman with anorexia nervosa who underwent heart transplant at a large transplantation center in Germany. She received psychotherapeutic interventions intended to lower the risk of non-adherence. Results: This first reported case of heart transplant in a patient with a previous diagnosis of anorexia nervosa also documents psychotherapeutic interventions that were favorable for sustainable weight-gain and how the multidisciplinary environment enabled their development and implementation. We provide details on the contribution of the psychologist in the case, including hypnotherapy interventions and adjustments in routine nursing practices. Conclusions: This paper shows how mental health professionals working in multidisciplinary teams improve patient outcomes in organ transplantation. In order to collect and systematize clinical knowledge of psychotherapeutic interventions for transplant candidates with mental health issues, additional studies with multiple centers, multiple cases, and a range of mental health disorders are needed.

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Section: Methodsmentioning

confidence: 99%

The Contribution of Psychotherapists to Patient Care in Multidisciplinary Heart Transplantation Care Teams

Tigges-Limmer¹,

Ensminger²,

Brocks³

et al. 2018

obm transplant

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“…Expert reviews and commentaries support a set of central tenets for the process of performing the evaluation. 7,[9][10][11]17,[19][20][21][22][24][25][26]265 The evaluator must inform patients about the evaluation's purpose and that it is only one component of the assessment for cardiothoracic and/or MCS candidacy. Patients must be given the opportunity to participate fully, without language barriers.…”

Section: Performance Of the Psychosocial Evaluationmentioning

confidence: 99%

“…Factors such as language barriers, low health literacy and the patient's medical condition may hinder determinations of capacity to give consent. 7,11,19,21,126,255,265 The evaluator should consider modifications to the psychosocial evaluation process to remove or limit these factors' impact. 131 For example, the evaluator may require that patients receive decision aids (which typically address literacy and health literacy barriers 173,[177][178][179] ) and/or other educational strategies before the psychosocial evaluation is conducted.…”

Section: Screening For Capacity To Give Informed Consentmentioning

confidence: 99%

“…Implementation, progress, and outcomes of recommended treatments or interventions should be monitored to allow timely updates to the transplantation or MCS team. 12,21,265 This is particularly important for treatments implemented to ameliorate psychosocial contraindications to transplantation/implantation. Whether the psychosocial evaluator or another transplant/MCS team member will monitor treatment progress and completion, and who will communicate this information to the team, should be delineated at the time of referral.…”

Section: Coordination Of Recommended Psychosocial Treatments or Intermentioning

confidence: 99%

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The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support

Dew

DiMartini

Dobbels

et al. 2018

The Journal of Heart and Lung Transplantation

143

111

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The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.

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“…Psychosocial factors are typically considered in the process of selecting patients, which adds complexity to the decision-making process. In a 2015 paper, the authors described the key interconnected components of a psychosocial transplant evaluation, which fall into three domains: psychiatric, social, and functional 11 . The psychiatric portion of the evaluation focuses on psychiatric history and current stability; coping mechanisms; general adjustment; recent and past substance abuse, including nicotine and alcohol use; and mental status.…”

Section: Psychosocial Complexities Of Transplant Listingmentioning

confidence: 99%

Who gets a lung transplant? Assessing the psychosocial decision-making process for transplant listing

Lewandowski

Skillings

2016

gcsp

Self Cite

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In the United States, there is a significant shortage of available donor organs. This requires transplant professionals to hold simultaneous, yet divergent roles as (1) advocates for patients who are in need of a lifesaving transplant, and (2) responsible stewards in the allocation of scarce donor organs. In order to balance these roles, most transplant teams utilize a committee based decision-making process to select suitable candidates for the transplant waiting list. These committees use medical and psychosocial criteria to guide their decision to list a patient. Transplant regulatory bodies have established medical standards for identifying appropriate medical candidates for transplantation. However, transplant regulatory bodies have not developed policies to standardize psychosocial criteria for listing patients. This affords transplant centers the autonomy to develop their own psychosocial criteria for determining which patients will be placed on the transplant waiting list. This lack of a standardized policy has resulted in inconsistent psychosocial practices amongst transplant centers nationwide. Since there has been no formal review of the inconsistency in psychosocial policy and practice, this paper seeks to explore the non-standardized psychosocial approach to organ transplant listing. The authors review factors that are relevant to the standardization of the psychosocial decision-making process, including shared decision-making, clinician judgment, bias in decision-making and moral distress in transplant staff. We conclude with a discussion about the impact of these issues on psychosocial practices in solid organ transplantation.

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Team-Based Biopsychosocial Care in Solid Organ Transplantation

Cited by 14 publications

References 25 publications

The Contribution of Psychotherapists to Patient Care in Multidisciplinary Heart Transplantation Care Teams

The Contribution of Psychotherapists to Patient Care in Multidisciplinary Heart Transplantation Care Teams

The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support

Who gets a lung transplant? Assessing the psychosocial decision-making process for transplant listing

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