The “You Are Not Alone” Care Program for Liver Transplantation

The effect of Liver Transplantation on the quality of life of the recipient's main caregiver - a systematic review

Liver transplantation (LT) is a transformative, life-saving procedure with life-long sequale for patients and their caregivers. The impact of LT on the patient's main caregiver can be underestimated. We carried out a systematic review of the impact of LT on the Health-Related Quality of Life (HRQL) of LT patients' main caregivers. We searched 13 medical databases from 1996 to 2015. We included studies with HRQL data on caregivers of patients following LT then quality assessed and narratively synthesized the findings from these studies. Of 7076 initial hits, only five studies fell within the scope of this study. In general, they showed caregiver burden persisted in the early period following LT. One study showed improvements, however, the other four showed caregiver's levels of stress, anxiety and depression, remained similar or got worse post-LT and remained above that of the normal population. It was suggested that HRQL of the patient impacted on the caregiver and vice versa and may be linked to patient outcomes. No data were available investigating which groups were at particular risk of low HRQL following LT or if any interventions could improve this. The current information about LT caregivers' needs and factors that impact on their HRQL are not adequately defined. Large studies are needed to examine the effects of LT on the patients' family and caregivers to understand the importance of caregiver support to maximize outcomes of LT for the patient and their caregivers.

Lifestyle and Self-Management by Those Who Live It: Patients Engaging Patients in a Chronic Disease Model

BACKGROUND

Patients pursuing organ transplantation have complex medical needs, undergo comprehensive evaluation for possible listing, and require extensive education. However, transplant patients and their supports frequently report the need for more lifestyle and self-management strategies for living with organ transplantation.

OBJECTIVES

First, to explore feasibility of a successful, patient-run transplant lifestyle educational group (Transplant Living Community), designed to complement medical care and integrated into the clinical setting; and second, to report the major themes of patients' and supports' qualitative and quantitative feedback regarding the group.

METHODS

Informal programmatic review and patient satisfaction surveys.

RESULTS

A total of 1862 patient satisfaction surveys were disseminated and 823 were returned (response rate, 44.2%). Patients and their supports reported positive feedback regarding the group, including appreciation that the volunteer was a transplant recipient and gratitude for the lifestyle information. Five areas were associated with the success of Transplant Living Community: 1) a "champion" dedicated to the program and its successful integration into a multidisciplinary team; 2) a health care environment receptive to integration of a patient-led group with ongoing community development; 3) a high level of visibility to physicians and staff, patients, and supports; 4) a clearly presented and manageable lifestyle plan ("Play Your ACES"(a) [Attitude, Compliance, Exercise, and Support]), and 5) a strong volunteer structure with thoughtful training with the ultimate objective of volunteers taking ownership of the program.

CONCLUSION

It is feasible to integrate a sustainable patient-led lifestyle and self-management educational group into a busy tertiary care clinic for patients with complex chronic illnesses.

[Effects of a pre-transplant educational program on the improvement of knowledge at hospital discharge after a liver transplant]

OBJECTIVE

To determine the effect of an educational program implemented before liver transplant on improving understanding at hospital discharge after the transplant and examine the contribution of different demographic and clinical variables on the level of knowledge.

METHODS

A quasi-experimental study with a non-equivalent control group undertaken at the Hepato-Biliary-Pancreatic and Transplant Unit of Carlos Haya Regional University Hospital, Malaga, Spain. Sampling was consecutive (non-probabilistic), with a sample size of 31 patients for each group. An educational program was designed, encompassing the following Nurse Intervention Classification (NIC): Teaching: disease process; Teaching: prescribed diet; Education: prescription drugs; Protection against infection; Management of Hyperglycaemia; Management of Hypoglycaemia. For the outcome variable, a knowledge questionnaire was designed, with a total score range between 5-30 points, structured according to 6 indicators for Nurse Outcomes Classification (NOC): Description of the disease process, Description of the medication prescribed, Description of the prescribed diet, Description of self-care responsibilities, Description of practices that reduce transmission, Identification of actions to take in relation to blood glucose.

RESULTS

The study included 61 patients, 33 for the control group and 28 for the intervention group. The mean score on the questionnaire of the intervention group was 20.25 ± 2.8 and that of the control group 13.06 ± 3.51 points. The difference between the two groups was 7.19 (95% CI: 5.73-8.64; P<.01). The analysis of the indicators showed that there were significant differences between the study groups, except for the indicator identification of actions to take in relation to blood glucose. No demographic or clinical variable (sex, education level, primary caregiver, waiting list time, time in hospital unit, hospital stay and days since the last talk before the transplant (only in intervention group)) was significantly associated with level of knowledge.

CONCLUSION

This educational program conducted at Carlos Haya hospital in patients on the liver transplant waiting list improved their knowledge after their transplant.