The Psychosocial Assessment of Transplant Candidates: Internal Consistency, Interrater Reliability, and Content Validity of the Thai Version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-Thai Version)

The role of attachment and parental bonding in the psychosocial assessment of transplant candidates: a cross-sectional study

BACKGROUND

Kidney transplant involves profound psychological, relational, and social changes for both the patients and their family context. Occasionally, the family or social support can be deemed "dysfunctional" as it fails to fully comprehend the patient's needs and requirements. Attachment style, which pertains to the motivation to seek proximity and care in relationships with caregivers, has a significative role in the social support system for transplant, therapeutic adherence, and maintenance of the transplanted organ. We sought to assess attachment styles among patients awaiting transplantation using psychosocial measures in order to study their impact on psychopathology, quality of life, and transplant eligibility.

METHODS

Eighty-five patients with chronic kidney disease awaiting transplantation were recruited at the Italian Transplant Center and were administered the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), the Attachment Style Questionnaire (ASQ), the Parental Bonding Instrument (PBI), the Short Form Health Survey-36 (SF-36), and the Middlesex Hospital Questionnaire (MHQ). Measures were entered in blocks in a stepwise multiple regression.

RESULTS

The SIPAT score was significantly associated with key psycho-physical constructs. SIPAT was negatively predicted by maternal care (β = -.35, p = .001), secure attachment (i.e., confidence) (β = -.23, p = .029), and general physical health (β = -.25, p = .016) - which could be considered protective factors for transplant suitability. Conversely, anxiety symptoms were positively associated with SIPAT (β = .32, p = .001) and may serve as a risk factor for post-transplant issues.

CONCLUSIONS

These findings highlight that in the evaluation of kidney transplant candidates, greater attention should be paid to parental bonding, adult attachment, and psychopathological symptoms, as these factors may play a key role as protective or risk factors for post-transplant issues. A timely assessment of these constructs may improve the evaluation of psychosocial suitability for transplantation, as well as allow the provision of targeted psychotherapeutic interventions to enhance the acceptance and management of illness in patients awaiting kidney transplants.

Psychometric assessment of the Persian version of the stanford integrated psychosocial assessment for transplantation

OBJECTIVE

Despite advancements in surgical techniques and immune system suppression, methods for assessing psychosocial risks for transplant candidates or recipients have not progressed significantly. One tool that can assist in this regard is Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). The present study aimed to design and conduct a psychometric evaluation of the validity and reliability of the Persian version of this instrument.

MATERIALS AND METHODS

The present cross-sectional study was conducted from September 2022 to September 2023. The research population included all patients scheduled for organ transplantation who enrolled in the study using convenience sampling. After translating the tool, its content and face validity were initially assessed. Exploratory and confirmatory factor analysis was then used to determine the structural validity. Reliability was assessed using Cronbach's alpha and the Intraclass Correlation Coefficient. Data were analyzed using SPSS 18 and SmartPLS 4.1.0.9 software. Data were analyzed using SPSS version 18 and SmartPLS 4.1.0.9.

RESULTS

The Persian SIPAT exhibited robust psychometric properties. Content validity indices were above the acceptable thresholds. EFA identified four factors (patient's readiness level, social support system, psychological stability & psychopathology, and lifestyle & effect of substance use) accounting for 76.35% of the variance. Confirmatory factor analysis validated the structure, with all factor loadings exceeding 0.575 and average variance extracted ranging from 0.619 to 0.857. Reliability tests showed Cronbach's alpha ranging from 0.832 to 0.906 and ICC values exceeding 0.78, indicating strong internal consistency and stability.

CONCLUSION

The Persian SIPAT is a reliable and valid instrument for assessing psychosocial readiness and risk in Iranian transplant candidates, with potential applications in clinical and research settings.

Adaptation and validation of an abbreviated version of the SIPAT integrated psychosocial risk scale in patients with liver cirrhosis candidates for liver transplantation (SIPAT-11)

INTRODUCTION

Patients with liver cirrhosis who are candidates for liver transplantation must be evaluated both clinically and socially in order to obtain the optimal outcomes and avoid futile therapeutic measures. For the evaluation of the social aspects in these patients, no validated scale in Spanish is available. The SIPAT (Stanford Integrated Psychosocial Assessment for Transplantation) scale is an instrument that measures the social, family and psychological aspects in candidates for solid organ transplantation. The objective of this study is to adapt and validate an abbreviated version of the SIPAT scale in Spanish for patients with liver cirrhosis.

MATERIAL AND METHODS

Prospective observational study carried out in the Hepatology Unit of the La Fe Unversity Hospital in Valencia, by questionnaire validation methodology. To analyze the reliability of the questionnaire, the internal consistency of all variables was calculated, for variability an exploratory factor analysis, and for stability the test-retest test was carried out.

RESULTS

96 patients who were admitted for decompensated cirrhosis to the Hepatology Unit of the La Fe Hospital in Valencia between November 1, 2017 and January 31, 2017 were selected. 84% were men, the mean age was 60.01 (SD 10.12) years. In 73.2% of those admitted, the etiology of cirrhosis was alcoholic. 14.4% had a Child's stage A, 57.7% B and 27.8% C. The internal consistency of all variables reached a Cronbach's Alpha of 0.766. In the exploratory factor analysis, 6 dimensions of the questionnaire were identified that explain 84.27% of the total variability. To see the stability of the instrument, the measurement was repeated at 2 and 6 months of follow-up, obtaining in the test-retest a kappa agreement of 0.612 and 0.565 respectively.

CONCLUSION

The SIPAT-11 questionnaire has good psychometric characteristics in cirrhotic patients who are candidates for liver transplantation. It is easy to complete and can be administered by professionals who are not specialists in the area of Mental Health.

Assessing reliability and validity of SIPAT and opportunities for improvement: A single-center cohort study

Psychosocial assessment is a standard component of patient evaluations for transplant candidacy. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a widely used measure to assess psychosocial risk for transplant. However, there are questions regarding the SIPAT's reliability and validity. We examined the SIPAT's psychometric performance and its impact on equitable access to transplant in a diverse cohort of 2825 patients seeking liver transplantation between 2014 and 2021 at an urban transplant center. The SIPAT demonstrated good internal consistency reliability at the overall score [Cronbach's α = 0.85, 95% CI (0.83, 0.86)] and domain levels (0.80 > α > 0.70). There was mixed support for structural validity, with poor overall model fit in confirmatory factor analysis and 50% of questions achieving the 0.70-factor loadings threshold. Adjusting for sociodemographic variables, the odds of not being waitlisted for psychosocial reasons were three times higher for patients with Medicaid insurance than patients with private insurance [OR 3.24, 95% CI (2.09, 4.99)] or Medicare [OR 2.89, 95% CI (1.84, 4.53)], mediated by higher SIPAT scores. Black patients had nearly twice the odds of White patients [OR 1.88, 95% CI (1.20, 2.91)], partially mediated by higher social support domain scores. Patients with Medicaid, non-White patients, and those without a college degree scored significantly higher on collinear questions, disproportionately contributing to higher SIPAT scores. The SIPAT did not perform equally across insurance type, race/ethnicity, and education groups, with the lowest subgroup validity associated with patient readiness and psychopathology domains. The SIPAT should be interpreted with caution, especially as a composite score. Future studies should examine validity in other populations.

Association of the Stanford Integrated Psychosocial Assessment for Transplant and 1-Year Outcome of Living Kidney Transplantation in Japan

BACKGROUND

Because most kidney transplantations in Japan are performed on the basis of living donors, after-transplant outcomes should achieve optimum results, overcoming participants' possible reduced adherence.

OBJECTIVE

To investigate the association between the Japanese version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-J) and outcomes, 1 year after the patient's living kidney transplant (LKT).

METHODS

The prospective cohort study was undertaken at Tokyo Women's Medical University Hospital from January 2020 to July 2021, with a 1-year follow-up period. The SIPAT-J assesses 18 psychosocial risk factors: (1) Patient's Readiness Level and Illness Management (SIPAT A), (2) Social Support System Level of Readiness (SIPAT B), (3) Psychological Stability and Psychopathology (SIPAT C), and (4) Lifestyle and Effect of Substance Use (SIPAT D). The evaluators, a psychiatrist and 3 clinical psychologists, conducted an independent, blinded application of the SIPAT-J using participants' medical records. The study focused on physical composite outcomes, psychiatric outcomes, and nonadherent behaviors.

RESULTS

The participants were 173 LKT recipients (median age [interquartile range], 51 [38-59]); 67.1% were male and 67.1% were employed. The median (interquartile range) SIPAT scores were SIPAT A [7 (5-9)], SIPAT B [7 (5-9)], SIPAT C [2 (0-4)], SIPAT D [3 (3-4)], and SIPAT total [20 (16-23)]. The physical composite outcome was 25 (14.5%), psychiatric outcome 9 (5.2%), and nonadherent behavior 17 (9.8%). SIPAT C (odds ratio = 1.34, 95% confidence interval = 1.06-1.72, P = 0.02) was significantly associated with the psychiatric outcome. SIPAT B (odds ratio = 1.49, 95% confidence interval = 1.12-1.98, P = 0.01) and SIPAT total (odds ratio = 1.13, 95% confidence interval = 1.03-1.24, P = 0.01) were significantly associated with nonadherent behaviors. There was no significant association between the SIPAT and physical composite outcomes.

CONCLUSION

This study is the first to examine the association between SIPAT and physical and psychiatric outcomes 1 year after LKT, controlling for follow-up periods and factors other than SIPAT. Comprehensive psychosocial assessment before LKT and early identification of factors that may negatively affect transplant success can allow targeted interventions to be implemented and increase the likelihood of favorable recipient outcomes.

Characterization of the stanford integrated psychosocial assessment for transplant for heart, liver, and kidney transplant candidates in Japan

BACKGROUND

The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive psychosocial assessment proven useful for predicting the outcomes of organ transplantation that is expected to be useful in Japan. However, the characteristics of organ-specific SIPAT scores for organ transplant recipient candidates in Japan are unclear and, to date, the SIPAT has not been properly utilized in clinical practice. The purpose of this study was to present basic data that can be used to establish the relation between SIPAT scores and post-transplantation psychosocial outcomes as well as organ-specific outcomes.

METHODS

This study included 167 transplant recipient candidates (25 heart, 71 liver, and 71 kidney) who completed a semi-structured interview based on the Japanese version of SIPAT (SIPAT-J) prior to transplantation. The differences between organs in terms of SIPAT scores and differences in SIPAT scores based on demographic data were comparatively analyzed.

RESULTS

The total SIPAT scores were higher for liver recipient candidates than for heart recipient candidates (P = .019). Regarding the subscales, SIPAT B (social support system) scores were higher for liver and kidney recipient candidates than for heart recipient candidates (P = .021), whereas SIPAT C (psychological stability and psychopathology) scores were higher for liver recipient candidates than for kidney recipient candidates (P = .002). Recipient candidates with a history of psychiatric treatment and those who were unemployed had higher SIPAT scores, regardless of the transplant organ, than recipient candidates without a history of psychiatric treatment and those who were employed (P < .001, P = .016, respectively).

CONCLUSIONS

There were notable differences in the total SIPAT-J and subscale scores among the liver, heart, and kidney recipient candidates. Each organ was associated with specific psychosocial issues that should be addressed before transplantation. Interventions such as information provision and patient education based on SIPAT assessment results for each organ may improve recipient post-transplant outcomes.