Bibliotherapy for psychosocial distress in lung transplant patients and their families

Investigating the components of bibliotherapy implementation process in digital hospital libraries of Iran: Survey analysis

The study aimed to identify the components of bibliotherapy implementation in digital hospital libraries of Iran. The research method regarding purpose is applied and regarding methodology is survey. This showed the desired level of reliability was human resources, information resources, technology and technology infrastructure, services, copyright and financial resource. The most important basic requirements for the implementation of this plan in hospital digital libraries were as follows: Method of providing information resources: ‘Collection of various digital resources to launch bibliotherapy (audiovisual resources, audio, video, etc.)’; the most desirable people to provide information resources: ‘Librarians of digital libraries in consultation with physicians and consultants’; digital resource prioritisation: ‘Multimedia Resources’; services for users: ‘Providing digital information resources, suitable for any age group in the field of bibliotherapy’; legal barriers: ‘The unwillingness of authors and publishers to support free access and at the same time protect the copyright of digital resources in the field of bibliotherapy’; and economic barriers: ‘Impossibility to provide the necessary funding to provide bibliotherapy related services in hospital digital libraries’. Its conceptual and structural model, design and research results indicate a proper fit of the components. Based on the findings of the present study, it can be concluded that the components of bibliotherapy implementation in hospital digital libraries can be classified into six sections in terms of importance and effectiveness: technical and technological infrastructure, services, financial resources, information resources, copyright and human resources.

To transplant or not? The importance of psychosocial and behavioural factors before lung transplantation

The gratifying results of lung transplantation in terms of survival and quality of life stimulate the referral of an ever-increasing number of patients with end-stage lung disease. This in turn compounds the organ shortage, which is the limiting factor in the transplantation rate. In the absence of good alternative treatment modalities, an evidence-based pretransplant screening process is a prerequisite to detennine which patients will benefit most from transplantation. Within this evidence-based screening process, medical selection criteria are well established. There is a growing awareness that psychosocial and behavioural factors may determine outcome after transplantation as well. This paper reviews the available evidence for psychosocial and behavioural factors in the screening process for lung transplantation. The relation of various factors with post-transplant outcome was explored. Psychosocial characteristics before transplantation consist of 1) anxiety and depression, 2) personality disorders, 3) neurocognitive problems, and 4) lack of social support. Pretransplant behavioural factors include 1) noncompliance with medication, 2) alcohol abuse or dependence, 3) smoking, 4) noncompliance with dietary guidelines, and 5) noncompliance with monitoring of vital parameters and infections. It appears that the lack of rigorous studies limit the feasibility of an evidence-based screening process. Prospective studies are crucial to this further investigation of the relationship between psychosocial and behavioural determinants before transplantation and outcomes after transplantation, in terms of compliance, morbidity, and mortality. Identification of modifiable risk factors for poor outcome before transplantation is a first step in developing interventions.

Comparing different modes of delivery: a pilot evaluation of a family-focused, cognitive-behavioral intervention for anxiety-disordered children

Cognitive behavior therapy delivered by trained clinicians has been shown to be an effective treatment for childhood anxiety. However, the prevalence of anxiety disorders in children and adolescents, combined with the practical and psychological obstacles that often prevent families from accessing professional help, mean that alternative ways of reaching prospective clients must be explored. This pilot study aims to compare the relative efficacy of two different modes of delivering a family-focused, cognitive-behavioral intervention for children with an anxiety disorder. The two modalities compared were: a parent-delivered program (bibliotherapy) and a clinician-delivered program (individual therapy). Twenty-seven children aged between 7 and 14, together with their parents, were randomly assigned to one of the two conditions listed above. Results at post-treatment showed a significant improvement for children in both treatment conditions in terms of diagnostic status, number of diagnoses and severity of primary diagnosis at follow-up. Children in the bibliotherapy condition demonstrated a significant improvement over time in terms of child- and parent-reported anxiety levels. No differences were found between the two treatment conditions on any outcome measure. These results were maintained at 3- and 6-month follow-up. Although a pilot study, these data suggest that a bibliotherapy format of the intervention described may have potential merit. The implications for service delivery are discussed, as are the limitations of this research.

Telephone-based coping skills training for patients awaiting lung transplantation

Impaired quality of life is associated with increased mortality in patients with advanced lung disease. Using a randomized controlled trial with allocation concealment and blinded outcome assessment at 2 tertiary care teaching hospitals, the authors randomly assigned 328 patients with end-stage lung disease awaiting lung transplantation to 12 weeks of telephone-based coping skills training (CST) or to usual medical care (UMC). Patients completed a battery of quality of life instruments and were followed for up to 3.4 years to assess all-cause mortality. Compared with UMC, CST produced lower scores on perceived stress, anxiety, depressive symptoms, and negative affect and improved scores on mental health functioning, optimism, vitality, and perceived social support. There were 29 deaths (9%) over a mean follow-up period of 1.1 year. Survival analyses revealed that there was no difference in survival between the 2 groups. The authors conclude that a telephone-based CST intervention can be effectively delivered to patients awaiting lung transplantation. Despite the severity of pulmonary disease in this patient population, significant improvements in quality of life, but not somatic measures or survival to transplant, were achieved.

Psychological disorders and distress after adult cardiothoracic transplantation

This review summarizes and integrates evidence concerning mental health outcomes following heart, lung, and heart-lung transplantation. Drawing on English-language case reports and empirical studies published between January 1980 and December 2004, the goals of the review were to (a) describe the prevalence and clinical characteristics of psychological disorders, as well as the level and pattern of clinically significant distress in the years posttransplant; (b) review the major risk factors for poor posttransplant psychological outcomes; (c) consider evidence suggesting that posttransplant psychological outcomes predict physical morbidity and mortality after transplant; (d) summarize findings from intervention studies designed to improve posttransplant psychological outcomes; and (e) provide patient care recommendations for the practicing clinician and recommendations for continued clinical research. Several major conclusions can be drawn from this literature. First, depressive and anxiety-related disorders and associated distress are common posttransplant. While new onsets of disorder may decline after the first year posttransplant, the development of new medical complications in the late years posttransplant may provoke renewed distress and recurrences of disorder. Second, risk factors for posttransplant psychological disorders and elevated distress include both standard risk factors observed in other populations (eg, younger age, lifetime history of psychiatric disorder) and transplant-specific factors related to physical functional impairments, social supports, and strategies for coping with health problems. Third, while little evidence has been published to date, there is some indication that posttransplant psychological outcomes can predict subsequent physical health outcomes. Fourth, extremely few intervention studies in cardiothoracic transplant recipients have been performed. The few reports indicate that multicomponent psychosocial strategies focused on risk factor reduction and enhancement of personal coping resources may lead to reductions in psychological distress. An important caveat in considering all of the evidence reviewed is that most studies focus on heart rather than lung or heart-lung recipients. Recommendations for practicing clinicians focus on assessment and treatment options, based on the evidence to date. Research recommendations focus on the need for intervention effectiveness studies.

A randomized evaluation of quality-of-life therapy with patients awaiting lung transplantation

Research shows that patients wait-listed for lung transplantation have very poor quality of life (QOL). This study evaluated the effectiveness of Quality-of-Life Therapy (QOLT) in improving QOL, mood disturbance and social intimacy in adults awaiting lung transplantation. Thirty-five adults were randomized to QOLT (n = 17) or supportive therapy (ST; n = 18) and received individual, telephone-based treatment sessions. QOL, mood and social intimacy assessments were conducted at baseline and at 1 and 3 months after treatment. Repeated measures analyses of variance showed significant Condition x Time interaction effects for all three primary outcome measures. Subsequent post hoc analyses showed that the two groups did not differ significantly at baseline, but did differ significantly at the 1- and 3-month follow-up assessments. When compared to ST patients, QOLT patients had significantly higher QOL scores at the 1- and 3-month assessments, lower mood disturbance scores at the 3-month assessment, and higher social intimacy scores at the 1-month assessment. Results indicate that a patient's QOL, mood state and relationship with the primary caregiver can be positively impacted by a brief psychological intervention prior to lung transplantation.

Psychosocial aspects of the organ transplant experience: what has been established and what we need for the future

This article briefly describes the current status and limitations of the organ transplant process that has now become a routine medical procedure. The article discusses how transplantation is not a cure for end-stage organ disease but an alternative form of treatment with both potential medical and psychosocial problems. Both transplant candidates and recipients encounter psychosocial problems. The article examines how these psychosocial problems affect transplant patients prior to transplant, immediately following surgery, and posttransplant. The psychosocial problems include psychiatric diagnoses, individual and family adjustment and relationship problems, sexual dysfunction, return-to-work (RTW) difficulties, and compliance problems and variables related to noncompliance. The article also reviews the special problems of pediatric and adolescent transplant recipients. The need for empirically supported interventions is noted in each of the problem areas. The author outlines problems with previous research studies that hamper solid interpretations of the data, and discusses literature suggesting that the psychosocial problems of transplant candidates and recipients are likely to be underreported. The article concludes with recommendations about the need to switch research efforts toward intervention studies in the problem areas already solidly identified by the literature.

Predictors of quality of life and adjustment after lung transplantation

STUDY OBJECTIVE

Few studies have examined predictors of quality of life and adjustment after lung transplantation. This study determined whether pretransplant psychological measures predicted physical health, quality of life, and overall adjustment posttransplant. Cross-sectional analyses also examined differences in adjustment and quality of life for lung transplant candidates and recipients.

DESIGN AND PARTICIPANTS

Seventeen transplant candidates and 60 transplant recipients completed questionnaires measuring adjustment and quality of life. In addition, we examined archival data on 107 transplant candidates who had received pretransplant psychological assessments, and posttransplant physical health status data were collected on these patients. Of the 107 patients who provided a pretransplant psychological assessment, 32 completed the questionnaires measuring posttransplant adjustment and quality of life.

SETTING

University medical center transplant service.

RESULTS

Cross-sectional analyses indicated significantly better adjustment and quality of life posttransplant. Pretransplant psychological variables were not associated with measures of posttransplant physical health. Hierarchical multiple regression analyses found that pretransplant anxiety and psychopathology predicted posttransplant adjustment (beta's ranging from 0.32 to 0.68) and greater pretransplant anxiety also predicted worse posttransplant quality of life (beta's ranging from 0.29 to 0.62). Subjective sleep disturbances were associated with poorer adjustment and quality of life (beta's ranging from 0.36 to 0.75), and were found to mediate the relationship between presurgical anxiety and posttransplant adjustment and quality of life.

CONCLUSIONS

This study found that psychological status pretransplant predicted adjustment and quality of life posttransplant. Moreover, increased anxiety levels pretransplant predicted subsequent subjective sleep disturbances, which were, in turn, associated with poorer adjustment and quality of life. The benefits of pretransplant stress management interventions are discussed.