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Wadhwani SI, Alvarado A, Shifman HP, Bautista B, Yalung J, Squires JE, Campbell K, Ebel NH, Hsu E, Vittorio J, Zielsdorf S, Desai DM, Bucuvalas JC, Gottlieb L, Kotagal U, Lyles CR, Ackerman SL, Lai JC. Caregivers' and providers' perspectives of social and medical care after pediatric liver transplant: Results from the multicenter SOCIAL-Tx study. Liver Transpl 2024; 30:717-727. [PMID: 38166123 DOI: 10.1097/lvt.0000000000000327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/12/2023] [Indexed: 01/04/2024]
Abstract
Disparities exist in pediatric liver transplant (LT). We characterized barriers and facilitators to providing transplant and social care within pediatric LT clinics. This was a multicenter qualitative study. We oversampled caregivers reporting household financial strain, material economic hardship, or demonstrating poor health literacy. We also enrolled transplant team members. We conducted semistructured interviews with participants. Caregiver interviews focused on challenges addressing transplant and household needs. Transplant provider interviews focused on barriers and facilitators to providing social care within transplant teams. Interviews were recorded, transcribed, and coded according to the Capability, Opportunity, Motivation-Behavior model. We interviewed 27 caregivers and 27 transplant team members. Fifty-two percent of caregivers reported a household income <$60,000, and 62% reported financial resource strain. Caregivers reported experiencing (1) high financial burdens after LT, (2) added caregiving labor that compounds the financial burden, (3) dependency on their social network's generosity for financial and logistical support, and (4) additional support being limited to the perioperative period. Transplant providers reported (1) relying on the pretransplant psychosocial assessment for identifying social risks, (2) discomfort initiating social risk discussions in the post-transplant period, (3) reliance on social workers to address new social risks, and (4) social workers feeling overburdened by quantity and quality of the social work referrals. We identified barriers to providing effective social care in pediatric LT, primarily a lack of comfort in assessing and addressing new social risks in the post-transplant period. Addressing these barriers should enhance social care delivery and improve outcomes for these children.
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Affiliation(s)
- Sharad I Wadhwani
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Alejandra Alvarado
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Holly P Shifman
- Oakland University Beaumont School of Medicine, Rochester, Michigan, USA
| | - Bethany Bautista
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - Jared Yalung
- Department of Pediatrics, University of California, San Francisco, San Francisco, California, USA
| | - James E Squires
- Department of Pediatrics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kathleen Campbell
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Noelle H Ebel
- Department of Pediatrics, Stanford University, Stanford, California, USA
| | - Evelyn Hsu
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Jennifer Vittorio
- Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
- Department of Pediatrics, New York University Langone Health, New York, New York, USA
| | - Shannon Zielsdorf
- Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Dev M Desai
- Department of Surgery, UT Southwestern Medical Center, Dallas, Texas, USA
| | - John C Bucuvalas
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Laura Gottlieb
- Department of Family & Community Medicine, San Francisco, San Francisco, California, USA
| | - Uma Kotagal
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Courtney R Lyles
- Department of Medicine, San Francisco, San Francisco, California, USA
| | - Sara L Ackerman
- Department of Social & Behavioral Sciences, San Francisco, San Francisco, California, USA
| | - Jennifer C Lai
- Department of Medicine, San Francisco, San Francisco, California, USA
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