Children's experiences and expectations of kidney transplantation: A qualitative interview study

Life experiences after kidney transplantation in adolescents: A qualitative meta-synthesis

PURPOSE

To systematically evaluate the life experience of adolescents after kidney transplantation.

METHODS

We use computer search Web of Science, PubMed, Cochrane Library, Embase, EBSCO, CNKI, Wanfang, VIP database, search database to October 2024, screening after kidney transplant adolescents life experience of qualitative study. We used the Australian Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research to quality evaluation, and using the thematic analysis method to integrate the results.

RESULTS

7 articles were included, and 31 research results were integrated into 8 new categories and combined results are 3 integration results: complex emotional experience; eager for multifaceted support; self-adjustment.

CONCLUSION

Nursing staff should pay attention to the psychological experience and needs of adolescents, to eliminate their stigma, to promote positive cognition, and to improve their quality of life.

Living with a new kidney from the perspective of adolescents: A mandala-supported qualitative study

BACKGROUND

Despite advances in transplant procedures, children and adolescents still face some challenges post-transplant and are at high risk for psychiatric, academic, and social problems. This study aims to explore the lived experiences of adolescent kidney transplant recipients through interviews and the use of mandala art therapy.

METHODS

This study adopted a descriptive phenomenological design and thematic analysis approach based on Husserl's philosophy. The sample included kidney transplant recipients aged 12-18 years admitted to the pediatric nephrology polyclinic of a university hospital in southern Türkiye. Data were collected through in-depth interviews conducted during a mandala art activity with 14 adolescent kidney transplant recipients. The qualitative data were analyzed using Colaizzi's seven-stage qualitative analysis method, which is suitable to the descriptive phenomenological design employed in the present study.

RESULTS

Four themes and seven subthemes emerged from the data related to the problems and experiences of adolescents with kidney transplantation and growing up with a new kidney. (1) Education, (2) Ideas about the kidney; including the sub-themes "What the kidney transplant process gave them, Feelings about their kidneys", (3) Family; including the sub-themes "Relationship with the donor, Relationship with siblings", (4) Social environment; including the sub-themes "Experiences with hospital, Relationship with friends and Desire for friendship with a transplanted Peer".

CONCLUSION

Mandala art therapy-assisted interviews are an effective communication method for adolescent kidney transplant recipients to express their feelings and thoughts and to look at life from a broader perspective. Understanding the life experiences of adolescents with kidney transplantation and the difficulties they face may enable better and more systematic planning of the care to be given to them.

Modification and scoring of a transition tool to understand transition readiness among pediatric kidney transplant recipients

BACKGROUND

A successful transition from pediatric to adult healthcare for adolescent and young adult kidney transplant recipients is essential for maintaining graft and overall health. Readiness for transition is multifactorial and can be challenging to assess. The purpose of this study is to describe the development of a scoring system for a transition readiness assessment for pediatric kidney transplant recipients and assess overall and domain-specific readiness for transition.

METHODS

This is an observational study of adolescent and young adult kidney transplant recipients over 5 years who were given either the modified Middle (MTRC-m) or modified Late Transition Readiness Checklist (LTRC-m) during post-transplant clinic visits. We developed a scoring system for both checklists and assessed their reliability.

RESULTS

The MTRC-m (38 items) demonstrated good reliability (Cronbach's α = 0.84). The LTRC-m (43 items) demonstrated excellent reliability (Cronbach's α = 0.90). On both the MTRC-m and LTRC-m, patients scored highest on adherence and risky behavior knowledge. Scores were lowest in the "Managing my healthcare needs (self-advocacy)" and "How I feel about myself" domains.

CONCLUSIONS

A scored transition assessment allows for rapid appraisal of transition readiness within a clinic setting. We find that participants report high levels of knowledge regarding health-seeking behaviors and risky behaviors, endorse less readiness for managing their care independently, and express a moderate to high degree of worry about their future and their health. While transition programs have traditionally, and necessarily, focused on education, our results demonstrate that programs should expand to also focus on behavior performance and emotional well-being.

Identifying experiences of supportive care of children and young people affected by kidney failure: A qualitative systematic review

BACKGROUND

Children and young people affected by kidney failure experience complexities in their care. Little is known about the unique needs of this young patient population group living with a long-term condition.

OBJECTIVE

A meta-aggregation of all qualitative studies was conducted to identify experiences of supportive care among children and young people living with kidney failure.

METHODS

A systematic review of qualitative studies was conducted following the Joanna Briggs Institute meta-aggregation method. This review has been reported according to the PRISMA statement guidelines. Six electronic databases (CINAHL, Cochrane Library, MEDLINE, Proquest, PsycINFO, and Scopus) were comprehensively searched by an expert systematic review librarian using keywords and subject headings, from inception to September 2022. All studies were accessed using a predetermined inclusion and exclusion criteria. Methodological quality assessment and data extraction performed. Qualitative findings accompanied by illustrative quotes from included studies were extracted and grouped into categories which created the overall synthesised findings.

RESULTS

A total of 34 studies were included in this review representing a total of 613 children and young people affected by kidney failure. There was a total of 190 findings which created 13 categories representing experiences of supportive care. The meta-aggregation developed five synthesised findings namely: 'physical needs', 'information and technology', 'treatment and healthcare', 'social needs' and 'psychological impacts'.

CONCLUSION

This systematic review identified that children and young people affected by kidney failure can experience a range of unmet supportive care needs in routine clinical services. Kidney failure impacted children and young people's self-identify, social and peer networks, introduced daily practical needs because of inherent physical and psychological burden due to the failure and associated treatments. Despite improvements in the medical management of kidney failure in children and young people, further attention is needed to optimise supported self-management in this young patient group.

Holistic care and symptom management for pediatric kidney transplant recipients

While many aspects of life may improve substantially for children and young people undergoing kidney transplant, there may be new challenges including symptoms that can be detrimental to health-related quality of life. Addressing symptoms requires attention to patient and family perspectives and a holistic approach grounded in symptom management. The interdisciplinary pediatric nephrology transplant team should be attuned to the prevalence of common symptoms including fatigue, anxiety, depression, post-traumatic stress, pain, and sleep disturbances, as well as poor body image and sexual health. These common symptoms require regular assessment with a focus on appropriate interventions and how care may be impacted by transplant status.

Safeguarding children and young people requiring kidney replacement therapy: challenges and potential opportunities

Kidney replacement therapy (KRT) makes considerable physical and psychological demands on children, young people and their families. The impact can be wide-ranging, affecting education, employment, mental health, finances and relationships for both child and caregiver. It is vitally important for those working with these families to recognise the psychosocial challenges they face and to know the range of interventions available. This article explores the psychosocial impact of KRT, considering opportunities to minimise risk and optimise outcomes for children, young people and their families.

Parenting a child with a kidney transplant-A study of everyday life experiences

BACKGROUND

Kidney transplantation in children shows excellent long-term outcomes. However, parents feel responsible for ensuring that their child adheres to complex medical interventions. The dual role - as both parent and medical caregiver - gives rise to fatigue, stress, and emotional pain. Parental and family functioning are critically important to a child's disease course, development and well-being.

OBJECTIVE

To explore the experiences and perspectives of mothers and fathers of children with a kidney transplant.

DESIGN

An explorative study using a qualitative method.

PARTICIPANTS

Twelve parents (seven mothers and five fathers) of seven children with a kidney transplant.

APPROACH

A qualitative exploratory study taking a phenomenological-hermeneutic approach.

METHOD

Semi-structured individual interviews were conducted. The data were analysed using Ricoeur's theory of narrative and interpretation on three levels: naïve reading, structural analysis, and critical interpretation and discussion.

FINDINGS

Four themes were generated: Kidney transplantation as a turning point, the importance of a close collaboration with health care professionals, being the child's voice, and managing the dual role as a parent, and medical caregiver in everyday life.

CONCLUSION

Child kidney transplantation led to a transformation in the child, on the physical, mental, and social levels; however, the child was still in need of special attention and support. Problems with the kidney graft functioning resulted in frustration and disappointment in parents. Teamwork between a child's parents became evident, in coping with the dual role as a parent and medical caregiver. Parents aimed to maintain a clear structure related to medication and disease-related treatment. A close and trustful relationship and collaboration with health care professionals were significant and included listening to the voice of the child.

Paediatric kidney transplantation in under-resourced regions-a panoramic view

Kidney transplantation is the ideal choice of kidney replacement therapy in children as it offers a low risk of mortality and a better quality of life. A wide variance in the access to kidney replacement therapies exists across the world with only 21% of low- and low-middle income countries (LLMIC) undertaking kidney transplantation. Pediatric kidney transplantation rates in these under-resourced regions are reported to be as low as < 4 pmcp [per million child population]. A robust kidney failure care program forms the cornerstone of a transplant program. Even the smallest transplant program entails a multidisciplinary workforce and expertise besides ensuring family commitment towards long-term care and economic burden. In general, the short-term graft survival rates from under-resourced regions are comparable to most high-income countries (HIC) and the challenge lies in the long-term outcomes. This review focuses on specific issues relevant to kidney transplants in children in under-resourced regions by highlighting limitations in the capacity and health workforce, regulatory norms, medical issues, economic burden, factors beyond financial hardship and ethical considerations relevant to these regions. Finally, the perspective of strengthening transplant programs in these regions should factor in the bigger challenges that exist in achieving the health-related sustainable development goals by 2030.

Donor considerations in pediatric kidney transplantation

This article reviews kidney transplant donor options for children with end-stage kidney disease (ESKD). Global access to kidney transplantation is variable. Well-established national policies, organizations for organ procurement and allocation, and donor management policies may account for higher deceased donor (DD transplants) in some countries. Living donor kidney transplantation (LD) predominates in countries where organ donation has limited national priority. In addition, social, cultural, religious and medical factors play a major role in both LD and DD kidney transplant donation. Most children with ESKD receive adult-sized kidneys. The transplanted kidney has a finite survival and the expectation is that children who require renal replacement therapy from early childhood will probably have 2 or 3 kidney transplants in their lifetime. LD transplant provides better long-term graft survival and is a better option for children. When a living related donor is incompatible with the intended recipient, paired kidney exchange with a compatible unrelated donor may be considered. When the choice is a DD kidney, the decision-making process in accepting a donor offer requires careful consideration of donor history, kidney donor profile index, HLA matching, cold ischemia time, and recipient's time on the waiting list. Accepting or declining a DD offer in a timely manner can be challenging when there are undesirable facts in the donor's history which need to be balanced against prolonging dialysis in a child. An ongoing global challenge is the significant gap between organ supply and demand, which has increased the need to improve organ preservation techniques and awareness for organ donation.

Older adults' use of patient portals: Experiences, challenges, and suggestions shared through discussion board forums

Patient portals (PPs) are robust health IT programs that engage and empower patients in their care. Although PPs can benefit older adults who manage chronic conditions, their use of PPs have been largely overlooked and little training has been provided to them. Previously, our research team developed an older-adult-friendly Theory-based PP eLearning Program (T-PeP) and tested its impact on older adults with chronic conditions. As part of T-PeP, participants used discussion forums. The aim of this study was to explore older adults' experiences with using PPs, perceived impact of PP on their health, and suggestions for improvement through analysis of discussion posts. A total of 205 posts were subjected to content analysis. Findings from 10 major themes explained older adults' experiences with PPs and offered suggestions for vendors and healthcare organizations. As U.S. population is aging, older adults must be considered during the development and implementation of health IT programs.