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Visintini C, Mansutti I, Palese A. What Are the Perceptions of Recipients of Allogeneic Hematopoietic Stem Cell Transplant About Medication Adherence?: A Synthesis of Qualitative Studies. Cancer Nurs 2024:00002820-990000000-00228. [PMID: 38498800 DOI: 10.1097/ncc.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Recipients of allogeneic hematopoietic stem cell transplant (HSCT) may encounter difficulties in adhering to their post-transplant medication as prescribed to avoid complications. Despite the relevance of patients' perspectives to inform the clinical practice, to date, no summary regarding their lived experience of oral medication adherence (MA) has been produced. OBJECTIVE To summarize the lived experience of MA by recipients of allogeneic HSCT as documented in qualitative studies. METHODS A systematic review and meta-synthesis of qualitative research was performed. Six databases were searched up to June 27, 2023. Four qualitative studies met eligibility and were included: those designed and conducted with scientifically sound methodologies and those regarding adult patients who had undergone allogeneic HSCT and required an oral medication regimen in the post-transplant phase. Data were extracted and synthesized using thematic analysis. RESULTS Four analytical themes were identified: "The initiation is a challenge," "Time as a new issue," "Internal and external obstacles threaten medication adherence," and "Different strategies are the answer to medication non-adherence." CONCLUSIONS Medication adherence in patients after HSCT is a complex phenomenon wherein different factors play a role. When designing targeted interventions to improve MA, it is imperative to start with patients' experiences and perspectives. IMPLICATIONS FOR PRACTICE Patients developed different strategies to deal with obstacles to MA that may inform daily practice. Before discharge, healthcare professionals should emphasize to both patients and carers the importance of MA.
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Affiliation(s)
- Chiara Visintini
- Author Affiliations: Department of Biomedicine and Prevention, University of Rome Tor Vergata (Ms Visintini); and School of Nursing, Department of Medical Sciences, University of Udine (Drs Mansutti and Palese), Italy
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Condran B, Kervin M, Burton C, Blydt-Hansen TD, Morris SK, Sadarangani M, Otley A, Yong E, Mitchell H, Bettinger JA, Top KA. Parent and healthcare provider views of live varicella vaccination of pediatric solid organ transplant recipients. Pediatr Transplant 2023; 27:e14609. [PMID: 37746885 DOI: 10.1111/petr.14609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/28/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Live attenuated varicella vaccine (LAVV) has historically been contraindicated in children who are immunocompromised due to solid organ transplant (SOT) because of safety concerns. Recently, clinical guidelines were developed that support post-transplant varicella vaccination in selected SOT recipients based on emerging evidence of LAVV safety. This qualitative study sought to explore barriers and facilitators to implementing the new guidelines, as well as acceptability of LAVV among healthcare providers (HCPs) and parents. METHODS HCPs and parents of transplant recipients were recruited from four sites using purposive sampling. Data from semi-structured interviews were analyzed using an Interpretive Description approach that incorporated data from the interviews, academic knowledge and clinical experience, and drew from Grounded Theory and Thematic Analysis. The theoretical framework used was Adaptive Leadership. RESULTS Thirty-four participants (16 HCPs and 18 parents) were included in the analysis. Parents developed skills in adaptive leadership that included strategies to protect their child against infectious diseases. Foundational information that live vaccines were absolutely contraindicated post-transplant "stuck" with parents and led them to develop strategies other than vaccination to keep their child safe. Some parents struggled to understand that information previously presented as a certainty (contraindication of LAVV) could change. Their approach to adaptive leadership informed their appraisal of the new vaccination guidelines and willingness to accept vaccination. CONCLUSIONS HCPs should adopt a family-centered approach to communicating changing guidelines that considers parents' approach to adaptive leadership and discusses the changing nature of medical evidence. Trust between HCPs and parents can facilitate these conversations.
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Affiliation(s)
- Brian Condran
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
| | - Melissa Kervin
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
| | - Catherine Burton
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaun K Morris
- Clinical Public Health and Centre for Vaccine Preventable Diseases, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases and Child Health Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Anthony Otley
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Hana Mitchell
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Julie A Bettinger
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
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Ng JH, Halinski C, Nair D, Diefenbach MA. Impact of COVID-19 on Disease Self-management Among Patients With Advanced CKD: A Qualitative Study. Kidney Med 2023; 5:100689. [PMID: 37360218 PMCID: PMC10268812 DOI: 10.1016/j.xkme.2023.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/30/2023] [Indexed: 06/28/2023] Open
Abstract
Rationale & Objective Patients with advanced chronic kidney disease (CKD) and their care partners experienced decreased access to care, and worse physical and emotional health during the Coronavirus Disease-19 (COVID-19) pandemic. Few studies have explored how COVID-19-related challenges affected disease self-management among those with advanced chronic kidney disease (CKD) and their care partners. Leventhal's self-regulation model offers a comprehensive framework for understanding disease self-management through the interplay of cognitive beliefs, emotional reactions and social influences. The study aims to examine the impact of COVID-19 on self-management activities among patients with CKD and care partners. Study Design Qualitative study. Setting & Participants Adults with advanced CKD, including dialysis and transplant recipients, and their carepartners. Analytical Approach Thematic Analysis. Results Among 42 participants, 12 had stage 4 CKD, 5 had stage 5 CKD, 6 were receiving in-center hemodialysis, 5 had a kidney transplant, and 14 were care partners. We identified 4 patient-related themes with corresponding subthemes related to the impact of COVID-19 on self-management: 1) cognitive understanding that COVID-19 is an additional health threat to existing kidney disease, 2) heightened anxiety and vulnerability driven by perceived risk, 3) coping with isolation through virtual interactions with healthcare services and social circles, 4) increased protective behaviors to maximize survival. Three care partner-related themes emerged: 1) hypervigilance in family care and protection, 2) interaction with health system and adaptations to self-management, and 3) increased intensity in caregiving role to facilitate patient self-management. Limitations The qualitative study design limits the ability to generate generalizable data. Grouping patients with Stage 3 and 4 CKD, in-center hemodialysis, and kidney transplants together limited our ability to examine self-management challenges specific to each treatment requirement. Conclusions When faced with the COVID-19 pandemic, patients with CKD and their care partners experienced heightened vulnerability and thus increased cautionary activities to maximize survival. Our study provides the groundwork for future interventions to help patients and care partners live with kidney disease during future crises.
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Affiliation(s)
- Jia H. Ng
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
- Division of Kidney Diseases and Hypertension, Northwell Health
| | - Candice Halinski
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
- Division of Kidney Diseases and Hypertension, Northwell Health
| | - Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Michael A. Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
- Institute of Health System Science, Feinstein Institutes for Medical Research
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Lin K, Wei C, Li J, Guo X, Gao F, Zhao P, Liu H. Development and validation of the Chinese version of the self-management support scale for kidney transplant recipients. BMC Nurs 2023; 22:128. [PMID: 37072844 PMCID: PMC10111319 DOI: 10.1186/s12912-023-01269-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/25/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Providing self-management support to kidney transplant recipients is essential. However, a scale to identify the self-management support they have received is lacking. The purpose of this study is to develop a Self-management Support Scale for Kidney Transplant Recipients (SMSSKTR) and test its psychometric properties. METHODS This is an instrument development and validation study, which has a three-stage cross-sectional design. In Stage 1, a preliminary item pool was formed using a literature review, semi-structured interviews, and the Delphi method. In Stage 2, six experts were invited to assess content validity. A convenience sample of 313 participants was used to explore the factor structure by using exploratory factor analysis. The test-retest reliability was assessed using the intra-class correlation coefficient (ICC). In Stage 3, two hundred and sixty-five participants were recruited to validate the factor structure by using confirmatory factor analysis. Convergent validity was examined using Spearman's correlation coefficient. Cronbach's alpha coefficient and corrected item-total correlation coefficient were used to test the reliability of the entire scale and its dimensions. The study was reported according to the STARD and GRRAS checklists. RESULTS An initial 40-item scale was developed in Stage 1. In Stage 2, three factors with 22 items emerged from the exploratory factor analysis: instrumental support, psychosocial support, and relational support. The content validity index of the scale was 0.97. The intra-class correlation coefficient for the entire scale and the subscales were 0.915, 0.771, 0.896, and 0.832, respectively. In Stage 3, the confirmatory factor analysis indicated that the three-factor model had a good fit. The score of the scale was positively associated with that of the Self-Management Scale of Renal Transplant Recipients (r = 0.532). Cronbach's alpha was 0.959 for the entire scale and 0.956-0.958 for the three subscales. The corrected item-total correlation coefficient ranged from 0.62 to 0.82. CONCLUSION The 22-item SMSSKTR has sufficient psychometric properties to assess the self-management support they have received, which has not been measured before.
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Affiliation(s)
- Keke Lin
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Changyun Wei
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Jiaqi Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Xuejie Guo
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China
| | - Fengli Gao
- Nursing Department, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peiyu Zhao
- Nursing Department, China-Japan Friendship Hospital, Beijing, China
| | - Hongxia Liu
- School of Nursing, Beijing University of Chinese Medicine, Beijing, China.
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Tarsitano MG, Porchetti G, Caldara R, Secchi A, Conte C. Obesity and Lifestyle Habits among Kidney Transplant Recipients. Nutrients 2022; 14. [PMID: 35889847 DOI: 10.3390/nu14142892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background: Obesity may negatively impact clinical outcomes in kidney transplant (KT) recipients. Limited information is available on the prevalence of obesity in this population, and on the lifestyle habits associated with obesity. Methods: we conducted an online, anonymous survey to assess of the proportion of KT recipients with obesity, adherence to the Mediterranean diet (i.e., a dietary regimen with proven renal and cardiovascular outcomes) using the MEDI-Lite questionnaire, and level of physical activity using the International Physical Activity Questionnaire (IPAQ) short form among KT recipients. Results: 255 KT recipients participated. Median (25th−75th quartile) age was 56.0 (48.0; 62.0) years, 43.9% female, median BMI 23.9 (21.6; 26.5) kg/m2. The proportion of KT recipients with obesity was 9.8% (95% confidence interval, 6.4 to 14.1%). Adequate adherence to the Mediterranean diet (Medi-Lite score >9) was overall low (44.7%; 40.0 vs. 45.2% in those with or without obesity, respectively; p = 0.618). In participants with obesity the Medi-Lite score inversely correlated with BMI (R = −0.45; p < 0.025). Overall, 30.6% of participants had a low level of physical activity (44.0 vs. 29.1% of those with or without obesity, respectively; p = 0.125). The amount of energy expended walking was significantly lower among participants with obesity (462 (0.0; 1436) vs. 1056 (433; 2005) METs/week, p = 0.017). Conclusions: the burden of obesity among KT recipients is similar to that of the general population. Adherence to the Mediterranean diet was generally low, and nearly one-third of participants had a low level of physical activity. Building specialized multidisciplinary teams to manage obesity in KT recipients is urgently needed.
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McKeaveney C, Noble H, Courtney AE, Griffin S, Gill P, Johnston W, Maxwell AP, Teasdale F, Reid J. Dialysis, Distress, and Difficult Conversations: Living with a Kidney Transplant. Healthcare (Basel) 2022; 10:healthcare10071177. [PMID: 35885704 PMCID: PMC9321787 DOI: 10.3390/healthcare10071177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Providing holistic care to kidney patients is important; however, without full consideration of the perspectives of people living with a kidney transplant, the provision of truly ‘holistic healthcare’ cannot be possible. It is imperative to understand patient experiences by including kidney patients in key strategies and future renal service planning. Ignoring these important patient views means that there is a significant risk of inappropriate renal service provision and lack of adequate support, impacting overall health. The aim of this study was to develop an in-depth understanding of the lived experiences of kidney transplant recipients. Methods: A total of 23 participants were recruited between two regional nephrology units within the United Kingdom via clinical gatekeepers. In-depth interviews were undertaken. Interviews were digitally recorded, transcribed verbatim, and subjected to interpretative phenomenological analysis. Results: Two themes emerged: “managing ongoing fears of dialysis, distress, and COVID-19” and “dealing with difficult conversations”. Conclusions: Renal healthcare professionals need to understand more than the biological impact of receiving a kidney transplant. Understanding the holistic and multidomain experiences that these participants experience will help healthcare professionals to recognize the needs of this group and ensure more responsive psychosocial care.
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Affiliation(s)
- Clare McKeaveney
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | | | - Sian Griffin
- Department of Nephrology and Transplantation, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK;
| | - Paul Gill
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK;
| | - William Johnston
- Northern Ireland Kidney Patients Association, Belfast BT9 7AB, UK;
| | | | | | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
- Correspondence:
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