The Psychosocial Treadmill: the Road to Improving High-risk Behavior in Advanced Therapy Candidates
Purpose of Review
The purpose of this review is to explore the evaluation and identification of psychosocial risk factors during the heart transplant evaluation process with the goal of improving psychosocial candidacy prior to transplant listing. Subsequently, more patients will be able to receive life-saving heart transplant and experience success after transplant.
Evaluating and identifying psychosocial risk factors is an essential component of the transplant evaluation process. Less research exists demonstrating how patients may be able to reduce psychosocial risk factors over time to improve their candidacy for transplant. This review will describe a program developed for patients undergoing heart transplant evaluation at The Ohio State University Wexner Medical Center to improve their psychosocial risk.
By implementing a comprehensive, multidisciplinary intervention to address psychosocial risk factors pre-transplant, patients can improve their psychosocial candidacy and go on to be listed for heart transplant.
KeywordsHeart transplant Psychosocial evaluation Adherence Psychosocial candidacy Health coaching
Compliance with Ethical Standards
Conflict of Interest
Laura Newman declares no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 1.•• Coglianese EE, Samsi M, Liebo MJ, Heroux AL. The value of psychosocial factors in patient selection and outcomes after heart transplantation. Curr Heart Fail Rep. 2015;12:42–7. https://doi.org/10.1007/s11897-014-0233-5. Excellent article detailing the importance of psychosocial factors and how they impact outcomes.CrossRefPubMedGoogle Scholar
- 3.Dew M, Rosenberger E, Myaskovsky L, DiMartini A, DeVito Dabbs A, Posluszny D, et al. Depression and anxiety as risk factors for morbidity and mortality after organ transplantation: a systematic review and meta-analysis. Transplantation. 2015;100(5):988–1003. https://doi.org/10.1097/TP.0000000000000901.CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Sanchez R, Bailles E, Peri JM, Bastidas A, Perez-Villa F, Bulbena A, et al. Assessment of psychosocial factors and predictors of psychopathology in a sample of heart transplantation recipients: a prospective 12 months follow up. Gen Hosp Psychiatry. 2016;38:59–64. https://doi.org/10.1016/j.genhosppsych.2015.10.006.CrossRefPubMedGoogle Scholar
- 6.•• Rosenberger E, Fox K, DiMartini A, Dew M. Psychosocial factors and quality-of-life after heart transplantation and mechanical circulatory support. Curr Opin Organ Transplant. 2012;17(5):558–63. A good article highlighting the concerns with transplant and mechanical circulatory support patients.CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Maldonado JR, Dubois HC, David EE, Sher Y, Lolak S, Dyal J, et al. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT): a new tool for the psychosocial evaluation of pre-transplant candidates. Psychosomatics. 2012;53(2):123–32. https://doi.org/10.1016/j.psym.2011.12.012.CrossRefPubMedGoogle Scholar
- 8.Maltby MC, Flattery MP, Burns B, Salyer J, Weinland S, Shah KB. Psychosocial assessment of candidates and risk classification of patients considered for durable mechanical circulatory support. J Heart Lung Transplant. 2014;33(8):836–41. https://doi.org/10.1016/j.healun.2014.04.007.CrossRefPubMedGoogle Scholar
- 9.•• Maldonado J, Sher Y, Lolak S, Swendson H, Skibola D, Neri E, et al. The Stanford integrated psychosocial assessment for transplantation: a prospective study of medical and psychosocial outcomes. Psychosom Med. 2015;77(9):1018–30. A good update to the original article regarding the SIPAT as an evaluation tool and how it relates to outcomes.CrossRefPubMedGoogle Scholar
- 12.•• Easthall C, Barnett N. Using theory to explore the determinants of medication adherence; moving away from a one-size-fits-all approach. Pharmacy (Basel). 2017;5(3):50. Excellent article linking motivational interviewing and health coaching to improving adherence, and focusing on a patient-centered approach.CrossRefGoogle Scholar
- 13.Nafradi K, Nakamoto K, Schulz PJ. Is patient empowerment the key to promote adherence? A systematic review of the relationship between self-efficacy, health locus of control, and medication adherence. PLoS One. 2017;12(10):e0186458. https://doi.org/10.1371/journal.pone.0186458.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Brocks Y, Zittermann A, Grisse D, Schmid-Ott G, Stock-GieBendanner S, Schulz U, et al. Adherence of heart transplant recipients to prescribed medication and recommended lifestyle habits: a single-center experience. Prog Transplant. 2017;27(2):160–6. https://doi.org/10.1177/1526924817699959.CrossRefPubMedGoogle Scholar
- 15.Ehrlich KB, Miller GE, Scheide T, Baveja S, Weiland R, Galvin J, et al. Pre-transplant emotional support is associated with longer survival after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant. 2016;51(12):1594–8. https://doi.org/10.1038/bmt.2016.191.CrossRefPubMedGoogle Scholar
- 17.Lee KS, Moser DK, Dracup K. Relationship between self-care and comprehensive understanding of heart failure and its signs and symptoms. Eur J Cardiovasc Nurs 2017;1474515117745056. https://doi.org/10.1177/1474515117745056