Pre-to-post-transplantation psychosocial functioning, health-related quality of life, and nonadherence in pediatric patients
Eaton, Cyd Kumiko
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The goal of this study was to investigate differences in psychosocial functioning that occurred from pre-to-post transplantation and to identify pre-transplant psychosocial predictors of post-transplant health-related quality of life (HRQOL) and medication nonadherence in a sample of pediatric patients (ages 0-21 years) awaiting and eventually receiving a solid organ transplant. Patient, parent, and family factors were evaluated prior to transplantation at baseline (Time 1). Approximately 6 months after patients received a solid organ transplant, study measures were re-administered (Time 2). The final sample included 55 parents who completed data collection at both time points. Data were analyzed to 1) examine pre-to-post-transplant differences in patient health-related quality of life (HRQOL) and patient, parent, and family psychosocial functioning; and 2) identify pre-transplant psychosocial predictors of post-transplant HRQOL and medication nonadherence. Due to the large patient age range and the significant, inverse relationships between patients’ ages at Time 1 and HRQOL at Time 2, a post-hoc investigation was conducted to further analyze how patients’ ages potentially influenced HRQOL after transplantation. Results indicated that patients’ HRQOL improved and parents’ psychological distress decreased from pre-to-post-transplantation. Pre-transplant HRQOL emerged as the best predictor of post-transplant HRQOL for patients, with higher pre-transplant HRQOL predicting higher post-transplant HRQOL. Measurement issues prevented the valid assessment and analysis of medication nonadherence. The post-hoc investigation suggested that patients’ ages at the time of the pre-transplant evaluation related to post-transplant HRQOL in several different ways. Results offer information that providers may use as psychoeducation for families during the pre-transplant evaluation. Results further suggest that there is clinical utility in evaluating patients’ HRQOL at the pre-transplant evaluation to identify areas of psychosocial functioning that may benefit from targeted intervention to support better post-transplant HRQOL and adjustment. Lastly, patients’ ages at the time of the pre-transplant evaluation may differentially influence post-transplant levels of HRQOL.