Prevention of poor psychosocial outcomes in living organ donors: from description to theory-driven intervention development and initial feasibility testing
ABSTRACT Although some living donors experience psychological, somatic, and interpersonal difficulties after donation, interventions to prevent such outcomes have not been developed or evaluated.
To (1) summarize empirical evidence on psychosocial outcomes after donation, (2) describe a theoretical framework to guide development of an intervention to prevent poor outcomes, and (3) describe development and initial evaluation of feasibility and acceptability of the intervention.
Based on a narrative literature review suggesting that individuals ambivalent about donation are at risk for poor psychosocial outcomes after donation, the intervention targeted this risk factor. Intervention structure and content drew on motivational interviewing principles in order to assist prospective donors to resolve ambivalence. Data were collected on donors' characteristics at our institution to determine whether they constituted a representative population in which to evaluate the intervention. Study participants were then recruited to assess the feasibility and acceptability of the intervention. They were required to have scores greater than 0 on the Simmons Ambivalence Scale (indicating at least some ambivalence about donation).
Our population was similar to the national living donor population on most demographic and donation-related characteristics. Eight individuals who had been approved to donate either a kidney or liver segment were enrolled for pilot testing of the intervention. All successfully completed the 2-session telephone-based intervention before scheduled donation surgery. Participants' ratings of acceptability and satisfaction were high. Open-ended comments indicated that the intervention addressed participants' thoughts and concerns about the decision to donate.
The intervention is feasible, acceptable, and appears relevant to donor concerns. A clinical trial to evaluate the efficacy of the intervention is warranted.
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ABSTRACT: Background: A recommendation in original descriptions of motivational interviewing (MI) was to "explore ambivalence". Contrasting procedures for doing so have been clarified through the evolution of MI. Aims: This article describes two conceptually distinct methods for responding to ambivalence: decisional balance (DB) and MI's evocation of change talk, and reviews empirical evidence to recommend when each procedure is appropriate (and inappropriate) in clinical practice. Method: The authors summarize findings of clinical outcome research to examine how these two interventions impact the resolution of client ambivalence. Results: With ambivalent people, a DB intervention tends to decrease commitment to change, whereas evocation (a key element of MI) promotes change. When a person has already made the decision to change, evocation is unnecessary and may deter change, whereas DB may further strengthen commitment. Conclusions: DB is an appropriate procedure when the clinician wishes to maintain neutrality and not favor the resolution of ambivalence in any particular direction. Evocation is appropriate when the clinician intends to help clients resolve ambivalence in the direction of change.Behavioural and Cognitive Psychotherapy 11/2013; 43(02):1-13. DOI:10.1017/S1352465813000878 · 1.69 Impact Factor
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ABSTRACT: There has been dramatic growth in the last decade in the literature on psychosocial and financial impacts of living organ donation. With this growth has come recognition that these impacts must be considered when educating prospective donors about the donation process and when planning donor follow-up care after donation. Our review highlights recent studies that provide new information on the nature of psychosocial and financial outcomes in living donors, with special attention to studies examining unrelated donors (i.e., those with no biologic or longstanding emotional connection to the transplant patient), given that these individuals represent a growing segment of the living donor population. Limitations and gaps in available evidence are noted. We also discuss recent recommendations for post-donation monitoring of donors’ psychosocial and financial outcomes, and we consider advances in evidence regarding interventions and prevention strategies to minimize any adverse psychosocial and financial impacts of living donation.03/2014; 1(1). DOI:10.1007/s40472-013-0003-4
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ABSTRACT: Donor safety in living liver donation is of paramount importance, however, information on long-term outcomes is limited by incomplete follow-up. We sought to ascertain factors that predict post-donation follow-up in 456 living liver donors in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Completed donor follow-up was defined as physical, phone, or laboratory contact at a given time point. Univariate and multivariable mixed effects logistic regression models were developed to predict completed follow-up using donor and recipient demographic and clinical data and donor quality of life data. 90% of donors completed follow-up in the first three months, 83% at year 1; completed follow-up ranged from 57% to 72% in years 2-7 and from 41% to 56% in years 8-10. The probability of completed follow-up in the first year was higher for white donors (odds ratio (OR)=3.27, 95% confidence interval (CI)=1.25-8.58), but lower for donors whose recipients had hepatitis C virus or hepatocellular carcinoma (OR=0.34, 95% CI=0.17-0.69). After the first year, older age at donation predicted more complete follow-up. There were significant center differences at all time points (OR range 0.29-10.11), with center variability in both return for in-center visits and in the use of phone/long distance visits. Donor follow-up in the first year post-donation was excellent but decreased with time. Predictors of follow-up varied based on the time since donation. Adapting center best practices, enhanced by using telephone and social media to maintain contact with donors, represents a significant opportunity to gain valuable information about long-term donor outcomes. Liver Transpl , 2014. © 2014 AASLD.Liver Transplantation 08/2014; 20(8). DOI:10.1002/lt.23912 · 3.79 Impact Factor