Psychosocial Predictors of Adherence and Long-Term Health and Medical Outcomes in Pediatric Cardiothoracic Organ Transplantation: Use of Clinical Data-Mining from a Social Work Perspective
Background and Purpose: Social workers perform important roles within organ transplant services, especially in pediatrics where the parents and extended family are intimately involved. The role of social work in the area of organ transplantation remains underrepresented both within the social work p...
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| Format: | Others |
| Language: | English English |
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Florida State University
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| Online Access: | http://purl.flvc.org/fsu/fd/FSU_migr_etd-5740 |
| Summary: | Background and Purpose: Social workers perform important roles within organ transplant services, especially in pediatrics where the parents and extended family are intimately involved. The role of social work in the area of organ transplantation remains underrepresented both within the social work profession and research literature. Research on the psychological and social predictors of medication adherence is critical to the advancement of pretransplant assessments and transplant social work services. Transplant social workers assess the child and family prior to transplantation to determine if the child and family are psychologically and socially prepared to undergo the procedure and care for the child after transplantation, and assist posttransplantation with resources and services. Ultimately, consistency with medication is critical to quality of life and in preventing organ rejection. Methods: The study used hospital-generated data and medical records information to test the association between patient and family psychosocial characteristics and medication adherence outcomes. Data generated from the United Network of Organ Sharing (Department of Health and Human Services) offered medical information and patient and family demographics. The posttransplant data included patients' long-term health, medical outcomes, and adherence to medications. All patients received psychological, psychiatric, or psychosocial assessments prior to being listed for transplantation which included information on the family and patient psychosocial information. Medication adherence was measured using the posttransplant opinion of the physician and standard deviation scores of patients' immunosuppressive medication blood levels. Research on the psychosocial predictors of medication adherence as well as health and medical outcomes are critical to the advancement of pretransplant assessments and transplant social work services. Results: Complete data were collected on 105 pediatric heart and lung transplant recipients and their families. The children were predominantly male (57%), white (65%), heart transplant recipients (78%), and a mean age at transplant of 10.1 years (sd = 6.0). A majority of the parents had an educational level below a four-year college degree (70%), were from a two-parent or blended family home (64%), and had public insurance (70%). In the bivariate analyses, age of the child at transplant, organ type, time of the pretransplant diagnosis, medical status (ICU) at time of listing for transplantation, and patient on life-support predicted standard deviation scores of the medication blood levels. The physician's opinion of the patient's adherence was predicted by age of the child at transplant, child experience of maltreatment, having private insurance, greater parental level of education, having a two-parent home, quality family communication, and patient on life-support. Multivariate, step-wise analyses were conducted with each adherence outcome. The medication blood level standard deviation scores were predicted by age at transplant. The multivariate, step-wise model predicting the opinion of the physician of the patient's adherence included age of the child at transplantation, parental education, two-parent families, other significant psychosocial problems, and the pretransplant life support status of the child. The resulting model explained approximately 39.5% of the variance in the physician opinion of adherence. Conclusions: The ability to assess pediatric patients and their families for risk factors of non-adherence is central to their care both in the pretransplant and posttransplant periods. Efforts to help transplant social workers identify psychological and social aspects of the children and families are important, especially when these characteristics are associated with not taking their medication. The development of standardized and evidence-based pretransplant psychosocial assessments in pediatric populations is suggested, especially those surrounding family factors. Family-centered approaches to the promotion of adherence are suggested during pretransplant and posttransplant periods. === A Dissertation submitted to the College of Social Work in partial fulfillment of the requirements for the degree
of Doctor of Philosophy. === Summer Semester, 2012. === April 25, 2012. === Adherence, Heart, Lung, Organ Transplantation, Pediatrics, Psychosocial === Includes bibliographical references. === Linda Vinton, Professor Directing Dissertation; Kay Pasley, University Representative; Martell Teasley, Committee Member. |
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