Year of Publication

2016

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Melanie G. Hardin-Pierce

Clinical Mentor

Dr. Paul Tessmann

Committee Member

Dr. Karen Butler

Abstract

Background: The population focus is the University of Kentucky cardiothoracic transplant patients. This population is chronically ill and in end-stage organ failure. Literature suggests depression in a cause and consequence of non-adherence in chronically ill patients, especially in the transplanted population. The third leading cause of organ rejection is non-adherence with medical treatment. Because the availability of organs is low and the demand is high, it is imperative to thoroughly screen patients medically and psychosocially using evidence-based tools. Transplant psychosocial listing criteria are not well standardized compared to medical listing criteria to identify appropriate transplant candidates. Standardized assessment tools present the facts and eliminate the emotional factors form the decision-making process for selecting candidates for transplant. Research has demonstrated post-transplant non-adherence (e.g. lack of stable psychosocial support system, recidivism of substances of abuse, the development/relapse of psychiatric problems), and the number of rejection episodes is associated with the transplant psychiatrist's global rating of risk for post-transplant psychosocial problems. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) tool was developed in 2012 as a comprehensive standardized screening tool to assist in the psychosocial assessment of organ transplant candidates with the ability to identify subjects who are at risk for negative outcomes post-transplant. At the time of introduction of the tool to UK faculty, the tool had only been applied retrospectively to transplant patients at Stanford University.

Methods: The SIPAT tool was applied retrospectively to 100 electronic medical records (EMR) of post-transplanted cardiothoracic patients during the period the patient was selected as a transplant candidate. The EMR was then reviewed for the following negative patient outcomes or complications: lack of medical adherence; lack of stability of psychosocial support system; recidivism of substances of abuse; the development/relapse of psychiatric problems or graft failure and graft failure. Positive outcomes are defined as the absence of the negative outcomes/complications.

Results: The mean SIPAT score was 15.9 (SD=13.3) with an average number 1.97 (SD=1.37) complications. The regression analysis for this study indicates a significant moderate positive correlation (r=0.52) between the SIPAT scores and the number of complications patients experienced post-transplant. In the linear regression analysis, the SIPAT score was a significant predictor of the number of complications (b=.054; p<.0001). The SIPAT score explained 27% of the variability in the number of negative outcomes in post transplant patients. Furthermore, based on the listing criteria set forth by the SIPAT tool, 37% of the patients had absolute contraindications to listing the patients for a transplant. Based on their psychosocial assessments these patients would not have been transplanted until the contraindications had been addressed adequately.

Conclusion: The SIPAT tool predicts poor patient outcomes within the UK cardiothoracic transplant population further validating the tools abilities. This is beneficial because it provides a quantitative value to each psychosocial variable important in predicting post-transplant behaviors; therefore, it provides a visual score of predicted patient outcomes post-transplant compared to the qualitative tool currently used. In combination with organ-specific medical listing criteria, this tool would standardize psychosocial criteria for the selection of transplant candidates.

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