Lung Transplantation Clinical Trial
Official title:
Standardized Evaluation of Psychosocial Functioning in Patients Awaiting Lung Transplantation
In a prospective longitudinal cohort study we aim at investigating the extent to which pre-transplant psychosocial levels of functioning predict the medical and psychosocial outcomes of lung transplantation. There is evidence that e.g. persistently elevated depressive symptoms are associated with reduced survival after lung transplantation
There is ample evidence that there are high rates of anxiety and depression among patients
with end-stage lung disease. In addition, psychological dysfunction and distress seem to be
especially prevalent in patients awaiting lung transplantation. Even though patients benefit
from the transplant procedure with respect to long-term health-related quality of life
(HRQoL), they also face significant challenges in terms of psychosocial adjustment after the
transplantation. There is evidence that e.g. persistently elevated depressive symptoms are
associated with reduced survival after lung transplantation.
Currently, the screening process to help select among candidates for organ transplant
typically involves considering a variety of psychosocial factors. However, it remains
somewhat unclear which criteria are considered important in these evaluations, how
differences in various aspects of psychosocial functioning are weighed in making the
ultimate decision on the suitability of a patient for transplantation, and the extent to
which pretransplant psychosocial characteristics predict the medical and psychosocial
outcomes of the procedure. Standardized psychometric instruments with proven reliability and
validity can prevent the danger of personal bias in the selection of candidates for
transplantation. In addition, structured psychometric instruments can help to identify
patients with multiple care needs and can support the development of psychosocial
interventions designed to increase quality of life and to decrease the risk of a less
favorable transplant outcome through modifying the factors that might place patients at
risk.
In a longitudinal prospective cohort study, psychosocial functioning will be assessed at
multiple time points both before and after lung transplantation. Assessment of psychosocial
functioning will be conducted using a validated, structured interview which allows a
comprehensive evaluation of the level of adjustment in 10 aspects of psychosocial
functioning - the Transplant Evaluation Rating Scale (TERS) - and standardized self-report
instruments. The TERS has shown to be an important and significant predictor of several
facets of somatic and psychosocial outcomes e.g. in patients after liver transplantation,
left ventricular assist device implantation, and hematopoietic stem cell transplantation.
For each patient, a face-to-face psychosomatic evaluation 1 year after Transplantation will
take place during a routine clinical assessments at the Department of Respiratory Medicine.
The following outcome parameters will be assessed:
- Mental disorders (current)
- Psychological processing of lung transplantation (including organ integration and the
patient's relationship with the donor, chronic stress/psychological distress and the
emotional effects of transplantation/immunosuppression
- Return to work one year after lung transplantation
- Psychological interventions during the first postoperative year
- Intake of (new) psychotropic medication during the first postoperative year
;
Observational Model: Cohort, Time Perspective: Prospective
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