Preventive Intervention for Living Donor Psychosocial Outcomes: Feasibility and Efficacy in a Randomized Controlled Trial
There are no evidence‐based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single‐site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor...
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| Published in | American journal of transplantation Vol. 13; no. 10; pp. 2672 - 2684 |
|---|---|
| Main Authors | , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Hoboken, NJ
Wiley
01.10.2013
Elsevier Limited |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1600-6135 1600-6143 1600-6143 |
| DOI | 10.1111/ajt.12393 |
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| Abstract | There are no evidence‐based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single‐site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes—psychosocial variables in somatic, psychological and family interpersonal relationship domains—were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family‐related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial.
A single‐site clinical trial provides promising early evidence that a brief intervention offered to living kidney donors and living liver donors before surgery can prevent postdonation psychological distress, somatic complaints and donation‐related family problems. |
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| AbstractList | There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes-psychosocial variables in somatic, psychological and family interpersonal relationship domains-were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family-related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial. A single-site clinical trial provides promising early evidence that a brief intervention offered to living kidney donors and living liver donors before surgery can prevent postdonation psychological distress, somatic complaints and donation-related family problems. There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e., lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education), or (c) standard care only before donation. Ambivalence was reassessed post-intervention (before donation). Primary trial outcomes—psychosocial variables in somatic, psychological, and family interpersonal relationship domains—were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p=.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p=.038), lower rates of fatigue (p=.021) and pain (p=.016), shorter recovery times (p=.041), and fewer unexpected medical problems (p=.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p=.046) and fewer unexpected family-related problems (p=.045). They did not differ on depression, feelings about donation, or family relationship quality. The findings suggest the intervention merits testing in a larger, multisite trial. There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes-psychosocial variables in somatic, psychological and family interpersonal relationship domains-were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family-related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial. There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes--psychosocial variables in somatic, psychological and family interpersonal relationship domains--were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p=0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p=0.038), lower rates of fatigue (p=0.021) and pain (p=0.016), shorter recovery times (p=0.041) and fewer unexpected medical problems (p=0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p=0.046) and fewer unexpected family-related problems (p=0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial. A single-site clinical trial provides promising early evidence that a brief intervention offered to living kidney donors and living liver donors before surgery can prevent postdonation psychological distress, somatic complaints and donation-related family problems. [PUBLICATION ABSTRACT] There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes-psychosocial variables in somatic, psychological and family interpersonal relationship domains-were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family-related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial.There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes-psychosocial variables in somatic, psychological and family interpersonal relationship domains-were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family-related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial. There are no evidence‐based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single‐site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes—psychosocial variables in somatic, psychological and family interpersonal relationship domains—were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family‐related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial. A single‐site clinical trial provides promising early evidence that a brief intervention offered to living kidney donors and living liver donors before surgery can prevent postdonation psychological distress, somatic complaints and donation‐related family problems. |
| Author | DiMartini, A. F. Tan, H. P. Humar, A. Fox, K. R. Greenhouse, J. B. Switzer, G. E. McNulty, M. L. Zuckoff, A. Dew, M. A. DeVito Dabbs, A. J. |
| AuthorAffiliation | 1 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 9 Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA 4 Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA 8 Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA 2 Department of Psychology, University of Pittsburgh, Pittsburgh, PA 5 Department of Surgery, University of Pittsburgh, Pittsburgh, PA 3 Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA 10 Department of Statistics, Carnegie Mellon University, Pittsburgh, PA 6 Department of Medicine, University of Pittsburgh, Pittsburgh, PA 7 Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA |
| AuthorAffiliation_xml | – name: 2 Department of Psychology, University of Pittsburgh, Pittsburgh, PA – name: 9 Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA – name: 3 Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA – name: 8 Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA – name: 6 Department of Medicine, University of Pittsburgh, Pittsburgh, PA – name: 7 Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA – name: 5 Department of Surgery, University of Pittsburgh, Pittsburgh, PA – name: 1 Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA – name: 10 Department of Statistics, Carnegie Mellon University, Pittsburgh, PA – name: 4 Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA |
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| SubjectTerms | Adult Ambivalence Biological and medical sciences Clinical trials Counseling Feasibility Studies Female Humans Interpersonal Relations Intervention kidney donor liver donor living donor Living Donors - psychology Male Medical research Medical sciences Mental Disorders - prevention & control Miscellaneous Organ Transplantation - psychology Prevention and actions Prognosis psychosocial outcomes Public health. Hygiene Public health. Hygiene-occupational medicine Quality of Life Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases |
| Title | Preventive Intervention for Living Donor Psychosocial Outcomes: Feasibility and Efficacy in a Randomized Controlled Trial |
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