Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA; Department of Psychology, University of Pittsburgh, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA; Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA.
Am J Transplant. 2013 Oct;13(10):2672-84. doi: 10.1111/ajt.12393. Epub 2013 Aug 7.
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.
目前尚无针对活体捐赠后预防不良心理社会后果的循证干预措施。我们进行了一项单中心随机对照试验，以研究利用动机性访谈（MI）针对残留矛盾（即捐赠犹豫不决和不确定性）这一导致不良心理社会结局的主要风险因素的预防干预对捐赠后的影响。在 184 名潜在的肾脏或肝脏捐赠者中，有 131 名对捐赠存在矛盾心理；其中 113 名被随机分配到（a）MI 干预组、（b）积极对照组（健康教育）或（c）仅在捐赠前接受标准护理。在干预后（捐赠前）重新评估矛盾心理。主要试验结局为躯体、心理和家庭人际关系领域的心理社会变量，在捐赠后 6 周和 3 个月进行评估。MI 组的矛盾心理下降最显著（p = 0.050）。在躯体结局方面，到捐赠后 3 个月，MI 组报告的身体症状较少（p = 0.038）、疲劳发生率较低（p = 0.021）和疼痛发生率较低（p = 0.016）、恢复时间较短（p = 0.041）和意外医疗问题较少（p = 0.023）。在心理和人际关系结局方面，他们的焦虑症状发生率较低（p = 0.046）和意外家庭相关问题较少（p = 0.045）。他们在抑郁、对捐赠的感受或家庭关系质量方面没有差异。这些发现表明，该干预措施值得在更大的多中心试验中进行测试。
