De Geest Sabina, Burkhalter Hanna, Berben Lut, Bogert Laura Jane, Denhaerynck Kris, Glass Tracy R, Goetzmann Lutz, Kirsch Monika, Kiss Alexander, Koller Michael T, Piot-Ziegler Chantal, Schmidt-Trucksäss Arno
University of Basel, Switzerland.
Prog Transplant. 2013 Sep;23(3):235-46. doi: 10.7182/pit2013250.
Understanding outcomes after transplant requires a biopsychosocial model that includes biomedical and psychosocial factors. The latter, to date, are assessed only in a limited way as part of transplant registries or cohort studies. The Swiss Transplant Cohort Study (STCS) is a nationwide open cohort study (starting May 2008) to systematically and prospectively assess psychosocial factors. This article describes the framework underpinning STCS's psychosocial assessment.
The STCS framework was adapted from the multidimensional conceptual perspective of Dew et al to describe transplant psychosocial domains and specific outcomes by adding a time perspective, a system perspective, and interaction among domains.
We propose a multidimensional, multilevel biopsychosocial framework representing mutually influencing domains from before to after transplant, and exemplify each domain by factors included in STCS and their measurement. The transplant patient, centrally positioned, is described by clinical and sociodemographic characteristics (eg, socioeconomic status, educational, professional, and relationship status). The following psychosocial domains further describe the patient: (1) physical/functional (eg, perceived health status, sleep quality, daytime sleepiness), (2) psychological (eg, depression, stress), (3) behavioral (eg, medication adherence, smoking, drug use, physical activity, sun protection), (4) social (eg, work capacity/return to work), and (5) global quality of life. Factors associated with health care system level (eg, trust in transplant team) are also included in the model.
The STCS's psychosocial framework provides a basis for studying the interplay of biomedical, sociodemographic, psychosocial, behavioral, and health care system factors in view of transplant outcomes and therefore has the potential to guide biopsychosocial transplant research.
了解移植后的结果需要一个包含生物医学和心理社会因素的生物心理社会模型。迄今为止，作为移植登记或队列研究的一部分，心理社会因素仅以有限的方式进行评估。瑞士移植队列研究（STCS）是一项全国性的开放性队列研究（始于2008年5月），旨在系统地、前瞻性地评估心理社会因素。本文描述了STCS心理社会评估的基础框架。
STCS框架是从Dew等人的多维概念视角改编而来，通过增加时间视角、系统视角以及各领域之间的相互作用来描述移植心理社会领域和特定结果。
我们提出了一个多维、多层次的生物心理社会框架，该框架代表了移植前后相互影响的领域，并通过STCS中包含的因素及其测量方法对每个领域进行了举例说明。处于中心位置的移植患者由临床和社会人口学特征（如社会经济地位、教育程度、职业和关系状况）来描述。以下心理社会领域进一步描述了患者：（1）身体/功能（如感知到的健康状况、睡眠质量、日间嗜睡），（2）心理（如抑郁、压力），（3）行为（如药物依从性、吸烟、吸毒、体育活动、防晒），（4）社会（如工作能力/重返工作岗位），以及（5）总体生活质量。与医疗保健系统层面相关的因素（如对移植团队的信任）也包含在该模型中。
STCS的心理社会框架为研究生物医学、社会人口学、心理社会、行为和医疗保健系统因素在移植结果方面的相互作用提供了基础，因此有潜力指导生物心理社会移植研究。
