Heyes Cathy M, Schofield Toni, Gribble Robert, Day Carolyn A, Haber Paul S
Drug Health Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.; NHMRC Centre for Research Excellence in Mental Health and Substance Use, Australia.
Discipline of Behavioural and Social Sciences in Health, The University of Sydney, NSW, Australia.
Transplant Direct. 2016 Sep 7;2(10):e104. doi: 10.1097/TXD.0000000000000617. eCollection 2016 Oct.
Liver transplantation (LT) is the optimum treatment for patients with end-stage alcoholic liver disease (ALD). However, despite a recognized risk of relapse to harmful drinking, ALD transplant patients are reluctant to use speciality alcohol treatment to support their abstinence, even when offered within the LT context. This study aimed to understand and identify factors contributing to alcohol treatment reluctance by ALD patients undergoing transplantation.
We conducted an in-depth qualitative study of ALD transplant patients. Minimally structured face-to-face interviews explored participants' alcohol-related experiences and their reasons for not using alcohol treatment during the course of their transplantation. Thematic analysis was used to analyze and interpret interview data to understand treatment reluctance based on participants' experiences.
Five major themes were identified among 3 subgroups of patients (pretransplant and posttransplant abstainers and posttransplant relapsers): (i) the "contract" of mandatory abstinence, (ii) the "gap in the program" involving the lack of candour between patient and staff about alcohol-related matters and the lack of addiction services, (iii) a preference by participants to self-manage their alcohol use disorder, (iv) social support as a facilitator of abstinence and the risk of relapse when social support is diminished, and (v) the fear of stigmatization. Each of these factors were dynamically interrelated and differed slightly for each subgroup.
The LT services may benefit from the inclusion of integrated specialist addiction services in their model of care. Such an approach may enhance the acceptability of alcohol treatment and reduce the risk of relapse among ALD transplant participants, especially for those whose social supports have diminished.
肝移植（LT）是终末期酒精性肝病（ALD）患者的最佳治疗方法。然而，尽管人们认识到存在复饮有害饮酒行为的风险，但ALD移植患者仍不愿使用专业酒精治疗来支持戒酒，即使在肝移植背景下提供此类治疗也是如此。本研究旨在了解和确定导致接受移植的ALD患者不愿接受酒精治疗的因素。
我们对ALD移植患者进行了深入的定性研究。采用结构松散的面对面访谈，探讨参与者与酒精相关的经历以及他们在移植过程中不接受酒精治疗的原因。运用主题分析法对访谈数据进行分析和解读，以根据参与者的经历了解治疗抵触情绪。
在患者的3个亚组（移植前和移植后戒酒者以及移植后复饮者）中确定了5个主要主题：（i）强制戒酒的“契约”；（ii）“项目中的差距”，包括患者与工作人员在酒精相关问题上缺乏坦诚以及缺乏成瘾服务；（iii）参与者倾向于自我管理酒精使用障碍；（iv）社会支持作为戒酒的促进因素以及社会支持减少时复饮的风险；（v）对污名化的恐惧。这些因素相互动态关联，每个亚组略有不同。
肝移植服务可能会受益于在其护理模式中纳入综合的专业成瘾服务。这种方法可能会提高酒精治疗的可接受性，并降低ALD移植参与者的复饮风险，特别是对于那些社会支持减少的参与者。
