Medical Biology Centre, School of Nursing and Midwifery, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7BL, Northern Ireland, UK.
Centre of Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK.
BMC Psychol. 2022 Jul 29;10(1):186. doi: 10.1186/s40359-022-00893-7.
Renal transplantation is considered the gold standard treatment for end-stage kidney disease. Adolescent and young adult kidney transplant recipients have the highest rate of graft loss amongst transplanted patients. It is largely accepted this is due to psychosocial and behavioural difficulties, which impact adherence to prescribed therapies. This phenomenon is not isolated to a particular healthcare system having been observed in multiple countries across different continents. It is a global issue of concern. We sought to review the psychosocial needs of these patients, and the interventions designed to meet these needs.
A scoping review was conducted based on Arksey and O'Malley's six-stage framework. Eligibility criteria included primary studies of any type that investigated the psychosocial needs of adolescent and/or young adult renal transplant recipients or studies which examined interventions designed to address these needs. Search strategies were developed and conducted on PsycINFO, PubMed, Embase, and CINAHL. Articles meeting the inclusion criteria were critically reviewed using a descriptive-analytical narrative method.
Thirty-nine studies met our inclusion criteria, 30 of which related to psychosocial needs, and the remainder examined psychosocial interventions. Four main themes were derived from our analysis of psychosocial needs literature, as follows: the need for (1) emotional support, (2) acceptance, (3) direction, (4) equality in healthcare. 2 main themes emerged from analysis of psychosocial intervention literature, namely: psychosocial (1) capability, (2) assessment. Despite the evidence that graft health is strongly associated with psychosocial wellbeing, findings revealed a significant lack of literature investigating how best to meet psychosocial needs. Trends were observed amongst intervention studies, namely interventions of novel and non-evidenced based design, with the aim of improving medication adherence through organisational strategies and education. However, literature regarding psychosocial needs showed non-adherence to therapies was not simply a result of disorganisation or lack of understanding, but rather, was founded on a recipient's idiosyncratic relationship with their prescribed therapies e.g., psychological, social or financial reasons for non-adherence.
Future research should be directed at investigating the efficacy of evidence-based interventions that empower the individual patient to overcome their specific barrier to an optimal relationship with their therapies.
肾移植被认为是终末期肾病的金标准治疗方法。青少年和年轻成年肾移植受者在移植受者中的移植物丢失率最高。人们普遍认为，这主要是由于心理社会和行为困难，影响了对规定治疗的依从性。这种现象并非特定于特定的医疗保健系统，在不同大洲的多个国家都有观察到。这是一个全球性的问题。我们试图审查这些患者的心理社会需求，以及旨在满足这些需求的干预措施。
根据 Arksey 和 O'Malley 的六阶段框架进行了范围审查。纳入标准包括调查青少年和/或年轻成年肾移植受者心理社会需求的任何类型的原始研究，或研究旨在解决这些需求的干预措施的研究。制定并在 PsycINFO、PubMed、Embase 和 CINAHL 上进行了搜索策略。符合纳入标准的文章使用描述性分析叙述方法进行了批判性审查。
39 项研究符合我们的纳入标准，其中 30 项与心理社会需求有关，其余研究则研究了心理社会干预措施。从我们对心理社会需求文献的分析中得出了四个主要主题，如下所示：（1）情感支持、（2）接受、（3）方向、（4）医疗保健平等的需求。从心理社会干预文献分析中得出了两个主要主题，即：心理社会（1）能力、（2）评估。尽管有证据表明移植物健康与心理健康密切相关，但研究结果表明，关于如何最好地满足心理社会需求的文献明显缺乏。在干预研究中观察到了趋势，即具有新颖性和无证据基础设计的干预措施，旨在通过组织策略和教育提高药物依从性。然而，关于心理社会需求的文献表明，不遵守治疗方案不仅仅是因为缺乏组织或缺乏理解，而是因为受者与规定治疗方案的特殊关系，例如不遵守治疗方案的心理、社会或经济原因。
未来的研究应该针对调查增强个体患者克服与治疗方案最佳关系的特定障碍的基于证据的干预措施的疗效。
