Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA.
College of Population Health, University of New Mexico, Albuquerque, New Mexico, USA.
Clin Transplant. 2022 Nov;36(11):e14796. doi: 10.1111/ctr.14796. Epub 2022 Aug 31.
Kidney transplant evaluation (KTE) is a period marked by many stressors for patients, which may lead to poorer patient-reported outcomes (PROs). Research on the association of cultural and psychosocial factors with PROs during KTE is lacking, even though cultural and psychosocial variables may mitigate the relationship between acceptance status and PROs.
Using a prospective cohort study of 955 adults referred for KTE, we examined whether cultural factors and psychosocial characteristics, assessed at the initiation of KTE, are associated with PROs at KTE completion, controlling for demographics and medical factors. Also, we analyzed whether these factors moderate the relationship between transplant acceptance status and PROs.
In multivariable regression models, a stronger sense of mastery was associated with higher physical and mental QOL. A stronger sense of self-esteem was associated with higher kidney-specific QOL. Depression was associated with a lower mental QOL, but only in those who were accepted for transplant. Having low levels of external locus of control was associated with better mental QOL in those who were not accepted for transplant. Higher anxiety was associated with poorer kidney-specific QOL among those who were not accepted for KT, but trust in physician was only associated with greater satisfaction in transplant clinic service for those who were accepted for KT.
Targeting interventions to increase patient mastery and external locus of control, and reduce depression and anxiety in patients undergoing kidney transplant evaluation may be useful approaches to improve their experience during this stressful period.
肾移植评估（KTE）期间患者会面临许多压力源，这可能导致患者报告的结局（PROs）较差。尽管文化和社会心理变量可能缓和接受状态与 PROs 之间的关系，但在 KTE 期间，文化和社会心理因素与 PROs 之间关联的研究仍然缺乏。
我们采用了一项针对 955 名接受 KTE 的成年人的前瞻性队列研究，在 KTE 开始时评估文化因素和社会心理特征，以检查它们是否与 KTE 完成时的 PROs 相关，控制人口统计学和医疗因素。此外，我们还分析了这些因素是否调节了接受移植状态与 PROs 之间的关系。
在多变量回归模型中，更强的掌控感与更高的身体和心理健康相关。更强的自尊心与更高的肾脏特异性 QOL 相关。抑郁与心理健康 QOL 降低相关，但仅在接受移植的患者中。外部控制感较低与未接受移植的患者心理健康状况较好相关。未接受 KT 的患者中，较高的焦虑与肾脏特异性 QOL 较差相关，但对医生的信任仅与接受 KT 的患者对移植门诊服务的满意度较高相关。
针对接受肾移植评估的患者，增加患者掌控感和外部控制感、减少抑郁和焦虑的干预措施可能是改善他们在这一压力期体验的有用方法。
