Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Department of Surgery, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Transplant Rev (Orlando). 2022 Dec;36(4):100728. doi: 10.1016/j.trre.2022.100728. Epub 2022 Oct 29.
Psychiatric and substance use disorders (SUD) commonly cause and contribute to advanced liver diseases and psychosocial phenomena remain some of the most challenging matters that liver transplantation (LT) teams encounter. Patients are often most focused on biomedical aspects of their treatment and LT course rather than subtler psychosocial factors which must be addressed alongside medical and surgical problems. This means that patients may not accept teams' recommendations for psychiatric and SUD treatment despite their primary role in treating liver disease and promoting successful LT. Alcohol-related liver disease is the archetype of these challenges. A crucial, actionable, and rarely discussed factor in creating a therapeutic interface between liver patients and psychiatric and SUD specialists is medical and surgical clinicians' interprofessional psychosocial communication (IPC; i.e., a clinician's personal ability to communicate effectively with patients about psychiatric and substance-related matters). In this article, we describe three crucial IPC timepoints during a typical ALD transplantation timeline, briefly review and synthesize diverse literature and perspectives into an overview of potential IPC pitfalls, propose practical IPC strategies for institutions and clinicians, and indicate future areas of study.
精神和物质使用障碍（SUD）通常会导致并加重晚期肝脏疾病，而精神社会现象仍然是肝移植（LT）团队面临的最具挑战性的问题之一。患者通常最关注治疗和 LT 过程中的生物医学方面，而不是更微妙的社会心理因素，这些因素必须与医疗和手术问题一起解决。这意味着，尽管精神和 SUD 治疗在治疗肝脏疾病和促进 LT 成功方面发挥着主要作用，但患者可能不会接受团队对其进行治疗的建议。酒精相关性肝病就是这些挑战的典型范例。在肝脏患者和精神与 SUD 专家之间建立治疗性接口的一个关键、可操作但很少被讨论的因素是医疗和外科临床医生的跨专业社会心理沟通（IPC；即，临床医生个人有效与患者就精神和物质相关问题进行沟通的能力）。在本文中，我们描述了典型 ALD 移植时间线上的三个关键 IPC 时间点，简要回顾和综合了不同的文献和观点，概述了潜在的 IPC 陷阱，为机构和临床医生提出了实用的 IPC 策略，并指出了未来的研究领域。
