Killian Michael O, Mayewski Sonnie E, Brumm Schyler E, He Zhe, Gupta Dipankar
College of Social Work, Florida State University, Tallahassee, FL.
College of Medicine, Florida State University, Tallahassee, FL.
JHLT Open. 2025 Jun 13;9:100319. doi: 10.1016/j.jhlto.2025.100319. eCollection 2025 Aug.
Pre-transplant psychosocial assessment, in conjunction with medical and surgical evaluation, is a critical component of determining pediatric heart transplant candidacy. Psychosocial factors such as family dynamics, health literacy, mental health, financial stability, and adherence potential are often multidimensional and interdependent, making their assessment both vital and complex. However, few standardized tools exist to guide these evaluations in pediatric heart transplant settings, and even fewer have demonstrated empirical validity or predictive value. To address this gap, the Pediatric Psychosocial Assessment Tool (PPAT) was developed to provide a structured, semi-quantitative framework for evaluating psychosocial risk in pediatric transplant candidates.
This study presents initial validation data for the PPAT, based on 189 assessments conducted at a large pediatric heart transplant center. The tool evaluates nine psychosocial domains, assigns risk ratings, and yields a total risk score.
Confirmatory factor analysis supported the unidimensional structure of the tool, and internal consistency was strong (α = 0.89). Higher PPAT scores were significantly associated with lower odds of being listed for transplant by the center's multidisciplinary medical review board (MRB), even after accounting for clinical factors. Domain-level findings revealed financial and health literacy issues as commonly identified risk areas.
The PPAT holds promise as a valid, reliable, and clinically useful instrument for guiding MRB discussions and targeting interventions to support high-risk families. Future directions include expanding implementation to other centers and integrating the PPAT into digital platforms using artificial intelligence and natural language processing to enhance efficiency, consistency, and patient-centered care.
移植前的心理社会评估与医学和外科评估相结合，是确定儿童心脏移植候选资格的关键组成部分。家庭动态、健康素养、心理健康、经济稳定性和依从性潜力等心理社会因素往往是多维度且相互依存的，这使得对它们的评估既至关重要又复杂。然而，在儿童心脏移植环境中，几乎没有标准化工具来指导这些评估，而且证明具有实证效度或预测价值的工具更少。为了填补这一空白，开发了儿童心理社会评估工具（PPAT），以提供一个结构化的半定量框架，用于评估儿童移植候选者的心理社会风险。
本研究基于在一家大型儿童心脏移植中心进行的189次评估，展示了PPAT的初步验证数据。该工具评估九个心理社会领域，分配风险等级，并得出总风险分数。
验证性因素分析支持了该工具的单维结构，内部一致性很强（α = 0.89）。即使在考虑临床因素后，较高的PPAT分数也与该中心的多学科医学审查委员会（MRB）将其列入移植名单的较低可能性显著相关。领域层面的研究结果显示，经济和健康素养问题是常见的风险领域。
PPAT有望成为一种有效、可靠且临床有用的工具，用于指导MRB的讨论，并针对高风险家庭进行干预。未来的方向包括将其应用扩展到其他中心，并利用人工智能和自然语言处理将PPAT整合到数字平台中，以提高效率、一致性和以患者为中心的护理。
