The influence of psychosocial factors on heart transplantation.

Abstract

This research addresses the role that psychosocial factors currently play in selection of candidates for heart transplantation, and the predictive validity of these factors to selection decisions and patient outcomes. The initial focus of this research was on what psychosocial factors are considered and how much impact they have individually and collectively on selection decisions. This investigation examined how individual members of a cardiac transplant team (University Medical Center, Tucson, Arizona) arrive at these decisions and how these individual judgments are combined into a consensual team decision. Further, in an effort to usefully standardize the psychosocial information used in patient assessments, we developed a consensus weighting formula for the whole transplant team. Our findings from the initial phase of the research indicate general agreement among team members that psychosocial factors are of some importance in screening transplant candidates. Most team members give primary attention to medical factors, though all were attentive to the influence of psychosocial factors on patient eligibility for transplant and on post-transplant adjustment. We next examined the relationship between what the team believes they are doing in selecting candidates for transplantation against empirical data from the cases the team has evaluated. However, when belief was tested against empirical evidence we find some disparity between what the team reported as important to their decision making and the actual decisions the team had made. Our results showed that team members use some, but not all, psychosocial factors in their transplant eligibility decisions. Lastly, we investigated the relationship between psychosocial factors and various patient outcomes. We investigated the extent to which outcome measures: mortality, morbidity, functional status, quality of life, patient management, and patient compliance, can be predicted by measures, including psychosocial measures, available at the time of initial evaluation. Our results indicate an association between pre-transplantation psychosocial evaluation and certain behavior aspects of transplant outcome, patient management and compliance. However, no relationship was found between psychosocial factors and medical and functional outcomes. The findings from this empirical prediction model should add to the information available to the team at the time of the pre-transplant screening decision.