A Critique Of The Article "Psychosocial Evaluation And Prediction Of Compliance Problems And Morbidity After Heart Transplantation", Written By Shapiro Et Al.

1736 words - 7 pages

In the journal article "Psychosocial evaluation and prediction of compliance problems and morbidity after heart transplantation", the authors attempt to answer the question of whether preoperative psychosocial evaluations have reliable predictive value for heart transplant outcomes (Shapiro et al., 1995). Organ transplant programs use differing selection criteria and screening procedures to establish which patients are within established risk factor limits to safely receive and benefit from heart transplantation surgery. Such screening is necessary due to fact that heart transplantation is an expensive and risky operation which requires the utilization of scarce resources and has limited life prolonging benefits. In this study, the authors followed a group of 125 adult patients who underwent heart transplantation surgery between 1992-1994. The subjects were all patients at the same hospital and each were evaluated by a psychiatrist, a social worker and a transplant nurse coordinator as part of the standardized patient screening process for that centre.Data gathered on each patient included demographic information, medical diagnoses, and psychiatric data obtained through a semi structured clinical interview. The variables of interest were the presence or absence of psychiatric disorders, substance abuse, cognitive impairment, personality disorders, quality of social support, and the patient's motivation and understanding of the transplant procedure. Also, a summary or overall assessment of the patient's likelihood of developing postoperative compliance and behavioral problems were provided by the interviewing psychiatrist. This summery, referred to as the "global psychosocial risk", is represented by a single data point and it is the psychiatrist's overall impression and assessment of the patient which encompasses many of the independent variables of interest discussed above. Postoperatively, the surviving patients who lived to be discharged from the centre were assessed and rated by their respective primary transplant nurse coordinator. Variables rated by the nurse included the number of postoperative infections, rejection episodes, missed follow-up appointments, ideal weight maintenance, coronary angiography data and compliance problems with medication management.The results indicate several significant associations between preoperatively diagnosed psychosocial predictor variables and a number of postoperative outcomes. Overall, 34.4% of patients were rated as being somewhat to extremely noncompliant to their prescribed medications and regimes. Significant correlations were found between postoperative nonadherence and the patients history of substance abuse, personality disorders, living arrangements and the global psychosocial risk assessment. The most significant of these findings is that of the predictive reliability of preoperative substance abuse and the global psychosocial risk factor as it pertains to postoperative nonadherence problems....

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