Maturity and adherence in adolescent and young adult heart recipients

Pediatric Transplantation - Tập 10 Số 3 - Trang 323-330 - 2006
Carol S. Stilley1, Kathy Lawrence2, Ann Bender3, Ellen Olshansky3, Steven A. Webber2, Mary Amanda Dew4
1School of Nursing, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15261, USA.
2Heart/Lung Transplant, Children's Hospital of Pittsburgh,
3School of Nursing
4Departments of Psychiatry, Psychology, Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA

Tóm tắt

Abstract: Background: Pediatric transplant (txp) teams note high rates of non‐adherence and risky behaviors linked to morbidity and mortality among adolescent and young adult recipients. Clinicians and parents alike report symptoms of social immaturity and failure to appreciate consequences of risky behavior; relationships between the two have not been studied in this population.Method: This two‐phase mixed method study examined adherence, high‐risk behaviors, and maturity in a sample of 27 heart recipients, aged 15–31, who underwent transplantation in childhood or adolescence at Children's Hospital of Pittsburgh. All subjects completed a projective ego development measure and a questionnaire about adherence to the post‐txp regimen. Nine recipients, purposely selected for good or poor adherence according to criteria determined by the transplant team and matched on age, participated in phase 2 qualitative interviews and mood assessments.Results: Sixty‐three percent of the phase 1 sample missed medications, 67% missed appointments, 11% smoked, 37% had difficulty with diet, 89% exercised infrequently, 33% had tattoos, 26% had more than two body piercings, and 11% used street drugs. Six themes and a core construct of maturity were identified with qualitative methodology. Poor adherers were less mature on every theme and consistently scored at a less mature level on the projective measure of ego development. Chronological age was not related to the level of maturity in qualitative or projective data. Most interview subjects reported high levels of anxiety, and two reported clinically significant levels of depression and anger; mood was not related to adherence.Conclusions: Non‐adherence and high‐risk behaviors are prevalent among adolescent and young adult heart recipients. Level of maturity appears to be associated with ability to adhere to the treatment regimen and avoid high‐risk behaviors.

Từ khóa


Tài liệu tham khảo

Boucek MM, 2004, Registry for heart and lung transplantation, seventh annual pediatric report, 23, 933

Lawrence KS, 1987, Pediatric heart transplantation, quality of life, 6, 329

10.1016/S1053-2498(98)00044-8

Bunzel B, 2000, Solid organ transplantation, are there predictors for posttransplant noncompliance? A literature overview, 70, 711

Dew MA, 1996, Medical compliance and its predictors in the first year after heart transplantation, J Heart Lung Transplant, 15, 631

Korsch BM, 1978, Noncompliance in children with renal transplants, Pediatrics, 61, 872, 10.1542/peds.61.6.872

Rianthavorn P, 2003, Noncompliance with immunosuppressant medications in pediatric and adolescent patients receiving solid organ transplants, Transplantation, 77, 778, 10.1097/01.TP.0000110410.11524.7B

10.1034/j.1399-3046.149.ptr1s077.1.x

Cole BR., 1994, Pediatric Renal Transplantation, 397

Erickson E., 1968, Identity, Youth and Crisis

Loevinger J., 1998, Adolescent Behavior and Society, 234

Gemelli R., 1996, Normal Child and Adolescent Behavior

Galambos NL, 1999, Adolescents' subjective age, an indicator of perceived maturity, 9, 309

Baum MF, 1991, Physiologic and psychological growth and development in pediatric heart transplant recipients, J Heart Lung Transplant, 10, 848

10.1046/j.1600-6135.2003.00226.x

10.1037/0022-3514.48.2.420

Novey DM., 1993, An investigation of the progressive sequence of ego development levels, J Clin Psychol, 49, 332, 10.1002/1097-4679(199305)49:3<332::AID-JCLP2270490305>3.0.CO;2-D

Bradford R, 2002, Quality of life in young people, ratings and factor structure of the quality of life profile-adolescent version, 25, 261

Beck AT, 1996, Beck Depression Inventory

Spielberger CD., 1983, Manual for the State‐Trait Anxiety Inventory

Spielberger CD., 1999, State‐Trait Anger Expression Inventory‐2 Professional Manual

Glaser B, 1967, The Discovery of Grounded Theory

Strauss AL, 1990, Basics of Qualitative Research: Grounded Theory Procedures and Techniques

Tobin GA, 2004, Methodological rigour within a qualitative framework, Methodol Issues Nurs Res, 48, 388

DuPasquier‐Fediaevsky L, 2005, Is the relationship between adherence and glycaemic control bi‐directional at adolescence? A longitudinal cohort study, Diabetic Med, 22, 427, 10.1111/j.1464-5491.2005.01429.x

Hoffman RP., 2002, Adolescent adherence in type 1 diabetes, Comprehensive Ther, 28, 129, 10.1007/s12019-002-0050-8

10.2500/108854198778557809

Viner RM, 2003, Motivational/solution‐focused intervetion improves HBA1c in adolescents with type 1 diabetes, a pilot study, 20, 739

10.1037/0022-3514.59.2.305

Mayers LB, 2003, Tattooing and body piercing, Pediatrics, 111, 1126, 10.1542/peds.111.5.1126

Dahnert I, 2004, Piercing and tattoos in patients with congenital heart disease, is it a problem?, 93, 618

Mufson L, 2001, A randomized effectiveness trial of interpersonal psychotherapy for depressed adolescents, Arch Gen Psychiatry, 61, 577, 10.1001/archpsyc.61.6.577

Thông tin
Thông tin xuất bản

Pediatric Transplantation

Tập 10 Số 3

323-330

Thông tin tác giả