title: Patient and family adjustment to kidney transplantation with and without an interim period of dialysis.
abstract: This exploratory study was designed to examine the process of patient and family adjustment to kidney transplantation and to compare differences between those who had and those who did not have dialysis pretransplant. To capitalize on benefits of longitudinal and cross-sectional designs, a mixed-method approach described by Aaronson and Kingry (1988) was used. Participants were recruited from two major transplant centers in Western Canada. Twenty patients with ESRD and their partners were studied longitudinally at three points: during the period before the kidney transplant assessment phase and then at 3 and 6 months posttransplant. Forty-seven ESRD patients and their partners comprised the cross-sectional sample. Participants comprising the cross-sectional sample provided responses from at least one of the three time points. Patients and/or their partners completed a series of questionnaires focusing on family functioning (Family Inventory of Life Events and Change [FILE], Feetham Family Functioning Survey [FFFS]); support and resources (Family Inventory of Resources for Management [FIRM]); as well as uncertainty (Uncertainty Stress Scale [USS]); sickness impact (Sickness Impact Profile [SIP]); and sense of coherence (Sense of Coherence Scale [SOC]). The findings indicated that patients and their partners were under considerable stress as they underwent kidney transplantation. Illness and family care strains as well as financial strains were significant. The participants expressed low to moderate uncertainty that decreased over time from the pretransplant to the posttransplant period. Patients on dialysis prior to transplant were more physically and psychologically affected than patients pre-empted to transplant. Those who were pre-empted to transplant reported minimal impact pretransplant but considerable improvement in their psychological and physical state posttransplant. In conclusion, transplantation without prior dialysis resulted in less physical and psychological impact for patients and their spouses. These findings point to a need for interdisciplinary education and support programs at both the pretransplant and posttransplant phase to help patients and their partners adjust to living with a kidney transplant. Given the beneficial effects of pre-emptive transplantation, emphasis must be placed on increasing the organ donor pool so that more pre-emptive transplants can be conducted.
authors.affiliation: School of Nursing, University of Victoria, Vancouver, British Columbia, Canada.
authors.forename: R
authors.initials: R
authors.lastname: Starzomski
authors.forename: A
authors.initials: A
authors.lastname: Hilton
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005190:Family / Q000523:psychology*; D005192:Family Health; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000601:surgery; D016030:Kidney Transplantation / Q000523:psychology*; D008016:Life Change Events; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015404:Nursing Methodology Research; D006435:Renal Dialysis / Q000523:psychology*; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014850:Waiting Lists