[The "Medication Experience Scale for Immunosuppressants" (MESI): initial results for a new screening instrument in transplant medicine].
BACKGROUND
After an organ transplant, immunosuppressants must be taken on a regular basis to prevent rejection of the transplanted organ. To our knowledge, there have been no studies to date on how transplant recipients experience the effects and side effects of immunosuppressants. The present study tested a newly developed screening instrument that records the subjective experiences and cognitive attitudes of patients vis-à-vis their immunosuppressive medication.


METHODS
98 patients were questioned before a heart, lung, liver or kidney transplant and 12 months after the transplant by means of various psychosocial measuring instruments (Sense of Coherence, SOC; Hospital Anxiety and Depression Scale, HADS-D; Quality of Life, SF-36; Satisfaction with Life, FLZ; Social Support, F-SOZU). 12 months after the transplants were performed, seven further items intended to measure the subjective experiences and cognitive attitudes of the patients vis-à-vis their immunosuppressive medication were used. The treating doctors assessed patients' overall compliance 12 months after the transplant operation.


RESULTS
Die "Medication Experience Scale for Immunosuppressants" (MESI) showed an internal consistency (Cronbach's alpha) of 0.78. Its values correlated significantly negatively with the sense of coherence recorded before the transplant. There were also significantly negative correlations with physical functioning, mental health, satisfaction with life and social support, as well as significantly positive ones with anxiety and depression 12 months post-transplant. In a comparison of organ groups, lung-transplant patients exhibited the highest MESI values. Patients whose compliance was assessed as "very good" experienced the effects of the immunosuppressants less intensely than patients with "good" to "moderate" compliance. Sensitivity of the MESI scale with regard to compliance was 0.81, with a specificity of 0.71, a positive predictive value of 0.68, and a negative predictive value of 0.83. The cut-off value between "very good" and "limited" compliance was a scale score of 15 points.


CONCLUSIONS
The MESI is a short, easy-to-use screening instrument for recording the subjective experiences and attitudes of patients after an organ transplant. Of clinical significance is the correlation with compliance. Patients with a scale score of > 15 in particular should be spoken to by their treating doctor with regard to their attitudes to and experiences of the immunosuppressants, as well as with regard to their compliance behaviour.
Goetzmann
Lutz
L
Psychosoziale Medizin, Universitätsspital Zürich. lutz.goetzmann@usz.ch
Klaghofer
Richard
R
Spindler
Anja
A
Wagner-Huber
Regula
R
Scheuer
Eberhard
E
Buddeberg
Claus
C
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D015203:Reproducibility of Results; D012944:Social Support; D014180:Transplantation / Q000009:adverse effects* / Q000523:psychology*
D007166:Immunosuppressive Agents