title: Inter-rater reliability of the Pediatric Transplant Rating Instrument (P-TRI): challenges to reliably identifying adherence risk factors during pediatric pre-transplant evaluations.
abstract: The purpose of this study was to assess the inter-rater reliability of the P-TRI, a 17-item instrument developed to identify risk factors associated with poor treatment adherence in pediatric solid organ transplant candidates. Because factors influencing treatment adherence may vary with age, the 89 subject samples were divided into pre-adolescent (0-11 yr) and adolescent (12-19 yr) groups. Each subject received two independent P-TRI ratings based on pretransplant psychosocial assessments separately conducted by a PSYC and a SWTC. Inter-rater reliability was assessed using the delta statistic. Overall, agreement was higher in the pre-adolescent group, with delta>0.70 for five items and delta<0.30 for two items. For the adolescent group, one item had a delta>0.70 and seven items had a delta<0.30. Overall, PSYC P-TRI ratings indicated fewer areas of concern on items assessing family dynamics compared with SWTC P-TRI ratings, whereas the reverse was true for items related to psychiatric history. Results highlight the challenges of conducting a reliable pretransplant assessment of adherence-related risk factors and suggest the need for revisions to the P-TRI prior to its use in clinical practice.
authors.affiliation: Child and Adolescent Psychiatry, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Fisher
authors.forename: A
authors.initials: A
authors.lastname: Storfer-Isser
authors.forename: R J
authors.initials: RJ
authors.lastname: Shaw
authors.forename: R S
authors.initials: RS
authors.lastname: Bernard
authors.forename: S
authors.initials: S
authors.lastname: Drury
authors.forename: S
authors.initials: S
authors.lastname: Ularntinon
authors.forename: S M
authors.initials: SM
authors.lastname: Horwitz
mesh_terms: D000293:Adolescent; D002140:California; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D015331:Cohort Studies; D003142:Communication; D005260:Female; D019983:Guideline Adherence; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D016377:Organ Transplantation / Q000523:psychology / Q000592:standards*; D010287:Parent-Child Relations; D010349:Patient Compliance / Q000706:statistics & numerical data; D018579:Patient Selection; D011300:Preoperative Care / Q000592:standards / Q000639:trends; D011368:Professional-Family Relations; D011594:Psychometrics; D015203:Reproducibility of Results; D009927:Tissue and Organ Procurement / Q000458:organization & administration*; D055815:Young Adult