title: Sweet and sour after renal transplantation: a qualitative study about the positive and negative consequences of renal transplantation.
abstract: OBJECTIVE
  This qualitative study investigated the renal patients' experience of positive and negative consequences of transplantation, as well as the strategies they use to adapt to the transplantation.
  
  
  METHODS
  A qualitative design (30 participants in total), using individual interviews (18 participants) and two focus groups (12 participants in total), was used.
  
  
  RESULTS
  The results showed that patients experienced a wide range of positive and negative emotions, in particular, guilt, gratefulness, and fear, partly as a result of their normative persuasions. Normative persuasions may transform inherent positive emotions into negative emotions and subsequent maladaptive behaviour. Not only physical limitations but also physical improvements were found to be related to the experience of negative emotions. Finally, the results indicated that patients mainly used adaptive coping strategies to adjust to life after transplantation, such as looking for opportunities, setting different priorities, making own choices, trying to maintain control, taking good care of oneself, and appreciating other things in life.
  
  
  CONCLUSIONS
  This study offers several new insights regarding the range of experiences of renal patients after transplantation. Health professionals are invited to pay more attention to the full range of positive and negative experiences following transplantation, including the existence of normative persuasions. Health professionals may assist renal patients by helping them to recognize and acknowledge both positive and negative emotions and to encourage the use of more beneficial coping strategies.
  What is already known on this subject? The quality of life (QoL) of renal patients significantly improves after transplantation but the post-transplant QoL is lower compared with the QoL in healthy populations. Patients on dialysis and those who have received a donor kidney tend to use mainly emotion-focused coping strategies. What does this study add? This study offers several new insights regarding experiences of renal patients after transplantation: Patients experience a range of positive and negative emotions like guilt, gratefulness, and fear. Emotions are partly a result of normative persuasions. Persuasions may transform positive emotions into negative emotions and maladaptive behaviour. Physical limitations and improvements can due to the persuasions lead to negative emotions. Patients mainly use adaptive coping strategies.
authors.affiliation: Department of Medical Humanities, EMGO+ Institute, VU University Medical Center (Vumc), Amsterdam, The Netherlands.
authors.forename: Karen
authors.initials: K
authors.lastname: Schipper
authors.forename: Tineke A
authors.initials: TA
authors.lastname: Abma
authors.forename: Carina
authors.initials: C
authors.lastname: Koops
authors.forename: Ineke
authors.initials: I
authors.lastname: Bakker
authors.forename: Robbert
authors.initials: R
authors.lastname: Sanderman
authors.forename: Maya J
authors.initials: MJ
authors.lastname: Schroevers
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D004644:Emotions; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D016030:Kidney Transplantation / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D036301:Qualitative Research; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: adaptation; emotions; psychological consequences; renal transplantation