title: Illness representation and treatment beliefs in liver transplantation: an exploratory qualitative study.
abstract: BACKGROUND
  The objective of this study was to gain detailed insight concerning liver transplanted patients' representations about transplantation, graft rejection and immunosuppressive drugs to adapt the educational follow-up.
  
  
  METHODS
  Semi-structured interviews were conducted with 8 patients. Each interview was recorded and fully transcribed. The verbatim was first coded according to the themes of the Common Sense Model and an inductive approach for the remaining text.
  
  
  RESULTS
  Transplantation is perceived both as a recovery and a new chronic condition. Participants feel powerless in the face of the risk of graft rejection. This risk is perceived as out of control as it is not associated with specific symptoms and external causes. The individual knowledge gained about transplantation relies on real-life experience shared between patients. Many participants feel anxiety. It responds to stress caused by immunosuppressant medication intake, routine check-ups, potential side effects and chronicity of immunodepression. Messages stressing the importance of the tacrolimus in the medication therapy are strengthened by a pre-discharge pharmaceutical consultation.
  
  
  CONCLUSIONS
  This study suggests that healthcare providers should systematically seek to determine illness representations to optimize the educational follow-up. The patient education program for liver transplanted patients should include three types of intervention: individualized education, behavioral intervention and psychological support. It should provide a support for stress management and acceptance of the new chronic condition. The involvement of a clinical pharmacist is relevant.
authors.affiliation: University Grenoble-Alps/CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble 38041, France. Electronic address: Jean-Didier.Bardet@imag.fr.
authors.forename: J-D
authors.initials: JD
authors.lastname: Bardet
authors.affiliation: University Grenoble-Alps/CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble 38041, France; Pharmacy Department, Lyon University Hospital, Lyon 69229, France.
authors.forename: B
authors.initials: B
authors.lastname: Charpiat
authors.affiliation: University Grenoble-Alps/CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble 38041, France; Pharmacy Department, Grenoble University Hospital, 38043 Grenoble, France.
authors.forename: P
authors.initials: P
authors.lastname: Bedouch
authors.affiliation: Institut d'Éducation Thérapeutique, University Pierre-et-Marie-Curie Paris 6, 75634 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Rebillon
authors.affiliation: UCBL-Lyon 1, Surgeon, General digestive surgery and liver transplantation Department, Lyon University Hospital, 69229 Lyon, France.
authors.forename: C
authors.initials: C
authors.lastname: Ducerf
authors.affiliation: University Grenoble-Alps, Inter-University Laboratory of Psychology (LIP), 38040 Grenoble, France.
authors.forename: A
authors.initials: A
authors.lastname: Gauchet
authors.affiliation: Institut d'Éducation Thérapeutique, University Pierre-et-Marie-Curie Paris 6, 75634 Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Tourette-Turgis
authors.affiliation: University Grenoble-Alps/CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble 38041, France; Pharmacy Department, Grenoble University Hospital, 38043 Grenoble, France.
authors.forename: B
authors.initials: B
authors.lastname: Allenet
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006084:Graft Rejection; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008107:Liver Diseases / Q000523:psychology* / Q000601:surgery*; D016031:Liver Transplantation / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011795:Surveys and Questionnaires
chemical_list: D007166:Immunosuppressive Agents
keywords: Croyances sur les médicaments; Graft rejection; Illness representations; Immunosuppresseurs; Immunosuppressive medicines; Liver transplantation; Medicine beliefs; Rejet du transplant; Représentations en santé; Transplantation hépatique