title: Pilot testing a model of psychological care for heart transplant recipients.
abstract: BACKGROUND
  Anxiety and depression are common after heart transplantation. This study aimed to pilot test the feasibility of a clinical model of psychological care for heart transplant recipients. The model of care involved nurse-led screening for anxiety and depression followed by referral for a course of telephone-delivered cognitive behaviour therapy as well as co-ordination of communication with on-going specialist and primary care services.
  
  
  METHODS
  A pilot randomised controlled trial was conducted. Heart transplant recipients who self-reported at least mild anxiety or depressive symptoms were randomised (defined as a score higher than 5 on the Patient Health Questionnaire-9 or the Generalized Anxiety Disorder-7 [GAD-7], or a score higher than 20 on the Kessler Psychological Distress Scale [K10]). The primary outcome was assessment of feasibility of conducting a larger trial, which included identification of recruitment and attrition rates as well as the acceptability of the intervention. Follow-up was conducted at 9 weeks and 6 months.
  
  
  RESULTS
  One hundred twenty-two of the 126 (97 %) heart transplant recipients assessed on their attendance at the outpatient clinic met the study eligibility criteria. Of these patients, 88 (72 %) agreed to participate. A moderate proportion of participants (n= 20; 23 %) reported at least mild symptoms of anxiety or depression. Five participants were excluded because they were currently receiving psychological counselling, two withdrew before randomisation and the remaining 13 were randomised (seven to intervention and six to usual care). The majority of the randomised participants were male (n= 9; 69 %) and aged over 60 (range 35-73). Median length of time post-transplant was 9.5 years (ranging from 1 to 19 years). On enrolment, 3 randomised participants were taking anti-depressants. One intervention group participant withdrew and a further 3 (50 %) declined the telephone-delivered CBT sessions; all because of restrictions associated with physical illnesses. Attrition was 30 % at the 6 month follow-up time-point.
  
  
  CONCLUSIONS
  Due to the poor acceptability of telephone-delivered cognitive behavioural therapy observed in our sample, changes to intervention components are indicated and further pilot testing is required.
  
  
  BACKGROUND
  ACTRN12613000740796 Date registered: 03/07/2013.
authors: Institute of Health and Biomedical Innovation, Queensland University of Technology (QUT), 60 Musk Ave, Kelvin Grove, QLD 4059 Australia.
authors: Aaron
authors: 0000-0002-9583-8636
authors: A
authors: Conway
authors: School of Psychology, Queensland University of Technology (QUT), Brisbane, Australia.
authors: Judith
authors: J
authors: Sheridan
authors: Advanced Heart Failure and Transplant Unit, The Prince Charles Hospital, Chermside, Australia.
authors: Joanne
authors: J
authors: Maddicks-Law
authors: Nursing Research and Practice Development Centre, The Prince Charles Hospital & School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Sydney, Australia.
authors: Paul
authors: P
authors: Fulbrook
keywords: Anxiety; Cognitive behavioural therapy; Depression; Psychological; Screening; Transplantation