Young people's experiences and expectations of successful renal transplants

BF Psychology

Watson, Evelyn ; Suzy, O'Connor

University:University of Glasgow

Department:Institute of Health and Wellbeing

关键词: Kidney transplant, renal transplant, expectations, lived experience, adolescence;   

Others  :  http://theses.gla.ac.uk/5982/1/2015WatsonD.Clin.Psy.pdf

来源: University of Glasgow

【 摘 要 】

Background:Kidney transplantation is currently the treatment of choice for young people with life-threatening kidney failure.After receiving a kidney transplant young people must adhere to a strict medication regimen to prevent their body from rejecting their transplanted kidney.Those who are between 11-17 years of age have been identified as being at increased risk of losing their transplanted kidney and this vulnerability has been partly attributed to medication non-adherence.Adolescence is a period of transition when several important developmental tasks must be undertaken such as building self-identity and achieving independence.Adolescence could impact the success of kidney transplantation in multiple ways.Given that young people are likely to think differently from other age groups due to their developmental stage (neurological, cognitive, and social), it is important to learn more about their self-reported lived experience of having a kidney transplant.Before receiving a kidney transplant, young people are likely to have experienced a period of significant ill-health and to have considered how this might improve post-transplant.It is possible they may use their pre-transplant expectations as a baseline for gauging later transplant success.Although it is recommended that expectations be one of the key elements considered during young people’s pre-transplant psychosocial assessments there is limited research focused upon this critical area.Aims:To build a detailed understanding of young people’s lived experience across the kidney transplant process, from the point of forming their pre-transplant expectations, and to learn more about the meaning they construct around this experience.Methods:Four young people (aged 14-17) who had received a successful kidney transplant within the past five years completed a non-directive semi-structured interview about this experience.Interview transcripts were analysed using Interpretative Phenomenological Analysis.Results:Three superordinate themes emerged from the data; ‘Pre-transplant struggles’, ‘Coping’, and ‘Post-transplant adjustment’.It was clear that at all stages of the transplant process, young people wanted to lead ‘normal’ lives similar to their healthy peers.Nonetheless they faced several difficult challenges to obtaining this, which they coped with using a range of different strategies.All of the participants’ pre-transplant expectations were linked to the general belief that life would become “normal” post-transplant.Most participants reported complete fulfilment of their expectations, yet contradicted this in describing a conflicted sense of being both “the same as” and “different from” their peers post-transplant.Interestingly, one participant reported their pre-transplant expectations had been markedly inaccurate.They said this had not only caused them considerable distress post-transplant, but also impeded their ability to accept their donor kidney and new self-care behaviours. Conclusions:Young people’s lived experience across kidney transplantation appears to be characterised by pre-transplant struggles, making post-transplant adjustments, and finding ways to cope with difficult circumstances.Many of the study’s findings parallel the results of previous research but there have also been several novel insights into this experience, such as the significance of organ integration processes during young people’s post-transplant adjustment.This study also offers preliminary support to the proposition that young people’s pre-transplant expectations can play an instrumental role in determining their psychological wellbeing, and their adaptation to new self-care behaviours, post-transplant.Several new directions for future research are indicated.