D. Beck

The role of goal cognitions, illness perceptions and treatment beliefs in self-reported adherence after kidney transplantation: A cohort study

OBJECTIVE Nonadherence to immunosuppressive medication (IM) after kidney transplantation is related to poorer patient and graft outcomes; therefore research into modifiable factors associated with nonadherence is a priority. In this prospective cohort study we investigated whether changes in goal cognitions, illness perceptions, and treatment beliefs were related to self-reported medication adherence six months after kidney transplantation. METHODS Interviews were conducted with patients in the out-patient clinic six weeks (T1: n=113) and six months (T2: n=106) after transplantation. Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS© Interview). The Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire and questions on goal cognitions were also administered at both time points. RESULTS Self-reported nonadherence increased significantly between 6 weeks and 6 months after transplantation from 17% to 27%. Importance of medication adherence as a personal goal and self-efficacy to successfully carry out this goal decreased significantly over time. Perceived necessity of immunosuppressive medication was high but significantly decreased over time. Concerns about the medicines were low. There were no significant changes in illness perceptions or concerns over time. An increase in perceived graft longevity (timeline) was related to higher likelihood of nonadherence six months post-transplant. Furthermore, younger adult patients were more likely to be nonadherent six months after transplantation. CONCLUSION The self-reported nonadherence levels found in this study so soon after transplantation demonstrate the need for early and continued intervention after kidney transplantation in order to maximise adherence and consequently clinical outcomes. Changes in (unrealistic) beliefs regarding the longevity of the graft may offer a potential target for intervention among nonadherent patients.

Attitudes to medication after kidney transplantation and their association with medication adherence and graft survival: a 2-year follow-up study

Background. Nonadherence to medication is a common problem after kidney transplantation. The aim of this study was to explore attitudes towards medication, adherence, and the relationship with clinical outcomes. Method. Kidney recipients participated in a Q-methodological study 6 weeks after transplantation. As a measure of medication adherence, respondents completed the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS©-interview). Moreover, the intrapatient variability in the pharmacokinetics of tacrolimus was calculated, which measures stability of drug intake. Data on graft survival was retrieved from patient records up to 2 years after transplantation. Results. 113 renal transplant recipients (19–75 years old) participated in the study. Results revealed three attitudes towards medication adherence—attitude 1: “confident and accurate,” attitude 2: “concerned and vigilant,” and attitude 3: “appearance oriented and assertive.” We found association of attitudes with intrapatient variability in pharmacokinetics of tacrolimus, but not with self-reported nonadherence or graft survival. However, self-reported nonadherence immediately after transplantation was associated with lower two-year graft survival. Conclusion. These preliminary findings suggest that nonadherence shortly after kidney transplantation may be a risk factor for lower graft survival in the years to follow. The attitudes to medication were not a risk factor.

Discrepancies between beliefs and behavior: A prospective study into immunosuppressive medication adherence after kidney transplantation

Background Nonadherence to immunosuppressive medication after kidney transplantation is a behavioral issue and as such it is important to understand the psychological factors that influence this behavior. The aim of this study was to investigate the extent to which goal cognitions, illness perceptions, and treatment beliefs were related to changes in self-reported immunosuppressive medication adherence up to 18 months after transplantation. Methods Interviews were conducted with patients in the outpatient clinic 6 weeks (T1; n = 113), 6 months (T2; n = 106), and 18 months (T3; n = 84) after transplantation. Self-reported adherence was measured using the Basel Assessment of Adherence to Immunosuppressive Medications Scale Interview. Psychological concepts were measured using the Brief Illness Perceptions Questionnaire, Beliefs about Medicines Questionnaire, and questions on the importance of adherence as a personal goal, conflict with other goals, and self-efficacy for goal attainment. Results Nonadherence significantly increased over time to 31% at T3. Perceived necessity of medication, perceived impact of transplant on life (consequences) and emotional response to transplantation significantly decreased over time. Participants who reported low importance of medication adherence as a personal goal were more likely to become nonadherent over time. Conclusions Illness perceptions can be described as functional and supportive of adherence which is inconsistent with the pervasive and increasing nonadherence observed. There appears therefore to be a discrepancy between beliefs about adherence and actual behavior. Promoting (intrinsic) motivation for adherence goals and exploring the relative importance in comparison to other personal goals is a potential target for interventions.

Predictors of Change in Donorsʼ Mental Health Three Months After Living Kidney Donation.: Abstract# A325

Background In order to optimize screening and support of living kidney donors, we examined which factors predict changes in donors’ mental health after living kidney donation. Methods Living kidney donors (N=137) completed validated questionnaires and participated in interviews a median of 2 months before and 3 months after donation. Using multilevel linear models we examined whether psychological complaints and wellbeing were predicted by sociodemographic characteristics, medical outcomes for donor and recipient, and psychological factors based on stress models of Lazarus (1999) and Ursin & Eriksen (2004). Findings There was no main effect of time on psychological complaints while wellbeing increased over time (p<.01). Donors’ home situation, greater stress, appraising donation as an uncontrollable or negative event, expectations of negative personal consequences, coping, social support, and more negative life events predicted negative changes in donors’ mental health. Medical outcomes were not related to changes in donors’ mental health. Discussion We recommend negative appraisals of donation and individual resources as targets for improved donor screening and support.

Changes in mental health among living kidney donors after donation: a a matched control study

Background It is unclear whether living kidney donors experience psychological burden as a result of their donation. Research is hampered by the lack of a suitable control group: changes in mental health could reflect normal fluctuations. We used a control group from the general population to compare changes in mental health over time. Methods Controls were matched with 125 living kidney donors on gender and baseline mental health. Donors and controls completed the Brief Symptom Inventory (BSI) and Mental Health Continuum twice, 6 months apart. Donors donated their kidney median 3 months after baseline. Multilevel linear models were used as well as the reliable change index (RCI) of the BSI. Findings Multilevel modelling showed that donors and controls did not differ in changes of mental health over time. Based on the RCI, 2 donors versus 4 controls showed a decrease in psychological complaints and 10 donors versus 5 controls showed an increase. RCI changes were not significantly different between donors and controls. Discussion We conclude that changes in donors’ mental health 3 months after donation do not significantly differ from natural fluctuations found in the general population.