Stress, coping and adherence to immunosuppressive medications in kidney transplantation
a comparative study
Keywords:
Stress, psychological, Adaptation, psychological, Medication adherence, Patient compliance, Kidney transplantationAbstract
CONTEXT AND OBJECTIVE: Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression. DESIGN AND SETTING: We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil. METHODS: Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale. RESULTS: The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02- 11.47; P < 0.05) and had a marginal trend toward significance with more advanced phases of stress (OR 4.7; CI: 0.99-22.51; P = 0.053). CONCLUSION: Stress and coping strategies may have implications for understanding and managing nonadherent behavior among transplantation patients and should be considered among the strategies for reducing nonadherence.
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Wolfe RA, Ashby VB, Milford EL, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725-30.
Pesavento TE. Kidney transplantation in the context of renal replacement therapy. Clin J Am Soc Nephrol. 2009;4(12):2035-9.
Hariharam S, Johnson CP, Bresnahan BA, et al. Improved graft survival after renal transplantation in the United States, 1988 to 1996. N Engl J Med. 2000;342(9):605-12.
Lamb KE, Lodhi S, Meier-Kriesche HU. Long-term renal allograft survival in the United States: a critical reappraisal. Am J Transplantat. 2011;11(3):450-62.
Denhaerynck K, Dobbels F, Cleemput I, et al. Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: a literature review. Transpl Int. 2005;18(10):1121-33.
Dew MA, DiMartini AF, De Vito Dabbs A, et al. Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation. 2007;83(7):858-73.
Sabaté E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.
Dobbels F, Vanhaecke J, Dupont L, et al. Pretransplant predictors of posttransplant adherence and clinical outcome: an evidence base for pretransplant psychosocial screening. Transplantation. 2009;87(10):1497-504.
Achille MA, Ouellette A, Fournier S, Vachon M, Hébert MJ. Impact of stress, distress and feelings of indebtedness on adherence to immunosuppressants following kidney transplantation. Clin Transplant. 2006;20(3):301-6.
Bronfenbrenner U. Toward an experimental ecology of human development. American Psychologist. 1977;32(7):513-31. Available from: http://cac.dept.uncg.edu/hdf/facultystaff/Tudge/Bronfenbrenner%201977.pdf. Accessed in 2015 (Sep 14).
Berben L, Dobbels F, Engberg S, Hill MN, De Geest S. An ecological perspective on medication adherence. West J Nurs Res. 2012;34(5):635-53.
Fine RN, Becker Y, De Geest S, et al. Nonadherence consensus conference summary report. Am J Transplant. 2009;9(1):35-41.
Takemoto SK, Pinsky BW, Schnitzler MA, et al. A retrospective analysis of immunosuppression compliance, dose reduction and discontinuation in kidney transplant recipients. Am J Transplant. 2007;7(12):2704-11.
De Geest S, Denhaerynck K, Dobbels F. Clinical and economic consequences of non-adherence to immunosuppressive drugs in adult solid organ transplantation. Compliance in solid organ transplantation. In: Grinyó JM, editor. International Transplantation Updates. Permanyer Publications; 2011. p. 63-81.
Butler JA, Roderick P, Mullee M, Mason JC, Peveler RC. Frequency and impact of nonadherence to immunosuppressants after renal transplantation: a systematic review. Transplantation. 2004;77(5):769-76.
Denhaerynck K, Burkhalter F, Schäfer-Keller P, et al. Clinical consequences of non adherence to immunosuppressive medication in kidney transplant patients. Transpl Int. 2009;22(4):441-6.
Gremigni P, Bacchi F, Turrini C, et al. Psychological factors associated with medication adherence following renal transplantation. Clin Transplant. 2007;21(6):710-5.
Cukor D, Rosenthal DS, Jindal RM, Brown CD, Kimmel PL. Depression is an important contributor to low medication adherence in hemodialyzed patients and transplant recipients. Kidney Int. 2009;75(11):1223-9.
Seyle H. The general adaptation syndrome and the diseases of adaptation. J Clin Endocrinol Metab. 1946;6:117-230.
Pedersen SS, Denollet J. Type D personality, cardiac events, and impaired quality of life: a review. Eur J Cardiovasc Prev Rehabil. 2003;10(4):241-8.
O’Dell KR, Masters KS, Spielmans GI, Maisto SA. Does type-D personality predict outcomes among patients with cardiovascular disease? A meta-analytic review. J Psychosom Res. 2011;71(4):199-206.
Hayward MB, Kish JP Jr, Frey GM, et al. An instrument to identify stressors in renal transplant recipients. ANNA J. 1989;16(2):81-5.
Sutton TD, Murphy SP. Stressors and patterns of coping in renal transplant patients. Nurs Res. 1989;38(1):46-9.
White M, Ketefian S, Starr AJ, Voepel-Lewis T. Stress, coping, and quality of life in adult kidney transplant recipients. ANNA J. 1990;17(6):421-4, 431; discussion 425.
Fallon M, Gould D, Wainwright SP. Stress and quality of life in the renal transplant patient: a preliminary investigation. J Adv Nurs. 1997;25(3):562-70.
Rosenberger J, Geckova AM, Dijk JP, et al. Factors modifying stress from adverse effects of immunosuppressive medication in kidney transplant recipients. Clin Transplant 2005;19(1):70-6.
Orr A, Willis S, Holmes M, Britton P, Orr D. Living with a kidney transplant: a qualitative investigation of quality of life. J Health Psychol. 2007;12(4):653-62.
Chen KH, Weng LC, Lee S. Stress and stress-related factors of patients after renal transplantation in Taiwan: a cross-sectional study. J Clin Nurs. 2010;19(17-18):2539-47.
Folkman S, Lazarus RS, Gruen RJ, DeLongis A. Appraisal, coping, health status, and psychological symptoms. J Pers Soc Psychol. 1986;50(3):571-9.
Lindqvist R, Carlsson M, Sjödén PO. Coping strategies of people with kidney transplants. J Adv Nurs. 2004;45(1):47-52.
Marsicano Ede O, Fernandes Nda S, Colugnati F, et al. Transcultural adaptation and initial validation of Brazilian-Portuguese version of the Basel assessment of adherence to immunosuppressive medications scale (BAASIS) in kidney transplants. BMC Nephrol. 2013;14:108.
Dobbels F, Berben L, De Geest S, et al. The psychometric properties and practicability of self-report instruments to identify medication nonadherence in adult transplant patients: a systematic review. Transplantation. 2010;90(2):205-19.
Schmid-Mohler G, Thut MP, Wüthrich RP, Denhaerynck K, De Geest
S. Non-adherence to immunosuppressive medication in renal transplant recipients within the scope of the Integrative Model of Behavioral Prediction: a cross-sectional study. Clin Transplant. 2010;24(2):213-22.
Dobbels F, Van Damme-Lombaert R, Vanhaecke J, De Geest S. Growing pains: non-adherence with the immunosuppressive regimen in adolescent transplant recipients. Pediatr Transplant. 2005;9(3):381-90.
Lipp MN. Manual do Inventário de Sintomas de Stress para Adultos de Lipp (ISSL). São Paulo: Casa do Psicólogo; 2000.
Vitaliano PP, Russo J, Carr JE, Maiuro RD, Becker J. The ways of coping checklist: revision and psychometric properties. Multivariate Behavioral Research. 1985;20(1):3-26. Available from: http://www. tandfonline.com/doi/abs/10.1207/s15327906mbr2001_1. Accessed in 2015 (Sep 14).
Seidl EMF, Tróccoli BT, Zannon CMLC. Análise fatorial de uma medida de estratégias de enfrentamento [Factorial analysis of a coping measure]. Psicologia: Teoria & Pesquisa. 2001;17(3):225-34.
Gardner MJ, Altman DG. Confidence intervals rather than P values: estimation rather than hypothesis testing. Br Med J (Clin Res Ed). 1986;292(6522):746-50.
Altman DG, Bland JM. Absence of evidence is not evidence of absence. BMJ. 1995;311(7003):485.
Carver CS, Scheier MF, Weintraub JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol. 1989;56(2):267-83.
Frazier PA, Davis-Ali SH, Dahl KE. Correlates of noncompliance among renal transplant recipients. Clin Transplant. 1994;8(6):550-7.
Brito DCS, Paula AM, Grincenkov FRS, Lucchetti G, Sanders-Pinheiro H. Análise das mudanças e dificuldades advindas após o transplante renal: uma pesquisa qualitativa [Analysis of changes and difficulties arising from kidney transplantation: a qualitative study]. Rev Latino- Am Enfermagem. 2015;23(3):419-26.
Medina-Pestana JO, Galante NZ, Tedesco-Silva H Jr, et al. O contexto do transplante renal no Brasil e sua disparidade geográfica [Kidney transplantation in Brazil and its geographic disparity]. J Bras Nefrol. 2011;33(4):472-84.
