Tibyan Ahmed, HBSc MSc candidate
Ajmera Transplant Centre, University Health Network and University of Toronto
On behalf of co-authors and fellow peers at the Kidney Health Education and Research Group
“The gift of life…minus its complete instructions manual” is how many liver transplant recipients (LTR) explain their post-transplant experience. As patients are sent home after their liver transplant surgery, they receive pages of instructions and resources on what to expect clinically, but it begs the question: where could they find what to do regarding their emotional concerns?
Despite successful surgeries, some LTR may experience feelings of stress, guilt, anxiety and depression following their operation. In particular, up to 60% of LTR experience depressive symptoms, which have been associated with poor outcomes. However, depressive symptoms are not systematically screened for in LTR. This means these symptoms often go undetected, untreated and not entirely discussed in post-transplant care guides.
Currently, there is no agreement on the best tool and method to screen for depressive symptoms. Of the many tools available, differences in scoring, score interpretations, precision and questionnaire length make them challenging for routine clinical use. In an effort to address these challenges, a 2-step depressive symptom screening approach has been used in the care of various patient populations. Within the field of transplant, this 2-step screening method for depressive symptoms was explored by our colleagues at the Kidney Health Education and Research Group in Toronto, Canada in patients on renal replacement therapies (dialysis or kidney transplant). The findings from their study showed its potential advantages in these types of patients).
We began to ask, could a 2-step screening approach for depressive symptoms also be used to help identify LTR who may benefit from additional mental health support? This was then studied in the abstract accepted for presentation at the ISOQOL 2022 Annual Conference, “2-Step Screening for Depressive Symptoms in Liver Transplant Recipients.” We performed secondary analysis of data collected from a sample of LTR in a single centre in Toronto, Canada. We simulated 2-step screening scenarios consisting of: a first step using an ultra-brief pre-screener (Patient Reported Outcomes Measurement Information System Depression Computer Adaptive Test Screener Item “in the past 7 days I felt depressed” [PROMIS-D CATs] or Patient-Health-Questionnaire-2 [PHQ-2]), followed by a second step of PROMIS-D CAT (in its entirety), only completed by participants above a pre-specified cut-off. Screening performance of the 2-step approaches was evaluated and a commonly accepted Patient-Health Questionnaire-9 score of ≥ 10 was used as a reference for moderate/severe depressive symptoms.
The results of this study showed that a 2-step screening method using PROMIS-D CATS pre-screener > “never” combined with a PROMIS-D CAT T score of ≥ 53 in its entirety had acceptable sensitivity and specificity for identifying moderate/severe depressive symptoms among LTR. This approach had lower question burden compared to PROMIS-D CAT alone, especially among patients with no depressive symptoms. LTR who were positively screened-in could begin discussions on the appropriate treatment, support and resources they need with their healthcare provider.
We hope a 2-step screening approach for depressive symptoms among LTR could help patients discuss how they feel with their healthcare provider, inform clinical decision making, and provide higher satisfaction of care. The findings from this study are advising the development of a pilot toolkit aimed at screening for various emotional and physical symptoms experienced by solid-organ transplant recipients, in addition to providing stepwise collaborative care pathways and self-management resources for patients, caregivers and healthcare providers. We are excited with the upcoming launch of the pilot in 2023. Our goal is to not only help to provide the gift of life, but also its more complete care guide.
Abstract will be presented in Oral Session 210 on Friday, 21 October, 3:40 pm – 5:10 pm.
This newsletter editorial represents the views of the author and do not necessarily reflect the views of ISOQOL.
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