Self-Management Measurement and Prediction of Clinical Outcomes in Pediatric Transplant
02/2018
Journal Article
Authors:
Annunziato, R. A.;
Bucuvalas, J. C.;
Yin, W.;
Anand, R.;
Alonso, E. M.;
Mazariegos, G. V.;
Venick, R. S.;
Stuber, M. L.;
Shneider, B. L.;
Shemesh, E.
Volume:
193
Journal:
J Pediatr
PMID:
29162346
URL:
https://www.ncbi.nlm.nih.gov/pubmed/29162346
DOI:
10.1016/j.jpeds.2017.09.069
Keywords:
Adolescent Child Child, Preschool Cohort Studies Female Graft Rejection/*diagnosis/epidemiology/etiology Humans Infant Liver Transplantation/*statistics & numerical data Male Parents Prospective Studies Psychometrics/methods Reproducibility of Results
Self-Management/*methods Surveys and Questionnaires Treatment Outcome United States *Assessment of Medication Adherence adherence pediatric transplant self-management transition
Abstract:
OBJECTIVE: To further refine a measure of self-management, the Responsibility and Familiarity with Illness Survey (REFILS), and to determine if this score predicts medication adherence and, thus, fewer instances of allograft rejection among pediatric liver transplant recipients. STUDY DESIGN: Participants were 400 liver transplant recipients and their parents recruited for the Medication Adherence in Children Who Had a Liver Transplant study, from 5 US pediatric transplant centers. The REFILS was administered to participants (ages 9-17 years) and their parents at enrollment (n = 213 completed dyads). The REFILS scores, and a discrepancy score calculated between patient and parent report of the patient's self-management, were used to predict Medication Level Variability Index (MLVI), a measure of medication adherence (higher MLVI = more variability in medication levels) and central pathologist-diagnosed rejection over a 2-year follow-up. RESULTS: When patients reported greater self-management, their adherence was lower (higher MLVI, r = 0.26, P < .01). Discrepancies between patient and parent report (patients endorsing higher levels than parents) were associated with lower adherence (r = 0.20, P < .01). Greater patient-reported self-management and higher discrepancy scores also predicted rejection. CONCLUSIONS: We found that when patients endorse more responsibility for their care, clinical outcomes are worse, indicating that indiscriminate promotion of self-management by adolescents may not be advisable. A discrepancy between patient and parent perception of self-management emerged as a novel strategy to gauge the degree of risk involved in transitioning care responsibilities to the child.