Monitor on Psychology - December 2011 - (Page 79)

little or no information on kidney transplantation by their physicians in the crucial first months after being diagnosed. “Very few people even understand that dialysis is not equivalent to a working kidney, so many don’t even realize that this treatment doesn’t always have to be as good as it will ever get for them,” Waterman says. In 2004, she developed a program called “Explore Transplant,” which trains dialysis nurses and social workers to talk to kidney disease patients about what they value — be it being able to travel freely or watch their children or grandchildren grow up. Using discussion guides and videos, the program teaches the health-care professionals how to discuss living and deceased donor transplantation, provide information on the process and work with patients to develop a plan. A randomized, controlled trial of the program, presented by Waterman at the 2009 American Transplant Congress, found that, compared with patients who received standard transplant education provided at their dialysis center, “Explore Transplant” patients had greater overall transplant knowledge and were more likely to pursue a transplant. More than onethird contacted a transplant center about undergoing an evaluation, compared with 22 percent of the control group, Waterman says. Yet even patients who get themselves in for a transplant evaluation may face additional hurdles to transplantation — particularly if they think the medical system may be discriminating against them, says Myaskovsky. Her research — presented at the 2010 American Transplant Congress — shows that patients who have previously perceived discrimination or racism from a health-care professional take more time to get approved for kidney transplant surgery because they often proceed more cautiously through the approval process. To help these patients move forward more quickly with their transplant evaluations, Myaskovsky is developing a program to help transplant teams identify those who felt discrimination even before the evaluation process begins. Then, the program will work with these patients to schedule their screenings and shorten the evaluation process to take place over a few days, rather than several months. “It’s not about trying to change their beliefs about discrimination because those are experiences they’ve already had,” she says. “But what we can do is change how we practice our clinical care, and target those patients for intervention.” Evaluating donors and recipients Even if a patient successfully completes all of his or her medical screenings, an organ transplant is far from a sure thing. For years, psychologists have assessed the psychological health of potential transplant recipients and evaluated their support structures to help ensure they will be able to adhere to the lifestyle changes and rigorous medication regimen they’ll face after the surgery. DeceMber 2011 • Monitor on psychology “Post-transplant adherence behavior is a very important aspect of the transplant process because you’ve invested all this time and effort into giving this patient the scarce resource of a kidney,” Myaskovsky says. “You want to make sure they’re doing everything they can to keep that kidney healthy.” Dew says one of the key factors in post-transplant success is a supportive, healthy caregiver. In research presented at the 2010 International Society for Heart and Lung Transplantation, Dew found that patients whose caregivers reported a greater burden and decreased quality of life in the year post-transplant were likely to be less healthy themselves and had lower rates of longterm survival. “We were surprised that the caregiver’s well-being had that kind of impact on the recipient’s chance for a long life,” Dew says. “This shows just how important it is to make sure that caregivers are also in good health pre-transplant, and that they won’t be totally burned out by their caregiving responsibilities.” As living kidney donation increases, however, organ recipients and their caregivers aren’t the only ones who need psychological assessments pre- and post-transplant. Mental health professionals also play a role in evaluating potential donors, to ensure they’re providing this generous gift with full knowledge of the potential risks and benefits involved. It’s important to make sure organ donors aren’t donating because they felt pressured into it and that they have the supports they will need for the recovery process, Dew says. From a psychological perspective, an evaluation may suggest a potential donor has mild depression, a substance abuse problem or anxiety disorder — complications that Dew says must be treated to ensure the donor is as healthy as possible before the transplant. Evaluations may also simply find that the donor is overwhelmed by the process and needs more time to think through whether this is something he or she really wants to do, she says. “It sounds like a simple intervention — giving them more time to make their decision — but the potential donor may not have thought that this was even a possibility,” Dew says. Education is working to save lives, albeit more slowly than needed. Many experts say the need for organs is only going to multiply, thanks to an aging population and increasing rates of diabetes and hypertension, two major causes of kidney failure. As experts in human behavior and motivation, psychologists will continue to have their work cut out for them in this field, Ganikos says. “This is the only field of medicine that depends on the generosity of the human public to make it happen,” she says. “We have the medical technology and pharmaceutical expertise in place to make transplantation doable, but we don’t have enough of the human element we need to save more lives.” n Amy Novotney is a writer in Chicago. 79

Table of Contents for the Digital Edition of Monitor on Psychology - December 2011

Monitor on Psychology - December 2011
Letters
President’s Column
Contents
From the CEO
Willpower Pioneer Wins $100,000 Grawemeyer Prize
Single-Sex Schooling Called Into Question by Prominent Researchers
Maternal Depression Stunts Childhood Growth, Research Suggests
For Boys, Sharing May Seem Like a Waste of Time
Good News for Postdoc Applicants
In Brief
Treatment Guideline Development Now Under Way
Government Relations Update
Psychologist Named Va Mental Health Chief
The Limits of Eyewitness Testimony
Judicial Notebook
Random Sample
Time Capsule
Deconstructing Suicide
Questionnaire
A Focus on Interdisciplinarity
A Time of ‘Enormous Change’
The Science Behind Team Science
Good Science Requires Good Conflict
A New Paradigm of Care
Speaking of Education
Science Directions
New Labels, New Attitudes?
Psychologist Profile
Early Career Psychology
Unintended Consequences
Better Options for Troubled Teens
Saving Lives, One Organ at a Time
New Journal Editors
APA News
Division Spotlight
Guidelines for the Conduct of President-Elect Nominations and Elections
American Psychological Foundation
Personalities

Monitor on Psychology - December 2011

https://www.nxtbook.com/nxtbooks/apa/monitor_201206
https://www.nxtbook.com/nxtbooks/apa/monitor_201205
https://www.nxtbook.com/nxtbooks/apa/monitor_201204
https://www.nxtbook.com/nxtbooks/apa/monitor_201203
https://www.nxtbook.com/nxtbooks/apa/monitor_201202
https://www.nxtbook.com/nxtbooks/apa/monitor_201201
https://www.nxtbook.com/nxtbooks/apa/monitor_201112
https://www.nxtbook.com/nxtbooks/apa/member_benefits
https://www.nxtbook.com/nxtbooks/apa/monitor_201111
https://www.nxtbook.com/nxtbooks/apa/monitor_201110
https://www.nxtbook.com/nxtbooks/apa/monitor_201109_test
https://www.nxtbook.com/nxtbooks/apa/monitor_201109
https://www.nxtbookmedia.com