Patients' perceptions of treatment for kidney failure: The impact of personal experience on population predictions

Estimates of the probability of various outcomes associated with treatment for kidney failure were made by chronic dialysis patients, dialysis patients awaiting transplant, successful transplant patients, and unsuccessful transplant patients back on dialysis. The latter two groups can be considered a natural experiment testing the impact of personal experience on population predictions. Consistent with the law of small numbers and the availability heuristic, successful transplant patients gave higher estimates of the population success rate for transplantation than unsuccessful transplant patients gave.     

Body-image,quality of life and psychological distress: a comparison between kidney transplant patients and a matching healthy sample

The purpose of the current study was to assess the uniqueness of the condition of kidney transplant recipients in comparison to a sample of matching healthy peers in relation to body-image dissatisfaction and identification, quality of life and psychological distress. Participants were 45 kidney transplant recipients who were under follow-up care at a Transplant Unit of a major Medical Center, and a sample of 45 matching healthy peers. Measures were taken using self-report questionnaires [Body-Image Ideals Questionnaire (BIIQ), Body Identification Questionnaire (BIQ), Brief Symptoms Inventory (BSI), and the SF-12]. The major findings were the following: (i) kidney transplant recipients reported lower levels of quality of life and higher levels of PsD when compared to their healthy peers; (ii) no difference in body-image dissatisfaction was found between the two studied groups; (iii) significant correlations between body-image dissatisfaction quality of life and PsD were found only in the kidney transplant recipients. The kidney transplantation condition has a moderating effect in the association between body-image dissatisfaction PsD but not in the association between body-image dissatisfaction and quality of life; (iv) kidney transplant recipients experienced higher levels of body identification than did their healthy peers. Taken together, these findings highlight the unique condition of kidney transplant recipients, as well as the function that body-image plays within the self.     

Psychological experiences of renal transplant patients: A qualitative analysis

Introduction: Organ‐sourcing developments now permit increasing numbers of renal transplants. Recipients commonly experience negative affect pre‐ and/or post‐transplant yet research on patient experience is lacking. Aims: This study aims to develop theory based on the lived experience of recipients, and to guide psychological and support interventions by counsellors and professional carers for the benefit of patients. Methods: A sample of eight participants was interviewed about their transplant experiences. The interview data were analysed using grounded theory methodology. Uniquely the research was conducted by a renal transplant patient, which potentially adds interpretive insight. Results: The central finding is that the issues facing transplant patients before and after transplant may be summarised as living with paradox and conflict. Thus, recipients may need to juxtapose anger/sadness about losses with an adaptive attitude to making the most of a second chance at life, and negotiate a positive relationship with an ‘alien’ organ. Conclusions/implications: The study offers evidence‐based guidance to counsellors supporting recipients to adjust to a changing sense of self, and to form adaptive relationships with self, others and the new kidney. Finally the research recommends action on improving awareness of and access to counselling and other supports for renal transplantees, and the need for in‐depth experiential research in this expanding area.     

Group Psychotherapy in France

This article discusses group therapy as part of a multidisciplinary approach to the management of the various psychological and physical rehabilitation concerns posed by kidney and liver transplant candidates and recipients at Howard University Hospital in Washington, DC. The group's history, format, intervention foci, and roles of clinicians and patients attending the group are described and evaluated. Given the relative paucity of research literature in this area, the authors offer recommendations for empirical evaluation of the benefits of multidisciplinary group psychotherapy in ameliorating physical and emotional suffering and prolonging life among transplant patients.     

Psychological differences of patients and relatives according to post-transplantation anxiety

The aim of this investigation is to analyze the psychological differences of patients and their relatives according to the formers' post-transplantation anxiety. We used two groups of participants: transplant patients (n = 166) and close relatives (n = 166). Four questionnaires were applied: a Psychological Survey (to both groups), the Hospital Anxiety and Depression Scale, and the Quality of Life Questionnaire (to the transplant patients), and the Leeds Scales for the Self-Assessment of Anxiety and Depression (to the relatives). Participants were assessed twice: post-Intensive Care Unit (ICU; when patients were moved from the ICU to the Transplantation Unit) and post-hospital (one year after transplant). Results showed that high anxiety in patients just after organ transplant was related to an increase of anxiety and depression symptoms both in patients and relatives one year after transplant; it was also related to a decrease in the quality of life of these patients.     

Global Predictions of Memory in Alzheimer’s Disease: Evidence for Preserved Metamemory Monitoring

Previous researchers have argued that there is a metamemory monitoring deficit in Alzheimer’s disease (AD) because patients tend to overestimate their recall performance on a word list. We propose that these previous results are a misleading by-product of the methodologies used, rather than evidence of an underlying metamemory deficit. In two experiments, AD patients and older adult controls made predictions of performance both before and after encoding a to-be-remembered list. Metamemory function was measured by observing the shift in predictions made with, and without, an opportunity to monitor the list. Experiment 1 found that although there were differences between the groups’ accuracy for their prestudy predictions of recall, both groups were equally accurate after encoding. Experiment 2 explored this using four lists that varied in item difficulty and semantic relatedness. This experiment replicated the findings of Experiment 1, and it was also found that the AD group became more accurate at predicting their performance with more exposure to study-test trials. These studies suggest that metamemory monitoring is intact in AD, because AD patients utilize information gained during processing the to-be-remembered items to revise their predictions of subsequent performance.     

From wealth to well-being? Money matters,but less than people think

While numerous studies have documented the modest (though reliable) link between household income and well-being, we examined the accuracy of laypeople's intuitions about this relationship by asking people from across the income spectrum to report their own happiness and to predict the happiness of others (Study 1) and themselves (Study 2) at different income levels. Data from two national surveys revealed that while laypeople's predictions were relatively accurate at higher levels of income, they greatly overestimated the impact of income on life satisfaction at lower income levels, expecting low household income to be coupled with very low life satisfaction. Thus, people may work hard to maintain or increase their income in part because they overestimate the hedonic costs of earning low levels of income.     

Affective forecasts and the Valentine's Day shootings at NIU: People are resilient,but unaware of it

People overestimate the extent to which emotion-producing life events affect subsequent affect. However, research has yet to conclusively demonstrate that this phenomenon occurs following significant trauma affecting entire communities, or whether it applies to predictions of discrete emotions. Exploring such issues, student reports of emotion states were collected both before and after the oncampus Valentine's Day, 2008 shootings at Northern Illinois University (NIU). A separate group of students not on campus when the shootings occurred provided emotion state reports and predictions of the emotions they would expect to experience 2 weeks after a shooting occurred. Examination of these data suggests that: (1) emotion states of NIU students reflected resilience, and (2) students made affective forecasting errors indicating that this resilience was unexpected. These data confirm results of prior affective forecasting studies, extending them to cases of traumatic experiences, and suggest that such studies can expand their focus to explore specific post-event emotions.     

肾移植患者生存质量及影响因素分析

探讨肾移植患者的生存质量及影响因素。采用健康状况调查问卷(SF-36)调查广州地区医疗机构145例肾移植受者移植前和移植后6个月的生存质量。移植后6个月患者的生存质量评分较移植前有明显提高。文化程度、有无配偶、经济状况、肾源、健康知识掌握程度等因素对患者的生存质量影响较大。医护人员应为肾移植患者提供个性化护理,以提高患者的生存质量。     

Effect of family environment and donor source on patient quality of life following renal transplantation.

The authors examined the degree to which the supportiveness of a patient's family environment predicts change in quality of life following renal transplantation. The sample consisted of 95 patients receiving renal grafts from either a living donor or a cadaveric donor. Patients were initially assessed prior to transplantation with follow-up assessment occurring an average of 5.5 months after transplantation. Among patients receiving a living-donor kidney, those reporting a more supportive family environment exhibited reduced depression, improved mobility, and improved social functioning. However, those living-donor recipients reporting less family support exhibited increased depression and diminished mobility and social functioning after transplantation. Patients receiving a kidney from a cadaveric donor showed modest improvements in quality of life regardless of the degree of family support.     

Restlessness and psychomotor agitation after kidney transplantation: their impact on perceived health status

Restlessness and psychomotor agitation are among the causes of morbidity and mortality in different diseases. They are known problems in end-stage renal disease patients but no study has ever evaluated their presence and effects in kidney recipients. This study aimed to explore the presence of restlessness and psychomotor agitation and their relation with morbidity of patients after renal transplantation. Sixty-one subjects were randomly selected from kidney transplant recipients being followed in Baqiyatallah Hospital, Tehran, Iran. Restlessness and psychomotor agitation were determined by Hospital Anxiety and Depression Scale (HADS). The correlation of these scores with demographic data, clinical data, sexual function, marital adjustment, quality of life, sleep quality and medical comorbidity of patients was evaluated. The scores of restlessness and psychomotor agitation were significantly correlated with the age at transplantation (r = .269, p = .04 and r = .324, p = .01, respectively), the total score of medical comorbidity (r = .273, p = .02 and r = .257, p = .04, respectively), role limitation due to emotional problems (r = -.26, p = .03 and r = -.25, p = .04, respectively) and mental health (r = -.277, p = .02 and r = -.252, p = .04 respectively). There was no correlation between these symptoms and the gender, marital status, and sexual relationship score of the patients (p > .05). Restlessness and psychomotor agitation are frequent and can impose high degrees of morbidity on renal transplant recipients. Proper management of these problems seems to improve the different aspects of quality of life in these patients.     

Disability and sunshine: can hedonic predictions be improved by drawing attention to focusing illusions or emotional adaptation?

People frequently mispredict the long-term emotional impact of circumstances. The authors examine 2 causes of such mispredictions-a focusing illusion and underappreciation of adaptation. In Experiment 1, the authors found, in 852 adults, that quality of life estimates (for living with disability) were not increased by reducing focusing illusions. In Experiment 2, the authors found, in 698 adults, that people's disability estimates were increased by asking them to reflect on adaptation. In Experiment 3, the authors found, across 312 Midwestern college students, that both approaches reduced the participants' predictions of the life satisfaction of their peers living in southern California. In the case of living in a better climate, the results suggest that attention to either cause influences people's predictions, whereas in the case of chronic disability, the results suggest that it is easier to get people to appreciate adaptation than it is to reduce focusing illusions.     

An advocacy intervention program for women with abusive partners: Six-month follow-up

Presented the 6-month follow-up findings of an experimental intervention designed to provide postshelter advocacy services to women with abusive partners. The intervention involved randomly assigning half the research participants to receive the free services of an advocate, 4 to 6 hours per week, for the first 10 weeks postshelter. One hundred forty-one battered women were interviewed about their experiences immediately upon their exit from a domestic violence shelter: 95% of the sample were interviewed 10 weeks thereafter (postintervention), and 93% were successfully tracked and interviewed 6 months later. At the 6-month follow-up, participants in both groups reported increased social support, increased quality of life, less depression, less emotional attachment to their assailants, and an increased sense of personal power. Although women in both groups reported some decrease in physical abuse over time, there were no statistically significant differences between those with and those without advocates, and abuse continued to be a problem for many women. Those who were still involved with their assailants continued to experience higher levels of abuse and had been more economically dependent upon the men prior to entering the shelter. Women who had worked with advocates continued to report being more satisfied with their overall quality of life than did the women in the control group. The authors thank the Editor and anonymous reviewers for their helpful comments. Thanks also to all present and past staff of the Community Advocacy Project, who helped in data collection and analyses. This work was supported by National Institute of Mental Health Grant 1R01 MH 44849.     

Quality of Life and Mental Health Comparisons Among Liver Transplant Recipients and Cirrhotic Patients with Different Self-Perceptions of Health

Our aim was to analyze the differences in quality of life and mental health among liver transplant recipients with better (G₁) and worse (G₂) perceived health and decompensated cirrhotic patients (G₃). We selected two groups of patients: 168 liver transplant recipients and 75 cirrhotic patients. The Hospital Anxiety and Depression Scale and SF-36 Health Survey were used. Statistically significant differences showed that cirrhotic patients (G₃) suffered the highest impairment, and liver transplant recipients with better self-perceived health (G₁) had the lowest impairment, whereas patients with worse self-perceived health (G₂) were in an intermediate position between both groups. Moreover, very striking differences, based on large effect sizes, were found among groups on some quality of life dimensions: physical-role, general health, vitality, and physical functioning. In conclusion, the biopsychosocial well-being of liver transplant recipients is better than that of cirrhotic patients, even if the former do not perceive their health positively.     

Self-Report Versus Performance-Based Activities of Daily Living Capacity Among Heart Transplant Candidates and Their Caregivers

Transplant candidates completed the Every Day Problems test (EPT), a performance-based measure of instrumental activities of daily living (IADL), and the Katz self-report scale of IADL functioning. Caregivers estimated the candidate's IADL capacity using the Katz scale. A healthy community group and patients with cardiac disease not undergoing transplant evaluation and their caregivers served as controls. Discrepancies between the EPT and Katz scales were generated. Results showed that the total number of discrepancies was significantly higher among the two patient groups as compared to controls. Three or more discrepancies (a total of 7 IADL domains were assessed) occurred in 40–52% of the participants and their caregivers in the two patient groups. Similarly, the total number of discrepancies between the Katz scale of the participant and their caregiver was significantly higher among the two patient groups as compared to controls, with only 33–44% showing perfect agreement in the patient groups as compared to 97% among controls. Despite a high prevalence of discrepancies in both patient groups, results did not support the hypothesis that transplant candidates tend systematically to overestimate their ability level on self-report IADL measures.     

Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments

People tend to hold overly favorable views of their abilities in many social and intellectual domains. The authors suggest that this overestimation occurs, in part, because people who are unskilled in these domains suffer a dual burden: Not only do these people reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the metacognitive ability to realize it. Across 4 studies, the authors found that participants scoring in the bottom quartile on tests of humor, grammar, and logic grossly overestimated their test performance and ability. Although their test scores put them in the 12th percentile, they estimated themselves to be in the 62nd. Several analyses linked this miscalibration to deficits in metacognitive skill, or the capacity to distinguish accuracy from error. Paradoxically, improving the skills of participants, and thus increasing their metacognitive competence, helped them recognize the limitations of their abilities.     

Do patients suffering from chronic diseases retrospectively overestimate how healthy they were before they fell ill?

Background/Objective: To examine the impact of a disease on a person's subjective health state, patients are often asked to assess their current health state and to retrospectively assess how healthy they were before they fell ill. The objective of this study was to test whether patients generally overestimated the quality of their pre-disease health. Method: Six samples of patients with chronic diseases (cancer patients, cardiovascular patients, and patients diagnosed with sarcoidosis, N between 197 and 1,197) were analyzed. The patients assessed their current health states and their health states at the time before diagnosis. The retrospective scores were compared with matched data from general population studies. Results: In three of the six studies, the retrospective health ratings of the patients were significantly higher than the general population norms (effect sizes between 0.24 and 0.46), two studies yielded nonsignificant effects, and in one study there was an opposite trend. The general overestimation of pre-disease health was more pronounced in older patients as compared with younger ones, and it was more pronounced when global health/quality of life was to be assessed. Conclusions: Retrospective assessments of pre-disease health states are not appropriate for assessing disease-related changes in a person's health state.     

Psychische Betreuung von Patienten und Angehörigen in der Transplantationsmedizin

During the decision making process and waiting period before organ transplantation patients and their families often suffer from psychological distress. After transplantation a subgroup of patients keeps showing psychological symptoms and also impairments of quality of life. Psychological treatment manuals are often demanded, but are rarely achieved. This study describes the experience with a low frequent (8 sessions/year) therapeutic group for lung transplant candidates. The group, which is based on a cognitive behavioural concept, is lead by a physician (internal medicine), a psychotherapist and a physiotherapist. This therapeutic group has been continuously offered for patients and their caregivers for the past 7 years. About 50% of all patients participated in this program before transplantation, after transplantation only a few patients visited the group sessions. On average 12 patients and 8 caregivers visited each session. One problem for these patients with severe lung-disease was the long distance between patient’s homes and the hospital. This has been the reason for self-help organisations to demand better psychotherapeutic outpatient support for patients and their families before and after organ transplantation.     

Do boys with attention-deficit/hyperactivity disorder have positive illusory self-concepts?

One hundred ninety-five boys with attention-deficit/hyperactivity disorder (ADHD) were compared with 73 comparison boys (M = 9.83 years, SD = 1.30) on self-perceptions relative to a teacher-rated criterion. Emphasis was placed on ADHD subgroup comparisons according to level of aggression, academic achievement, and depression compared with control boys. Consistent with the authors' prediction, ADHD boys overestimated relative to teacher report, more than did controls, in the scholastic competence, social acceptance, and behavioral conduct domains. Examination of discrepancy scores (child rating - teacher rating) by comorbidity subgroups suggested that aggressive and low-achieving ADHD boys tended to overestimate their competence the most in the domains in which they were the most impaired. Results are discussed in terms of prior literature on "positive illusions" in ADHD children.     

Psychodynamic Improvement in Eating Disorders: Welcoming Ignored,Unspoken, and Neglected Concerns in the Patient to Foster Development and Resiliency

ABSTRACT

Drawing upon case examples from their clinical, supervisory, and teaching experience, the authors suggest eating disorder treatment that primarily addresses behavioral change and is relatively short term leaves many patients behind in the search for a fuller sense of self and resilience. They have found that improvement rests upon ferreting out developmental deficits and other factors in early life that have been ignored, unspoken, and neglected; and without reflecting on, working through, and integrating these early experiences patients feel a part of themselves is still missing after symptom reduction. The authors assert that longer-term psychodynamic treatment facilitates therapeutic improvement by addressing six major domains: 1) mitigation of shame; 2) integration of split off affects and defenses; 3) achievement of greater intimacy and/or capacity to play; 4) confrontation of the tendency to spoil forward movement and self-sabotage; 5) identification with benign introjects and amelioration of a primitive, highly punitive superego; and 6) recognition and confrontation of denial of death. By describing the benefits of longer-term work with eating disorder patients, the authors hope to encourage others to expand the knowledge base of what constitutes therapeutic improvement and resilience, leading to lives that that are fuller, more creative, and productive.