The importance of social support in organ transplantation outcomes
Tuesday, October 15, 2013
Epidemiological studies have linked poor social support to negative health outcomes and higher mortality rates across a multitude of medical conditions. Social support appears to result in more positive biological profiles, and recent research on immune-mediated inflammatory processes shows how integrative physiological mechanisms directly link social support to physical health.
In addition to the influence of social support on general medical outcomes, this asset has been shown to be a key variable in organ transplant success. In a multisite, prospective study conducted with 318 heart transplant candidates, Spaderna and colleagues reported findings that regardless of disease severity, socially isolated heart transplant candidates who were also depressed were at increased risk for both clinical deterioration and mortality.
Another study linked poor social support following a liver transplant to greater likelihood of post-transplant mortality. There is evidence to suggest that children who receive an organ transplant may actually require more social support than average in order to achieve the same adult professional and educational success as their peers. Additionally, social support has been shown as a key predictor in immunosuppressive therapy adherence post-transplant.
Given the clear association between social support and transplant outcomes, preoperational assessment of this variable may be warranted. In 2012, The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) was introduced. This standardized tool for psychosocial evaluation of pretransplant candidates replaces the following tools: The Psychosocial Assessment of Candidates for Transplantation, The Psychosocial Levels System, and The Transplant Evaluation Rating Scale.
The SIPAT provides a non-organ specific, standardized means of assessing psychosocial variables important in predicting post-transplant behavior, with an emphasis on social support. A copy of the measure may be found here.
Additional consideration should also be given to post-transplant social support resources and interventions. Patients could be educated on the availability of social support groups in their community prior to discharge. This social support may include hospital-based support groups, local support groups, telephone networking, Internet support groups and chat forums, and events or seminars run by professional organizations.
Patients may also increase social support by creating a CaringBridge personal website to update loved ones on social needs and psychosocial challenges. The Support Planner function of this site helps family and friends coordinate care and organize helpful tasks, like bringing a meal, going out for coffee, taking care of pets and other needs.
Finally, complex patients may benefit from being assigned to a social worker who is able to monitor functional status and progress over longer periods of time.
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