Stress, coping and adherence to immunosuppressive medications in kidney transplantation: a comparative study

Abstract

CONTEXT AND OBJECTIVE: Adherence to medication is a key issue relating to outcomes from transplantation and it is influenced by several factors, such as stress and coping strategies. However, these factors have been poorly explored. We aimed to compare stress and coping strategies between adherent and nonadherent renal transplant recipients who were receiving immunosuppression. DESIGN AND SETTING:We conducted a comparative, cross-sectional and observational study at a university-based transplantation clinic in Juiz de Fora, Brazil. METHODS: Fifty patients were recruited and classified as adherent or nonadherent following administration of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Stress was evaluated using the Lipp Stress Symptom Inventory for Adults and coping strategies were assessed using the Ways of Coping Scale. RESULTS: The study included 25 nonadherent patients and 25 controls with a mean age of 44.1 ± 12.8 years and median post-transplantation time of 71.8 months. Stress was present in 50% of the patients. Through simple logistic regression, nonadherence was correlated with palliative coping (OR 3.4; CI: 1.02-11.47; P < 0.05) and had a marginal trend toward significance with more advanced phases of stress (OR 4.7; CI: 0.99-22.51; P = 0.053). CONCLUSION: Stress and coping strategies may have implications for understanding and managing nonadherent behavior among transplantation patients and should be considered among the strategies for reducing nonadherence. RESUMO

Mensuração da adesão aos medicamentos imunossupressores em receptores de transplante renal

“…And if that was not enough, there are some reports showing that these are the most non-compliant among all recipients. (16) Inversely, a more simple immunosuppressant therapy in relation to both number of drugs and prescribed dose per day can increase the chances of better adherence. (3) A recent study (27) did not find a significant correlation between levels of creatinine and patient age at KTP, time after KTP, time of separation of immunosuppressant drugs, and total score of BAASIS® items.…”

“…In this way, it is essential to develop educational strategies to reduce non-adherence. (15)(16)(17)(18) In randomized prospective study of incident renal transplant recipients, aimed to assess the impact of an educational/counseling program highlighting the importance of immunosuppressive medications and compliance, on treatment adherence after kidney transplantation. The non-adherence rates were 46.4 and 14.5 % in the control and treatment groups (p = 0.001), respectively.…”

Avaliação do conhecimento dos candidatos a transplante de fígado

“…Os conhecimentos sobre a doença e tratamento são passíveis de influenciar e ser influenciados por estas crenças comprometendo igualmente a adaptação à doença. [9][10] Os dados foram armazenados em planilha eletrônica para análise estatística no software Statistical Package for the Social Sciences (SPSS ® ). Os dados foram apresentados de forma descritiva; as variáveis categóricas foram expressas em frequências absolutas e relativas e as variáveis numéricas, medidas-resumo (média, quartis, mínimo, máximo e desvio padrão).…”

Non-adherence to immunosuppressants following renal transplantation: a protocol for a systematic review

“… 17 In addition, non-adherent patients have a greater symptom burden, higher distress levels 19 and report higher frequency of stress. 20 Hence, renal transplant recipients may require a range of supports to help them maintain a lifestyle associated with their health status. A recent systematic review evaluated interventions to improve medication adherence in adult renal transplant patients, 21 suggesting that those targeting behavioural risk factors or multidimensional interventions 22 23 combining educational, behavioural and emotional factors are more likely to be effective in improving non-adherence to medication.…”