Predictors and Influence of Goal Orientation on Self-Management and Health-Related Quality of Life after Lung Transplant

Abstract

Context Lung transplant recipients are encouraged to perform self-management behaviors to maximize health outcomes; however, performance is often less than ideal. Goal orientation is known to influence achievement of academic goals, but the influence of goal orientation on performance of self-management is unknown. Objectives To identify characteristics at transplant that are predictive of higher goal orientation and examine relationships between Goal Orientation Index (GOI) subscores (Acting, Planning, Reflecting), self-management behaviors (adhering, self-monitoring, and communicating critical changes), and health-related quality of life (HRQOL) at 1 year after transplant. Design A descriptive, secondary analysis of data from 33 lung transplant recipients who were assessed at transplant and followed for 1 year as part of a clinical trial. GOI subscores were dichotomized at the median to categorize recipients with high and low goal orientation. Logistic regression was used to identify predictors of higher GOI subscores. Correlations between higher GOI subscores, self-management, and HRQOL were examined. Results Lung transplant recipients reported relatively high mean GOI subscores (Acting, Planning, and Reflecting) and the 3 subscores were correlated (r=0.31–0.86). Self-care agency was the only significant predictor (P=.04) of higher GOI (Reflecting). Lung transplant recipients with higher Planning and Reflecting subscores were more likely to adhere (r=0.36 and 0.46, respectively). Recipients with higher GOI subscores reported significantly better mental HRQOL (r=0.42–0.36). Recipients with higher GOI Planning or Acting subscores reported significantly less anxiety (r=−0.39–0.46) and fewer depressive symptoms (r=−0.40–0.43). Conclusion Assessing goal orientation may offer a novel approach for promoting adherence and HRQOL after lung transplant.

Diary for self‐observation: A self‐management tool for recipients of lung transplantation—A pilot study

“…Patients who have had lung transplantation are encouraged to perform self‐management behaviours to maximize health outcomes. A study found that goal orientation as a tool may offer a novel approach for promoting adherence and health‐related quality of life after lung transplant (Zaldonis et al., 2015). This study shows willingness from the recipients of lung transplantation in using a diary and the diary was helpful in monitoring the daily self‐managements.…”

“…Self‐management should be learned and monitored in collaboration with healthcare professionals. This could help ensure that patients react appropriately to self‐management (Zaldonis et al., (2015)). It is important to help and support patients overcoming barriers promoting post‐transplant education (Neyhart, 2008).…”

Elements of Post-Transplant Recovery in Lung Transplant Recipients: A Scoping Review

“…The post-discharge phase emerges as the most extended period of recovery that patients encounter, with care for lung transplant recipients (LTRs) increasingly shifting from acute in-hospital care to home-based care (Lundmark, Erlandsson, et al, 2016). Moreover, LTRs are now perceived as individuals with chronic illnesses, necessitating adaptation and management of intricate self-care tasks to mitigate complications such as graft rejection or infection and sustain graft function (Rosenberger et al, 2017; Zaldonis et al, 2015). To empower LTRs to actively participate in their own recovery, continual support, particularly during home-based care, is imperative (Lundmark, Lennerling, et al, 2016).…”

Lung transplant recipients’ experiences of and attitudes towards self-management: a qualitative systematic review protocol

“…7 Lung transplant recipients are increasingly regarded as chronically ill patients 6 who need to adapt to and follow complex self-management tasks 8 to prevent complications, such as graft rejection or infections, and to enable the patient to keep the transplanted graft as long as possible. 9 This paradigmatic shift from short to long-term care of lung transplant recipients has resulted in the application of chronic illness management strategies that aim to foster lung transplant recipients' self-management. 10 Self-management, in this regard, can be defined as an: "individual's ability to manage the symptoms, treatment, physical and psychological consequences and life style changes inherent in living with a chronic condition".…”

“…16,17 However, research has also shown that self-management is insufficient in many aspects. 9,10,[18][19][20][21] Of these self-management aspects, medication adherence has been studied most extensively with up to 72% of lung transplant recipients displaying some extent of medication non-adherence at some time. 10,22 Suboptimal implementation of transplant-related self-management is also reported in other selfmanagement tasks including infrequent use of self-monitoring of lung function.…”