Liver transplant recipients’ experiences and perspectives of a telehealth-delivered lifestyle programme: A qualitative study

Abstract

Introduction Dietary modification and exercise are encouraged to address cardiometabolic risk factors after solid organ transplantation. However, the lived experience of attempting positive lifestyle changes for liver transplant recipients is not known. The aim of this study was to explore the experiences of liver transplant recipients and their perspectives of a 12-week telehealth lifestyle programme and assess the feasibility of this innovative health service. Methods Focus groups and one-on-one interviews were conducted with participants who had completed a 12-week, group-based, telehealth-delivered diet and exercise programme and thematic qualitative analysis was used to code and theme the data. Results In total, 19 liver transplant recipients participated in the study (25–68 years, median time since transplant 4.4 years, 63% male). Overarching themes included: (a) ‘broad telehealth advantages' which highlighted that telehealth reduced the perceived burdens of face-to-face care; (b) ‘impact of employment' which identified employment as a competing priority and appeared to effect involvement with the programme; (c) ‘adapting Mediterranean eating pattern to meet individual needs' which identified the adaptability of the Mediterranean diet supported by sessions with the dietitian; (d) ‘increasing exercise confidence' which recognised that a tailored approach facilitated confidence and acceptability of the exercise component of the programme. Discussion A telehealth lifestyle programme delivered by dietitians and exercise physiologists is an acceptable alternative to face-to-face care that can meet the needs of liver transplant recipients. There is a need to further innovate and broaden the scope of routine service delivery beyond face-to-face consultations.

Telehealth-delivered, Cardioprotective Diet and Exercise Program for Liver Transplant Recipients: A Randomized Feasibility Study

“…Adopting a MedDiet outside of the Mediterranean region has its challenges, 30 - 33 but with appropriate support, we found the MedDiet was an acceptable strategy to improve diet quality in an Australian liver transplant population. 34 The acceptability of the MedDiet pattern in Western societies and to what degree of adherence to “traditional” MedDiet principles is necessary for clinical effect is an ongoing scientific debate. 35 Nonetheless, with increasing clinical interest in shifting dietetic services to facilitate more cardioprotective diet patterns in liver clinics, 36 considerations of multicultural patient groups are a welcome development to better translate the evidence for MedDiet effectiveness for those living outside of the Mediterranean.…”

“… 56 In addition, qualitative analysis from participants indicated that the cost savings to patients through reduced travel time and lost work hours associated with face-to-face appointments were highly valued. 34 Experience with rapid disruptions to telehealth delivery of care during the COVID-19 pandemic 57 is likely to drive demand for this transition for many services.…”

“… 5 We were able to demonstrate clinical benefit with greater convenience and no perceptible increase in cost for LTRs, without sacrificing the rapport and trust that comes from engaging with a specialist center. 34 Inclusion of LTRs from regional and metropolitan areas captured the feasibility of telehealth connections across a range of locations. Recent experiences with Covid-19 disruptions to service delivery reflected the experience of this study whereby the cost of or access to technology is rarely a barrier to engaging with telehealth, however reliable and strong internet connection can at times be an issue for rural communities in Australia.…”

eHealth in transplantation

“…An important aspect is the willingness of patients to implement apps or eHealth solutions into their lives, independent of the usability, whereby the general acceptance for medical adherence apps is high [31,52,55]. The integration of social backing systems such as friends and family as well as patient priorities (daily schedule, sports, work) is important to support adherence to an app [62]. The use of a self‐managing app can improve the systolic blood pressure over time only by better self‐awareness [45].…”

“…Transplant centers have a large catchment area resulting in long travel distances for patients. Therefore, telemedicine concepts with web‐based platforms [40,41], mobile smartphone apps [29,44,61,64], videoconferencing [43,62,65,66], chat [42,61,67], remote vital sign monitoring [32,38,48,61], or various of those combinations [68,69] are well suited for transplantation follow‐up. However, the added benefit of new telemedicine concepts compared to standard care after transplantation must be demonstrated in order to justify the use of additional costs.…”