RESUMO
BACKGROUND: Alcoholic liver disease (ALD) due to alcohol use disorder (AUD) is the primary cause of liver transplantation (LT) in the United States. Studies have found that LT recipients experience a range of physical and emotional difficulties posttransplantation including return to alcohol use, depression, and anxiety. The aim of this study is to better understand the experiences of LT recipients with ALD because they recovered posttransplant to inform the development of a patient-centered intervention to assist patients during recovery. METHODS: Using qualitative methods, researchers conducted semi-structured interviews with 16 ALD LT recipients. The primary topics of the interview were physical recovery, mental health, substance use including alcohol and tobacco use, and financial experiences. Common patient themes were identified and coded. RESULTS: Within the domain of physical health, patients stressed that undergoing LT was a near-death experience, they were helpless, changes in weight influenced their perception of their illness, and they have ongoing medical problems. In the domain of mental health, patients described cognitive impairments during their initial recovery, difficulty in processing the emotions of having a terminal condition, ongoing depression, anxiety, and irritability. The patients also described their perception of having AUD, the last time they used alcohol and their attitude to AUD treatment posttransplant. Patients also described their reliance on one member of their social support network for practical assistance during their recovery and identified one member of their medical team as being of particular importance in providing emotional as well as medical support during recovery. CONCLUSIONS: The patient's description of their lived experience during the months following transplant informed the development of a patient-centered intervention that colocates behavioral health components with medical treatment that helps broaden their social network while addressing topics that emerged from this study.
RESUMO
BACKGROUND: Quality of care provided by hospice and palliative care agencies depends on a thorough understanding of the patient, the family, their history, and current risk factors. It is therefore imperative for social workers and other providers in these settings to assess patients and caregivers for substance use disorders and potential for substance misuse. OBJECTIVE: We aimed to examine how hospice social workers in the United States screen and assess for alcohol and substance use and risk of medication diversion among patients and family caregivers. DESIGN/MEASUREMENTS: Using a cluster random sample of U.S. Medicare-certified hospices, we reviewed blank copies of psychosocial assessments used by hospice social workers from 105 agencies. We conducted systematic content analyses of these assessments, identifying and examining all items related to substance use or addiction. RESULTS: Over two-thirds (68%) of agencies assessed substance use by patient and/or family members. Assessments tended to focus broadly on whether substance misuse was a current problem for the patient or his/her primary caregivers. Assessments were not standardized instruments and did not differentiate between drug types. No assessments directly addressed potential diversion of pain medications. Larger hospices serving more patients per day were more likely to include substance use content in their assessments. CONCLUSIONS: We recommend that hospice care providers implement structured substance use screening focused on both the patients and family. To stem the public health impact of prescription opioid misuse, we recommend adoption of structured screening instruments to evaluate drug diversion risk.