Adaptation and validation of an abbreviated version of the SIPAT integrated psychosocial risk scale in patients with liver cirrhosis candidates for liver transplantation (SIPAT-11). / Adaptación y validación de una versión abreviada de la escala SIPAT de riesgo psicosocial integrado en pacientes con cirrosis hepática candidatos a trasplante hepático (SIPAT-11).

INTRODUCTION: Patients with liver cirrhosis who are candidates for liver transplantation must be evaluated both clinically and socially in order to obtain the optimal outcomes and avoid futile therapeutic measures. For the evaluation of the social aspects in these patients, no validated scale in Spanish is available. The SIPAT (Stanford Integrated Psychosocial Assessment for Transplantation) scale is an instrument that measures the social, family and psychological aspects in candidates for solid organ transplantation. The objective of this study is to adapt and validate an abbreviated version of the SIPAT scale in Spanish for patients with liver cirrhosis. MATERIAL AND METHODS: Prospective observational study carried out in the Hepatology Unit of the La Fe Unversity Hospital in Valencia, by questionnaire validation methodology. To analyze the reliability of the questionnaire, the internal consistency of all variables was calculated, for variability an exploratory factor analysis, and for stability the test-retest test was carried out. RESULTS: 96 patients who were admitted for decompensated cirrhosis to the Hepatology Unit of the La Fe Hospital in Valencia between November 1, 2017 and January 31, 2017 were selected. 84% were men, the mean age was 60.01 (SD 10.12) years. In 73.2% of those admitted, the etiology of cirrhosis was alcoholic. 14.4% had a Child's stage A, 57.7% B and 27.8% C. The internal consistency of all variables reached a Cronbach's Alpha of 0.766. In the exploratory factor analysis, 6 dimensions of the questionnaire were identified that explain 84.27% of the total variability. To see the stability of the instrument, the measurement was repeated at 2 and 6 months of follow-up, obtaining in the test-retest a kappa agreement of 0.612 and 0.565 respectively. CONCLUSION: The SIPAT-11 questionnaire has good psychometric characteristics in cirrhotic patients who are candidates for liver transplantation. It is easy to complete and can be administered by professionals who are not specialists in the area of Mental Health.

Systematic Review of the Evaluation of Foster Care Programs.

OBJETIVE: The aim of this study was to conduct an exhaustive synthesis to determine which instruments and variables are most appropriate to evaluate foster care programs (foster, kinship, and professional families). This evaluation includes the children, their foster families, their families of origin, professionals, and foster care technicians. METHOD: The systematic review included randomized, quasi-randomized, longitudinal, and control group studies aimed at evaluating foster care interventions. RESULTS: A total of 86 studies, 138 assessment instruments, 18 constructs, and 73 independent research teams were identified. CONCLUSIONS: (1) although the object of the evaluations was the children, the informants were usually the people in charge of their care; therefore, effort should be made to involve the children in a more participatory way; (2) psychosocial functioning, behavior, and parenting are transversal elements in most evaluations, while quality of life and coping are not sufficiently well incorporated; (3) practical instruments (brief and easy to apply and correct) that are widely used and carry scientific guarantees should be prioritized to ensure the comparability and reliability of the conclusions; and (4) progress should be made in the study of evaluation models for all forms of foster care, including foster, extended, and specialized families.

OBJETIVO: El objetivo es realizar una síntesis exhaustiva que contribuya a determinar qué instrumentos y variables son las más adecuadas para evaluar programas de acogimiento familiar (familias extensas, ajenas y profesionalizadas), incluyendo en esta evaluación a los niños, sus familias acogedoras, sus familias de origen y a los profesionales y técnicos del acogimiento familiar. Método: La revisión sistemática incluyó estudios aleatorizados, cuasialeatorizados, longitudinales y con grupo control dirigidos a evaluar intervenciones de acogimiento familiar. RESULTADOS: Se identificaron 86 estudios, 138 instrumentos de evaluación, 18 constructos y 73 equipos de investigación independientes. CONCLUSIONES: (1) aunque el objeto de las evaluaciones sean los niños, habitualmente los informantes son las personas a cargo de sus cuidados, con lo que se debe hacer un esfuerzo por involucrarlos de forma más participativa; (2) el funcionamiento psicosocial, el comportamiento o la parentalidad son elementos transversales en la mayor parte de evaluaciones, sin embargo la calidad de vida y el afrontamiento no están suficientemente bien incorporados; (3) deben priorizarse instrumentos prácticos (breves y fáciles de aplicar y corregir), de amplio uso y con garantías científicas para asegurar la comparabilidad y fiabilidad de las conclusiones; (4) debe avanzarse en la investigación de modelos de evaluación en todas las modalidades de acogimiento familiar, ya sea en familias ajenas, extensas o especializadas.

A semi-structured interview is associated with bariatric surgery outcomes.

Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (𝛽 = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (𝛽 = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (𝛽 = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.

Social Support: From Exclusion Criteria to Medical Service.

One of the criteria used by many transplant centers in assessing psychosocial eligibility for solid organ transplantation is social support. Yet, social support is a highly controversial requirement that has generated ongoing debate between ethicists and clinicians who favor its consideration (i.e., utility maximizers) and those who object to its use on equity grounds (i.e., equity maximizers). The assumption underlying both of these approaches is that social support is not a commodity that can be purchased in the marketplace. This essay argues for the reconceptualization of social support as a product that can-and should-be purchased for transplant candidates to render them eligible for transplant.

[Allogeneic hematopoietic stem cell transplantation and treatment with CAR-T cells - identification of psycho-social vulnerability factors: Guidelines from the Francophone Society of Bone Marrow Transplantation and Cellular Therapy (SFGM-TC)]. / Allogreffe de cellules souches hématopoïétiques et traitement par CAR-T cells ­ repérage des facteurs de vulnérabilité psycho-sociale : recommandations de la Société francophone de greffe de moelle et de thérapie cellulaire (SFGM-TC).

Allogeneic hematopoietic stem cell transplantation (HCT) and CAR-T cells therapy are treatments with curative aim for certain hematological malignancies, refractory or relapse. Nevertheless, they carry the risk of morbidity and mortality and may have a significant psychosocial impact, particularly for HCT. It is therefore necessary to identify psychological difficulties and social problems, as well as the patient's resources, and those of his entourage, in order to improve his overall management. The objective of this evaluation is not to pose contraindications to treatments, but to adapt the personalized care project. This identification must be carried out early on in the pre-HCT assessment journey to enable the implementation of appropriate actions by the various care providers. Based on a review of the literature, we designed a psychosocial data collection grid that can be initiated in pre-transplant and updated by accompanying the patient at each stage of follow-up (discharge from hospital, day-hospital follow-up, D100 evaluation). This grid is divided into 3 axes: socio-family context, psychological and somatic aspects. This tool allows the traceability of the interventions of different professionals and is a support for multidisciplinary exchanges.

Psychosocial factors impacting antegrade continence enema outcomes in pediatric patients.

BACKGROUND: Children with constipation and encopresis are often treated with medication and behavioral approaches. When constipation persists, surgical interventions such as antegrade continence enema (ACE) procedures are considered. Many children benefit from these procedures; however, some children continue to have incontinence, experience complications, or discontinue the use of the ACE stoma. There is some evidence in the literature to indicate that psychosocial factors can have an impact on ACE outcomes; however, standardized biopsychosocial guidelines related to ACE candidacy and surgery do not currently exist. PURPOSE: The purpose of this review is to summarize the research to date on psychosocial factors related to ACE treatment outcomes and complications. Identifying what is known and what limitations remain can support future research to inform development of guidelines for pre-procedure evaluations. Psychosocial pre-procedure evaluations could help to inform eligibility for the procedure as well as interventions to enhance outcomes for children at increased risk for poor outcomes or complications from ACE. Age, psychiatric symptoms, and adherence to the ACE flush regimen were some of the factors identified in the literature as impacting ACE outcomes; however, there is limited research in this area.

Racial and ethnic disparities in psychosocial evaluation and liver transplant waitlisting.

Health disparities have been well-described in all stages of the liver transplantation (LT) process. Using data from psychosocial evaluations and the Stanford Integrated Psychosocial Assessment, our objective was to investigate potential racial and ethnic inequities in overall LT waitlisting and not waitlisting for medical or psychosocial reasons. In a cohort of 2271 candidates evaluated for LT from 2014 to 2021 and with 1-8 years of follow-up, no significant associations were noted between race/ethnicity and overall waitlisting and not waitlisting for medical reasons. However, compared with White race, Black race (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.07-2.56) and Hispanic/Latinx ethnicity (OR, 2.10; 95% CI, 1.16-3.78) were associated with not waitlisting for psychosocial reasons. After adjusting for sociodemographic variables, the relationship persisted in both populations: Black (OR, 1.95; 95% CI, 1.12-3.38) and Hispanic/Latinx (OR, 2.29; 95% CI, 1.08-4.86) (reference group, White). High-risk Stanford Integrated Psychosocial Assessment scores were more prevalent in Black and Hispanic/Latinx patients, likely reflecting upstream factors and structural racism. Health systems and LT centers should design programs to combat these disparities and improve equity in access to LT.

Interitem Psychometric Validation of the Stanford Integrated Assessment for Transplant Scale Among Thoracic Transplant Candidates.

BACKGROUND: Psychosocial evaluations are mandatory for transplant listing, however the methodology for creating psychosocial risk stratifications is unclear. The Standford Psychosocial Integrated Psychosocial Assessment for Transplant Scale is the most commonly used instrument, however its interitem validity has never been examined. OBJECTIVE: To investigate the interitem validity of a psychosocial assessment tool for transplant candidates among a sample of thoracic transplant candidates. METHODS: Clinic data consisting of Stanford Integrated Psychosocial Assessment for Transplant administrations from 173 heart and lung transplant candidates were fit to a partial credit model. Data were subsequently fit to 4 separate partial credit models based on subscale categories, demonstrating the discrimination parameter estimate of each item. Differential item functioning analyses were conducted on the data within each subscale by sex to investigate potential bias produced by each item. RESULTS: The initial partial credit model using the full scale did not converge, indicating the subscales possibly did not measure the same underlying construct. Subscale discrimination parameter estimates demonstrated that most items were adequately or highly discriminative. The item measuring history of substance use demonstrated poor fit and differential item functioning. CONCLUSIONS: While the Stanford Integrated Psychosocial Assessment for Transplant has demonstrated strong potential as a standardized framework for psychosocial assessments in transplant, this study identified some areas for improvement in the scoring system. The subscale scores appeared to show greater construct validity when utilized individually than when aggregated to form a total score. The substance use/abuse/dependence item did not fit well into its respective subscale. Future studies should aim to optimize the scoring system and re-asses its construct validity to improve its accuracy in discriminating between high-risk candidates and those needing psychosocial assistance.

Psychosocial Aspects of Metabolic and Bariatric Surgeries and Endoscopic Therapies.

Obesity is a prevalent progressive and relapsing disease for which there are several levels of intervention, including metabolic and bariatric surgery (MBS) and now endoscopic bariatric and metabolic therapies (EBMTs). Preoperative psychological assessment focused on cognitive status, psychiatric symptoms, eating disorders, social support, and substance use is useful in optimizing patient outcomes and minimizing risks in MBS. Very little is known about the psychosocial needs of patients seeking EBMTs, though these investigations will be forthcoming if these therapies become more widespread. As MBS and EBMT inherently alter the gastrointestinal (GI) tract, considerations for the longer-term GI functioning of the patient are relevant and should be considered and monitored.

Restriction of range effects in post-metabolic and bariatric surgery outcomes research: considerations for clinical decision making.

BACKGROUND: Preoperative psychopathology does not consistently predict postoperative outcomes in patients who undergo metabolic and bariatric surgery (MBS). Individuals with elevated pre-MBS psychopathology may be less likely to undergo surgery, which may create a floor effect given the limited range of scores on measures of psychopathology included in postoperative analyses, thereby decreasing the power to detect clinically significant differences between groups. OBJECTIVES: Our objective was to compare rates of clinically significant pre-MBS psychopathology across domains of functioning in patients who did and did not undergo MBS: surgical completers (SCs, n = 286) and nonsurgical completers (NSCs, n = 125). SETTING: Academic medical center, United States. METHODS: Participants (n = 411) were a racially diverse sample of MBS candidates who completed a preoperative psychosocial evaluation including measures of disordered eating, alcohol and tobacco use, pain catastrophizing, anxiety, and depressive symptomatology. RESULTS: Compared with SCs, NSCs had larger scale score variance on measures of psychopathology and were more likely to be Black; to report clinically significant scores on measures of binge eating, depression, anxiety, and pain catastrophizing; and to use tobacco. CONCLUSION: Results support the presence of a restriction-of-range effect but do not demonstrate a floor effect. These data suggest that current outcome data for MBS patients may not generalize to those who report clinically significant psychopathology at the pre-MBS psychosocial evaluation and may warrant caution when using the current literature to inform clinical decision making for this group. Findings also suggest a need for interventions that will better engage Black patients.

Recommendations for Psychosocial Evaluation of VAD candidates: Adoption, completion, and barriers to implementation.

BACKGROUND: Recommendations exist to guide clinicians on a comprehensive psychosocial (PS) evaluation prior to Mechanical Circulatory Support (MCS) implantation. OBJECTIVES: Assess adoption, beliefs, methodologies, and barriers to completion of the 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for Psychosocial evaluation of adult cardiothoracic transplant and long term mechanical circulatory support. METHODS: Cross-sectional survey distributed to all 183 implanting LVAD centers in North America via mail and email. RESULTS: Total of 58 Programs (35.6% response rate) representing 29 states and all regions of the United States responded. Respondents reported implanting 1,183 adults (range 0 - 85; mean = 21.5, SD = 18) in 2018. A majority (n = 55, 94.8%) reported that the 2018 Recommendations were consistent with their clinical practice and most (n = 51, 87.9%) had adopted the recommendations. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) (n = 25, 47.1%) was the most commonly cited assessment tool in the use, although 15 centers reported utilizing more than one tool during the assessment process. Most common barriers influencing completion of the PS evaluation include patient too ill (total responses = 104), lack of time (total responses = 89), patient poor candidate (total responses = 44), and lack of Insurance coverage/reimbursement (total responses = 41). CONCLUSION: The 2018 ISHLT Recommendations for PS evaluation of LVAD Candidates are widely adopted by respondents in clinical practice, although barriers are still reported to their implementation. Additional research is needed to understand strategies to reduce barriers to implementation and maintenance of the recommendations in clinical practice.

Neurocognitive and Psychopathological Predictors of Weight Loss After Bariatric Surgery: A 4-Year Follow-Up Study.

Twenty to thirty percent of patients experience weight regain at mid and long-term follow-up. Impaired cognitive functions are prevalent in people suffering from obesity and in those with binge eating disorder, thereby, affecting the weight-loss outcomes. The aim of our study was to investigate neurocognitive and psychopathological predictors of surgical efficacy in terms of percentage of excess weight loss (%EWL) at follow-up intervals of one year and 4-year. Psychosocial evaluation was completed in a sample of 78 bariatric surgery candidates and included psychometric instruments and a cognitive battery of neuropsychological tests. A schedule of 1-year and 4-year follow-ups was implemented. Wisconsin Sorting Card Test total correct responses, scores on the Raven's Progressive Matrices Test, and age predicted %EWL at, both, early and long-term periods after surgery while the severity of pre-operative binge eating (BED) symptoms were associated with lower %EWL only four years after the operation. Due to the role of pre-operative BED in weight loss maintenance, the affected patients are at risk of suboptimal response requiring ongoing clinical monitoring, and psychological and pharmacological interventions when needed. As a result of our findings and in keeping with the latest guidelines we encourage neuropsychological assessment of bariatric surgery candidates. This data substantiated the rationale of providing rehabilitative interventions tailored to cognitive domains and time specific to the goal of supporting patients in their post-surgical course.

Marijuana use among adult liver transplant candidates and recipients.

BACKGROUND: Data regarding marijuana (MJ) use among liver transplant (LT) candidates are limited. We set out to determine the incidence and pre- and post-LT outcomes of adult LT candidates with a self-reported history of MJ use. METHODS: Baseline clinical characteristics, waitlist, and post-LT outcomes of adult LT candidates from January 2010 to March 2017 were compared. RESULTS: Among 2690 LT candidates, 630(23%) and 298(11%) reported a history of MJ use and use within the past 12 months, respectively. Although the proportion of MJ users increased over time(ß = .76, p = .03), the proportion listed and transplanted did not change. Listing for LT increased with male (OR 1.24, 95% CI 11.01-1.52), MELD score (OR 1.08, 95% CI 1.01-1.15), HCC (OR 1.83, 95% CI 1.39-2.41) but decreased among MJ users (OR 0.67, 95% CI 0.50-0.91, p = .01). The median time to listing was longer among MJ users compared to non-users (115 vs. 87 days, p < .0005). Post-LT survival was similar in 83 MJ users and 306 non-users. CONCLUSION: The proportion of MJ users among LT candidates is increasing. MJ users have a greater burden of psychosocial issues which may contribute to longer evaluations and lower rate of LT listing. Post-LT survival was not impacted by self-reported MJ use history.

Psychosocial evaluation for liver transplantation: A brief guide for gastroenterologists. / Evaluación psicosocial para trasplante hepático: una guía breve para gastroenterólogos.

Liver transplantation is a lifesaving treatment that improves survival and quality of life. The procedure requires adequate transplant candidate selection carried out by a multidisciplinary team. Psychosocial evaluation is a necessary part of recipient selection and its primary aims are to identify problems and psychosocial needs of the patient and his/her family, to improve transplantation outcomes. Different psychosocial conditions are considered risk factors for morbidity and mortality after transplantation. The presence of those factors per se is not an absolute contraindication, thus adequate evaluation promotes equal access to healthcare, improves results, and optimizes resources. The present review provides an overview of and guidelines for the most important psychosocial issues during the pretransplantation phase.

Remote unaffiliated presurgical psychosocial evaluations: a qualitative assessment of the attitudes of ASMBS members.

BACKGROUND: A psychosocial evaluation is an important component of the preoperative assessment process for people seeking metabolic and bariatric surgery (MBS), and is required for accreditation of MBS programs. Recently, independent companies without affiliations with MBS programs have been marketing remotely administered, unaffiliated psychosocial evaluations for MBS (RUS), and American Society for Metabolic and Bariatric Surgery (ASMBS) members have raised concerns about these evaluations. OBJECTIVES: To explore ASMBS members' beliefs about RUS. SETTING: Online survey. METHODS: We developed a survey to evaluate ASMBS members' opinions, experiences, and/or concerns about in-person and RUS psychosocial evaluations for MBS. RESULTS: In total, 635 ASMBS members responded to the online survey and 156 responded to an open-ended question on RUS. Responses were coded based on a manual developed for this study, yielding themes of concerns about the quality of RUS, lack of ongoing relationships in RUS, and conditions under which/reasons why RUS evaluations could be acceptable. CONCLUSION: Respondents expressed both interest in and concerns about RUS in pre-MBS psychosocial evaluations. Use of RUS has the potential to improve access to MBS by providing a convenient and efficient means of completing the psychosocial evaluation. Conversely, respondents expressed concerns about the background and training of RUS providers, the quality of the reports, and the limited relationships between the RUS provider and both the MBS patient and the MBS team. We discuss the clinical and research implications of response themes, particularly for patients in rural areas or those who have other barriers to care.

Exploring the Developmental Impact of Cystic Fibrosis on Lung Transplant Candidacy: Considerations for Adulthood.

The average life expectancy for cystic fibrosis (CF) has increased over the past four decades resulting in a higher rate of adult CF patients. Adults seeking lung transplant to address CF-related advanced lung disease (ALD) represent a small, yet growing, subset of lung transplant recipients. Psychosocial factors such as adherence to medical recommendations, self-management of medical care, and caregiver support have been identified as positive prognostic factors in lung transplant outcomes. These factors are also implicated in the pediatric chronic illness literature and are crucial as patients begin to transition to a more autonomous and independent role in their own health management. Adults with CF facing ALD must navigate through another transitional phase as lung transplant requires additional supports and new expectations. A case series is used to highlight specific psychosocial considerations in this population and to explore the seemingly dichotomous relationship between independent self-management and caregiver support.

The Bariatric Interprofessional Psychosocial Assessment of Suitability Scale predicts binge eating, quality of life and weight regain following bariatric surgery.

Presurgical psychosocial evaluations are an important component of bariatric care; yet, bariatric programs vary widely in their assessment and interpretation of psychosocial risk. There is a need for validated clinical tools that help to standardize and streamline the assessment of variables relevant to surgical outcomes. The present study contributes to the validation of the Bariatric Interprofessional Psychosocial Assessment of Suitability Scale (BIPASS), a novel presurgical psychosocial evaluation tool, by: (a) examining the psychometric properties and optimal cutoff score, and; (b) examining the ability of the BIPASS tool to predict outcomes 1 and 2 years postsurgery, including weight regain, quality of life, psychiatric symptoms and adherence to postsurgical follow-up appointments. The BIPASS was applied retrospectively to the charts of 179 consecutively referred patients to a metropolitan bariatric surgery programme. Internal consistency for the BIPASS was acceptable, and interrater reliability was excellent. Higher BIPASS scores predicted higher binge eating symptomatology and lower mental health-related quality of life at 1 year postsurgery, and weight regain at 2 years (all P < .01). The BIPASS did not predict adherence to postsurgical follow-up appointments. Findings suggest that the BIPASS can be used to identify patients at increased risk of disordered eating, poor quality of life and weight regain early in the postsurgical course, thereby facilitating patient education and appropriate interventions.

Characteristics of Psychosocial Factors in Liver Transplantation Candidates with Alcoholic Liver Disease before Transplantation: A Retrospective Study in a Single Center in Taiwan.

Liver transplantation (LT) is an essential treatment for end-stage alcoholic liver disease (ALD). The patients' psychosocial condition plays a vital role in post-transplantation prognosis. A survey of the candidates' psychosocial wellbeing is necessary before LT. This study aims to investigate the psychosocial characteristics, including the depression degree, family function, alcohol use duration, and alcohol abstinence period, of LT candidates with ALD. In addition, 451 candidates for LT due to ALD were enrolled. They received psychosocial evaluations, including depression scale (Hamilton depression rating scale) and family functioning assessment (adaptability, partnership, growth, affection, resolve (APGAR) index). The test scores were analyzed according to age, alcohol use duration, and alcohol abstinence period. The Hamilton depression rating scale (HAM-D) score and the family APGAR index score differentiated significantly according to the age, alcohol use duration, and abstinence period of the LT candidates. The patients with shorter alcohol use duration tended to have more severe depressive symptoms and poorer family support. The younger patients showed a significantly shorter abstinence period, more severe depression, and poorer family functioning than older patients. The younger ALD patients and patients with shorter alcohol use duration showed an increased severity of depression before transplantation. They need more mental health care over time.