Decision-making experiences regarding kidney transplant among older adults in South Korea: A qualitative descriptive study.

OBJECTIVES: To explore the decision-making experiences of older patients with end-stage renal disease who chose to undergo kidney transplantation. METHODS: This was a qualitative descriptive study.Twelve participants aged over 60 years who underwent kidney transplantation were recruited from a kidney transplant clinic in a hospital in South Korea. Individual in-depth interviews were conducted from March to April 2021. The data were analysed using inductive thematic analysis. RESULTS: Four main themes were identified: 1) hesitation towards complex and risky kidney transplant, 2) internal suffering due to social prejudice and limits, 3) taking a step back from the decision-making process, and 4) being rushed into a decision on the brink of death. CONCLUSION: Older patients with end-stage renal disease experience hesitation and difficulties and are passive in the decision-making process for a kidney transplant. They lacked sufficient relevant information and decided to receive transplant surgery, feeling pressured by the recommendations of family and healthcare providers. PRACTICE IMPLICATIONS: Healthcare professionals should help older patients with end-stage renal disease make proactive decisions by providing tailored education programs and improving communication between the patients and their family members. Changing negative social perceptions and implementing supportive policies are necessary to resolve the difficulties experienced by such patients. PATIENT OR PUBLIC CONTRIBUTION: Patients were involved in the data collection as interview participants in this study.

Cardiovascular risk trajectory and its associated factors among candidates on the waiting list for deceased-donor kidney transplantation: A longitudinal study.

BACKGROUND: Cardiovascular disease is a significant cause of morbidity and mortality for wait-listed kidney transplant candidates. Since cardiovascular risk is related to a variety of factors and may change with time, longitudinal changes in cardiovascular risk and related factors in candidates need to be investigated. OBJECTIVES: This study aimed to examine the trajectory of the cardiovascular risk score and its related factors in patients on the waiting list for deceased-donor kidney transplantation (DDKT). METHODS: This longitudinal study enrolled 144 patients who were registered as candidates for a DDKT at a transplant center in South Korea. During the 5-year follow-up period, 3 candidates on the waiting list were transferred to other hospitals, 19 candidates died, and 31 candidates received kidney transplantation. RESULTS: Approximately 26.6 % of the candidates had a high level of cardiovascular risk, and this increased to 53.2 % after 5 years. A high risk of psychosocial status (ß=0.351, p=.026) was the most significant predictor of cardiovascular risk, followed by higher comorbidity (ß=0.263, p<.001). Comorbidities were a significant factor associated with cardiovascular risk throughout the 5-year period, whereas the duration of dialysis and waiting time were significant only within 1 year after baseline. CONCLUSION: Cardiovascular risk during 5 years on the waiting list for DDKT was associated with multidimensional factors, including psychosocial status before transplantation, comorbidity, waiting time for transplantation, and the duration of dialysis. In addition to managing comorbid conditions, shortening the waiting time and duration of dialysis is important for reducing cardiovascular risk during the long-term care of candidates on the waiting list for DDKT.

Adaptation Process After Kidney Transplantation in Older Adult Recipients: Applied Grounded Theory.

Despite the increase in older adults receiving kidney transplantation (KT), little is known about their experience and adaptation process after KT. The current study aimed to explore the process of adaptation after KT in older adult recipients using a qualitative design and grounded theory methodology. Sixteen recipients who had KT at age ≥60 years and received follow-up care were recruited at a university hospital in South Korea. Data were collected from July to December 2017 through in-depth interviews with individual participants. The core theme of the adaptation process after KT in older adult recipients was A Journey of Straining to Save the Last Lifeline. The adaptation process comprised three stages: confusion, depression, and compromise. Tailored interventions based on the in-depth understanding of the adaptation process found in the current study are needed to improve adaptation after KT in older adult recipients. [Research in Gerontological Nursing, 16(4), 183-193.].

Health Belief Model Constructs Affect Influenza Vaccine Uptake in Kidney Transplant Recipients.

This secondary analysis explored how the constructs of the health belief model affect influenza vaccine uptake in kidney transplant recipients (KTRs). In the parent study, a total of 180 KTRs were recruited at an organ transplant center in South Korea. A nonlinear path analysis using generalized structural equation modeling was performed. Previous influenza vaccination had a direct effect on their behavior, while cues to action alone did not directly affect their behavior. Perceived benefits played a key role as a mediator in improving influenza vaccine uptake in KTRs. This study highlights the need for health professionals to assess perceived benefits at the individual level and provide patient-centered interventions based on a consideration of theoretical mechanisms. As cues to action, recommendations for recipients' first vaccination after kidney transplant should focus on changing patients' perceptions of benefits by emphasizing the positive aspects of the influenza vaccine for immunosuppressed patients.

Influenza vaccine acceptance and health beliefs among Korean kidney transplant patients.

Kidney transplantation (KT) patients are at a higher risk than the general population for influenza virus infection. Although vaccination is primarily recommended for KT patients, little is known about the influenza vaccination rate and related health beliefs in South Korea. The influence of health beliefs on influenza vaccination among KT patients has never been explored. This study aimed to identify influenza vaccine acceptance and association with health beliefs among KT patients. A total of 180 patients who underwent a KT were recruited from an organ transplant center in Korea. Data were collected through structured questionnaires, which were analyzed using descriptive statistics and binary logistic regression. Approximately 47.2% of the participants received influenza vaccination. Previous influenza vaccination, lower perceived barriers, higher perceived benefits, older age, and longer duration after transplantation influenced influenza vaccine acceptance. The results suggest that various strategies are needed for increasing acceptance of influenza vaccination among KT patients. Getting vaccinated for influenza after KT might be crucial for the annual vaccinations. Improving benefits and decreasing barriers perceived by KT patients may contribute to increasing the acceptance. Education on influenza vaccination should be emphasized particularly for young patients under 45 years and up to 10 years after KT.

Waiting for a kidney transplant: the experience of patients with end-stage renal disease in South Korea.

AIMS AND OBJECTIVES: To explore the experiences of Korean patients with end-stage renal disease awaiting kidney transplantation. BACKGROUND: The need for kidney transplantation has increased worldwide, while the number of kidney donors has not increased commensurately. This mismatch is a serious issue in South Korea. Prolonged waits for transplantation may cause physical and psychosocial issues and lead to poor outcomes. Nevertheless, the experience of waiting for kidney transplantation in South Korea has never been explored in depth. DESIGN: A qualitative descriptive design was used. METHODS: The participants were eight patients diagnosed with end-stage renal disease on the waiting list for kidney transplantation in South Korea. Data were collected through individual in-depth interviews. All conversations during interviews were recorded and transcribed verbatim. Transcribed data were analysed using conventional content analysis. RESULTS: The experience of waiting for kidney transplantation consisted of six categories: (1) the light at the end of the tunnel, (2) being on call without any promise, (3) a tough tug of war between excitement and frustration, (4) doubts in the complexity, (5) A companion on the hard journey and (6) getting ready for D-day. CONCLUSIONS: Kidney transplantation candidates experience psychosocial difficulties and concerns while waiting for long periods of time without any assurance of resolution. Systematic education and psychosocial support from health care professionals and family members help patients get through what they describe as a difficult journey. Comprehensive management programs for kidney transplantation candidates are needed. RELEVANCE TO CLINICAL PRACTICE: Health care professionals need to recognise the psychosocial concerns of patients awaiting kidney transplantation. Clinicians should provide patients with information and support throughout the waiting period.