Implementation of a Psychological Screener in Pediatric Kidney and Heart Transplant Clinics
Gillian Mayersohn1,3, Angela Lee3, Neeta Vachharajani3, Kristen Jasper2, Stephanie Esses2, Kathleen Hurley2.
1Psychology, St. Louis Children's Hospital, St. Louis, MO, United States; 2Transplant, St. Louis Children's Hospital, St. Louis, MO, United States; 3Washington University School of Medicine, St. Louis, MO, United States
Literature examining the emotional challenges pediatric solid organ transplant (SOT) patients face is limited. However, existent literature highlights the difficulties SOT patients deal with both pre- and post-transplant including, but not limited to, anxiety, posttraumatic stress, depression, adjustment to medications, and learning problems1, 4, 7, 8. Additionally, literature has begun to elucidate a relationship between poor emotional functioning and higher rates of non-adherence5. Despite these findings, there is limited literature about utilizing comprehensive psychological screeners in pre- and post-SOT patients. While there does not appear to be literature on the use of Patient-Reported Outcome Measurement Information System (PROMIS) in pediatric SOT, there has been literature on the use of PROMIS with other pediatric chronic illness populations2, 6. PROMIS is becoming a standard tool used in assessing patient reported outcomes as it is ideal for measuring child self-reported health efficiently and precisely3. The objective of this study was to examine descriptive results of PROMIS questionnaires administered during outpatient solid organ transplant clinics, as well as demographic data of patients and caregivers.
During regular clinic visits, patients and caregivers were given an iPad to complete the screener. Caregivers included those of patients 5 and up who were English-speaking. Patients who completed self-reports were 8 and up, English-speaking, and cognitively able to complete the screener independently. Measures included: PROMIS Parent-Proxy and Pediatric Self-Report of Anxiety, Depression, and Psychological Stress. For patients over 18, there was no PROMIS Psychological Stress.
204 caregivers and 176 patients completed the screener between October 2019 and August 2021. 59 (33.5%) patients and 80 (39%) caregivers scored above the cut-off. Additional demographics are in figure 1 below. Data revealed that the duration it took to complete the screener ranged from 1 to 6 minutes depending upon the version administered.
Overall, results showed the screener was efficient to use in a busy outpatient SOT clinic. Given the low number of scores falling above the cut-off, further discussion about changing the cut-off is warranted. It may be that SOT patients and caregivers have a higher distress tolerance regarding psychological functioning symptoms and therefore rate symptoms as lower. Lowering the cut-off to 1 SD (vs 1.5 SD) above the mean may better capture patients who need psychological services. Additionally, further evaluation of the workflow leading to psychology or neuropsychology referrals is needed to ensure that the proper referrals are being placed. Future research should examine correlations among demographics, non-adherence, immunosuppressant medication levels, and screener results.
* Note: Given that the screener will continue to be administered between submission of abstract and IPTA, the data will be re-analyzed and updated.
[1] Annuniato, R. A., Jerson, B., Seidel, J., & Glenwick. D. S. (2012). The psychosocial challenges of solid organ transplant recipients during childhood. Pediatric Transplantation, 16, 803-811.
[2] Bevans K. B., Riley A. W., Landgraf J. M,, Carle A. C., Teneralli R. E., Fiese B. H., . . . Forrest, C. B. (2017). Children's family experiences: Development of the PROMIS pediatric family relationships measures. Qual Life Res, 26 (11), 3011-3023.
[3] DeWalt, D. A., Gross, H. E., Gipson, D. S., Selewski, D. T., DeWitt, E. S., Dampier, C. D., . . . Varni, J. W., (2015). PROMIS pediatric self report scales distringush subgroups of children within and across six common pediatric chronic health conditions. Qual Life Res, 24(9), 2195-2208.
[4] Forrest C. B, Bevans, K. B., Tucker, C., Riley, A. W., Ravens-Sieberer, U., Gardner, W., & Pajer, K., (2012). Commentary: the patient-reported outcome measurement information system (PROMIS®) for children and youth: application to pediatric psychology. Journal of Pediatric Psychology, 37(6), 614-621. McCormick, A. D., Schumacher, K. R., Zamberlan, M., Uzark, K., Yu, S., Lowery, R., Rottach, N., & Cousino, M. K. (2020). Generalized and specific anxiety in adolescents following heart transplant. Pediatric Transplantation, 20, 1-8.
[5] McCormick King, M. L., Mee, L., L., Gutierrez-Colina, A. M., Eaton, C. K., Lee, J. L., & Blount, R. L. (2014). Emotional functioning, barriers, and medication adherence in pediatric transplant recipients. Journal of Pediatric Psychology, 39(3), 283-293.
[6] Reeve, B. B., McFatrich, M., Mack, J. W., Pinheiro, L. C., Jacobs, S. S., Baker, J. N., . . . Hinds, P. S. (2020) Expanding construct validity of established and new PROMIS Pediatric measures for children and adolescents receiving cancer treatment. Pediatric Blood Cancer, 67(4):e28160.
[7] Stuber, M. L. (2010). Psychiatric issues in pediatric organ transplantation. Child Adolesc Psychiatr Clin N Am, 19(2), 285-300.
[8] Wu, Y. P., Aylward, B. S., Steele, R. G., Maikranz, J. M., & Dreyer, M. L. (2008). Psychosocial functioning of pediatric renal and liver transplant recipients. Pediatric Transplantation, 2, 582-587.