Health related quality of life and coping in liver transplant recipients

Abstract

Health related quality of life (HRQOL) and coping after liver transplantation (LTX) is the result from different factors, which are not clearly defined.Aim: The aim of this thesis was to explore health related quality of life, coping style and coping strategies before as well as after liver transplantation.Methods: Both an inductive and deductive approach has been used and the research methods were both quantitative and qualitative. The study group consisted of 1) 120 liver transplant recipients 2) 76 patients that had undergone heart-, kidney- or liver transplantation 3) 12 patients liver transplant recipients surviving 12 months and 4) 21 liver transplant recipients. The instruments used for data collection were SF-36, HAD-scale, the Pain-O-Meter, the Jalowiec Coping Scale (JCS-40) and Sense of Coherence-scale. Data were collected 1996-1999. Analysis of the data was performed mainly by descriptive and non-parametrical statistic methods (Mann-Whitney U, Kruskal-Wallis, Monotonic Agreement) and by qualitive phenomenological method according to Karlsson.Results: The results showed that liver transplant recipients reported HRQOL equal to a Swedish normative sample in the area of social functioning and mental health. However physical functioning was impaired many years after LTX. There were a significant difference in HRQOL between employed/students and patients on disability pension, retired or unemployed. Pain was a strong obstacle to reach HRQOL. Pain was prevalent after liver- and kidney transplantation as well as in the heart transplant group in patients with good graft function. The most common pain locations were hands, feet and back with often more than one pain location. It limited physical function, vitality and general health. There was a positive relationship between number of rejections and total pain intensity score. The patients experienced LTX as a process of adaptation from "facing the inevitable" to "honouring the donor". After LTX the patients were supposed to recapture a broken body and handle various stages of emotional chaos. To leave the experts were considered to be stressful and family and friends were important support. The meaning of LTX was to live by the threat of rejection and trying to find an identity beyond the results of the liver tests. In a longitudinal perspective confrontative coping were the most common coping strategy. The sense of meaning changed individually during the first 3 postoperative months as well as 6-12 months after surgery. During the second half postoperative year sense of comprehensibility changed at an individual level as well as the ability to confront stressful events. Conclusion: The overall HRQOL was good after liver transplantation, with a low prevalence of anxiety and depression. Pain was a common problem among patients with good graft function. The meaning of liver transplantation was a process of adaptation and finding an identity beyond the results of the liver tests. Confrontative coping was the most common strategy used in this group. Structured pain assessment, patient education and psychosocial support programme are important interventions to meet the results in this thesis.