[The "Medication Experience Scale for Immunosuppressants" (MESI): initial results for a new screening instrument in transplant medicine]. / Die "Medikamenten-Erfahrungs-Skala für Immunsuppressiva" (MESI) -- erste Ergebnisse zu einem neuen Screeninginstrument in der Transplantationsmedizin.

BACKGROUND: After an organ transplant, immunosuppressants must be taken on a regular basis to prevent rejection of the transplanted organ. To our knowledge, there have been no studies to date on how transplant recipients experience the effects and side effects of immunosuppressants. The present study tested a newly developed screening instrument that records the subjective experiences and cognitive attitudes of patients vis-à-vis their immunosuppressive medication. METHOD: 98 patients were questioned before a heart, lung, liver or kidney transplant and 12 months after the transplant by means of various psychosocial measuring instruments (Sense of Coherence, SOC; Hospital Anxiety and Depression Scale, HADS-D; Quality of Life, SF-36; Satisfaction with Life, FLZ; Social Support, F-SOZU). 12 months after the transplants were performed, seven further items intended to measure the subjective experiences and cognitive attitudes of the patients vis-à-vis their immunosuppressive medication were used. The treating doctors assessed patients' overall compliance 12 months after the transplant operation. RESULTS: Die "Medication Experience Scale for Immunosuppressants" (MESI) showed an internal consistency (Cronbach's alpha) of 0.78. Its values correlated significantly negatively with the sense of coherence recorded before the transplant. There were also significantly negative correlations with physical functioning, mental health, satisfaction with life and social support, as well as significantly positive ones with anxiety and depression 12 months post-transplant. In a comparison of organ groups, lung-transplant patients exhibited the highest MESI values. Patients whose compliance was assessed as "very good" experienced the effects of the immunosuppressants less intensely than patients with "good" to "moderate" compliance. Sensitivity of the MESI scale with regard to compliance was 0.81, with a specificity of 0.71, a positive predictive value of 0.68, and a negative predictive value of 0.83. The cut-off value between "very good" and "limited" compliance was a scale score of 15 points. CONCLUSION: The MESI is a short, easy-to-use screening instrument for recording the subjective experiences and attitudes of patients after an organ transplant. Of clinical significance is the correlation with compliance. Patients with a scale score of > 15 in particular should be spoken to by their treating doctor with regard to their attitudes to and experiences of the immunosuppressants, as well as with regard to their compliance behaviour.

Psychosocial situation and physical health in 50 patients > 1 year after lung transplantation.

BACKGROUND: Lung transplants have been performed worldwide since the early 1980s. While numerous studies have been published on somatic aspects after lung transplantation, there is considerably less information available on psychosocial aspects and on the correlation between the physical and the psychosocial state of health after transplantation. METHODS: Between 1992 and 2002, 125 patients underwent lung transplantation at University Hospital Zurich. To be included into the study, patients had to have received a lung transplant > 12 months previously and to have good knowledge of the German or Italian languages. With the aid of standardized questionnaires, psychosocial variables such as levels of anxiety and depression, self-esteem, and social support were determined. In addition, self-assessments of physical and psychological health were obtained. The medical data included information on FEV1, complications such as pulmonary infections, acute or chronic allograft rejection, and assessment of the patient's physical and psychological health by the treating doctors. RESULTS: The overall degree of anxiety and depression of the lung transplant recipients was comparable to standard samples of an average population. However, male lung transplant recipients were significantly more depressed than female recipients. Self-esteem was higher than in clinical comparison samples. Preceding pulmonary complications had long-lasting effects on the level of anxiety, whereas nonpulmonary complications did not have such an effect. CONCLUSIONS: Overall, the psychological well-being of patients after lung transplantation is similar to the normal population. Subgroups of patients with increased psychological distress have been identified.

Personality, illness perceptions, and lung function (FEV1) in 50 patients after lung transplantation.

OBJECTIVE: After lung transplantation little attention has been devoted to patient's personality and illness perceptions, although the importance of illness perceptions (e.g. to the psychosocial status of health) as well as the relationship between personality and illness perceptions is well-known from other areas of medicine. METHODS: Fifty patients more than one year after lung transplantation were surveyed by the NEO Five-Factor Inventory (NEO-FFI) as well as the "control" and "consequences" scales of the Illness Perception Questionnaire (IPQ). Medical data included the diagnoses of the underlying lung diseases and the pulmonary graft function as measured by the forced expiratory volume in one second (FEV(1)). RESULTS: In our patients, mean values of the personality factors "extraversion" (p=.003), "openness to experiences" (p<.001), "agreeableness" (p=.035), and "conscientiousness" (p<.001) were significantly higher compared to the normal population. "Openness to experiences" correlated positively and "neuroticism" negatively with the illness perception "control". There was no correlation between illness perceptions and lung function. CONCLUSION: In lung transplant recipients, personality traits are more relevant to illness perceptions ("control") than current graft function.

Predictors of differences in symptom perception of older patients and their doctors.

BACKGROUND: Doctors and their older patients do not necessarily agree on what health problem ought to be treated. Discordance influences diagnostic procedures, patient satisfaction and treatment outcome negatively. OBJECTIVE: The purpose of the present study was to determine the psychosocial factors influencing differences in symptom reports of patients and physicians. METHODS: A cohort study was carried out in a medical out-patient clinic. A total 141 women and 213 men agreed to give symptom reports while waiting for their doctor's appointment and allowed their treating physician to evaluate symptoms afterwards. RESULTS: Disagreement between patients and physicians on which symptoms triggered the visit appeared in one-third of the cases. This was more likely the longer symptoms existed, the less intensely patients experienced their symptom and the more restricted they felt because of the symptom. Psychosocial factors did not have a significant influence. CONCLUSIONS: Independently of psychosocial variables, the different illness concepts of patients and their treating physician influence the subject of the consultation. Doctors and patients were most likely to agree when patients reported their symptoms as being of recent onset and being intense. Symptom intensity and the associated degree of restriction seem to reflect two different conceptual dimensions of symptom evaluation.