62.2 PSYCHOSOCIAL PRETRANSPLANT EVALUATION: STANFORD PEDIATRIC PSYCHOSOCIAL OPTIMIZATION TOOL FOR TRANSPLANT (SPPOTT)

Abstract

Although the United Network for Organ Sharing (UNOS) requires a psychosocial assessment of patient and family prior to transplant surgery, there are no established guidelines about the content of the evaluation or standardized assessment protocols. The Pediatric Transplant Rating Instrument provides an outline of relevant areas of inquiry but has underperformed in its psychometric properties. There is a need for a well-validated assessment tool that incorporates patient, parent, and clinician perspectives on the suitability of the patient and family for transplant. The Stanford Pediatric Psychosocial Optimization Tool for Transplant (SPPOTT) has been developed based on a systematic review of the major known risk factors for pediatric nonadherence. It consists of a structured clinician-administered interview and patient- and parent-report questionnaire that generates computed scores in: 1) motivation for transplant; 2) psychiatric history; 3) substance abuse history; 4) prior history of treatment adherence; 5) parental supervision; 6) family environment; 7) social support; 8) financial resources; 9) medical coping; and 10) relationship with the treatment team. We will describe a single-center prospective clinical cohort study on the psychometric properties and feasibility of the SPPOTT as an adjunct to the pretransplant psychosocial evaluation. Forty families, half with children aged 0 to 11 years and half with youth older than 12 years (12+), with end-stage organ failure being considered for solid organ transplant, are being recruited for this study. Subjects will receive the structured clinical interview and patients 12+ and parents will complete the SPPOTT questionnaires. Scores generated from these 3 domains of assessment will be analyzed in each of the 10 SPPOTT categories. Interinstrument, test-retest, and interrater reliability results will be presented. Validation of a reliable, structured clinical assessment conducted prior to pediatric solid organ transplant surgery will provide a valuable tool, facilitating a more uniform approach to the pretransplant psychosocial assessment across transplant centers. Baseline data from SPPOTT scores will provide a foundation to investigate the predictive validity of the SPPOTT with respect to longer term clinical outcomes.