Psychosocial Evaluation Research Articles

Neuropalliative care in deep brain stimulation for Parkinson’s disease: Potential impactful areas of care

Neuropalliative care (NPC) is a relatively new subspeciality of neurology. Recent studies have demonstrated efficacy of NPC in Parkinson’s disease (PD). However, the implementation of NPC in deep brain stimulation (DBS) has yet to be addressed. Patients with PD being evaluated for and having undergone DBS potentially have unmet needs that may be best assessed and managed by neuropalliative neurologist. Specific areas include an in-depth psychosocial evaluation, exploration of patient and caregiver expectations, addressing caregiver needs, providing spiritual and marital support, and discussing advance directives.

Psychosocial Evaluation of Adults with Primary Immunodeficiency

PurposePrimary immunodeficiency disorder (PID) is a heterogeneous group of diseases characterized by immune dysregulation and increased susceptibility to infections, with various cognitive, emotional, behavioral, and social effects on patients. This study aimed to evaluate loneliness, social adaptation, anxiety, and depression and to identify associated factors in adults with immunodeficiency.MethodsA cross-sectional study in Turkey (Feb-Aug 2022) obtained sociodemographic data from patient records. The Social Adaptation Self-Evaluation Scale (SASS), UCLA-Loneliness Scale (UCLA-LS), and Hospital Anxiety and Depression Scale (HADS) were administered in individual patient interviews. HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D) scores were assessed using cut-offs of 10 and 7, respectively; SASS cut-offs for social imbalance and normalcy were < 25 and > 35, respectively.ResultsA total of 104 patients (60 women, 44 men) with a median age of 34 years (range: 18–89) were included in the study. Mean scores were SASS: 34.46 ± 8.11, UCLA-LS: 44.89 ± 12.66, HADS-A: 9.87 ± 4.77, and HADS-D: 9.12 ± 4.80. SASS score was negatively correlated with HADS-A, HADS-D, and UCLA-LS scores. There were positive correlations between UCLA-LS and HADS-A (r = -0.355, p < 0.01) and HADS-D (r = -0.614, p < 0.01) and between HADS-A and HADS-D (r = -0.454, p < 0.01). Low-income level was associated with higher HADS-A, HADS-D, and UCLA-LS scores and lower SASS score (p = 0.012, p = 0.041, p = 0.008, and p = 0.001, respectively).ConclusionAdults with PID are at risk for depression and experience high levels of loneliness. Social maladjustment and loneliness contribute to anxiety and depression, and loneliness is correlated with impaired social functioning. These findings emphasize the importance of biopsychosocial evaluation of individuals diagnosed with PID.

A semi-structured interview is associated with bariatric surgery outcomes.

Pre-surgical psychological evaluations (PSPE) are required by many insurance companies and used to help identify risk factors that may compromise bariatric post-surgical outcomes. These evaluations, however, are not yet standardized. The present study investigated the utility of a semi-structured assessment, Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT), on post-surgical outcomes across 18 months. A total of 272 adult patients underwent a psychosocial evaluation and received bariatric surgery November 2017 to September 2020 at a Midwestern academic medical center. Average age at pre-surgical evaluation was 45.2 (SD = 10.7) years and 82.3% of patients were female (n = 224). With an a priori α of 0.05, multi-level modeling with weight as the outcome and regression with complications as the outcome were used. Higher SIPAT Patient Readiness, indicating difficulty with adhering to health behaviors and a reduced understanding of bariatric surgery, was associated with elevated patient weight at the 18-month follow-up (𝛽 = 0.129, p = 0.03). Higher SIPAT Social Support, was associated with patient weight at the 18-month follow-up, with reduced support associated with greater weight (𝛽 = 0.254, p = 0.004). Higher SIPAT Social Support also was associated with a greater risk of complications across the 18-month follow-up window (𝛽 = -0.108, p = 0.05). Patients with higher readiness to adhere to behavioral changes, and those reporting an intact social support system, generally weighed less at 18 months. The SIPAT may be considered as part of the standardized pre-surgical assessment, however, further research is required to elucidate its utility.

Multiple daily injection insulin regimen is an effective, and more economical, alternative to continuous insulin infusion for type 1 diabetics

A clinical decision report using: Heller S, White D, Lee E, et al. A cluster randomised trial, cost-effectiveness analysis and psychosocial evaluation of insulin pump therapy compared with multiple injections during flexible intensive insulin therapy for type 1 diabetes: the REPOSE Trial. Health Technol Assess. 2017 Apr;21(20):1-278. https://doi.org/10.3310/hta21200 for a patient with type 1 diabetes.

Translation and validation of a simplified Chinese version of the psychosocial assessment tool

BackgroundThe Psychosocial Assessment Tool (PAT2.0) is widely used to assess psychosocial risk in families of children with cancer. Our study aims to apply PAT2.0 to Chinese patients and assess the reliability, content validity, and construct validity of the Chinese version.MethodsA total of 161 participants completed the study, each with only one child diagnosed with cancer. Psychometric evaluations, including internal consistency, score distribution, test-retest reliability, and construct validity, were conducted.ResultsCronbach’s alpha values ranged from 0.732 to 0.843, indicating good internal consistency. Additionally, intraclass correlation coefficient values ranged from 0.869 to 0.984, indicating excellent test-retest reliability. The Simplified Chinese version of PAT2.0 demonstrated high construct validity in factor analyses and correlations with the General Functioning Subscale of the Family Assessment Device.ConclusionThe translation process of the Chinese version of PAT2.0 was successful, proving its applicability for psychosocial evaluation and interventions in families of children with cancer in China.

Reflections of Medical Social Workers’Roles in Living Organ Donors’Psychosocial Assessment: Human Rights and Social Justice Perspectives

研究目的：本研究以人權與社會正義觀點來探討醫務社會工作人員在活體器官捐贈社會心理評估中的角色、任務以及工作內容，以確保捐贈者自主、自願及知情下同意器官捐贈的行為。&lt;br /&gt;研究方法：本研究採立意取樣，訪談現職從事活體器官捐贈社會心理評估工作或曾任職衛生福利部核准之活體肝臟移植或活體腎臟移植醫院之醫務社會工作人員。&lt;br /&gt;研究結果：訪談資料顯示，醫務社會工作人員在活體器官捐贈社會心理評估的工作內容是透過會談來確認捐贈者是權利主體，其捐贈決定是自主、自願以及知情下同意；同時，捐贈者的性別、身心障礙或族群等脆弱性特質形塑捐贈決策中的角色期待、家庭關係壓力與脅迫。&lt;br /&gt;研究結論：醫務社會工作人員在捐贈者社會心理評估裡的角色既是知情同意倫理彰顯者，以捐贈者為中心，進行充權，使其具備權利意識來決定同意或拒絕器官捐贈；也是捐贈者權益維護者，協助捐贈者審視捐贈決策的情境與社會脈絡，保護捐贈者不因脆弱性特質，遭受不公對待，而進行捐贈決策。Research Purpose Liver and kidney transplants are the most common forms of living organ transplants in Taiwan. According to Article 8, item 1, paragraphs 1 and 2 of the Human Organ Transplant Act, consent to organ donation should be given in a condition of&amp;ldquo;sound mental capacity&amp;rdquo;and&amp;ldquo;free will.&amp;rdquo;To avoid coercion or organ trafficking and selling in situations of living organ donation and transplantation, a thorough assessment and examination must be performed prior to the procedure. This study examined how medical social workers (MSWs) adopted human rights and social justice perspectives in the psychosocial assessment of living organ donors before surgery to ensure donors&amp;rsquo;autonomy and willingness. &lt;br /&gt;Method A purposive sampling technique was adopted that involved interviewing 12 MSWs (three males and nine females) assigned to living-donor liver transplant hospitals approved by the Ministry of Health and Welfare or working in psychosocial assessment of living organ donation at the time of interviewing. Interviews were conducted between March 23 and April 10, 2021. Thematic analysis was used to analyze the qualitative data. &lt;br /&gt;Results According to the research findings, the psychosocial assessment of living organ donation focuses on the donor&amp;rsquo;s demographic characteristics such as gender, age, marital status, and employment to ensure relationships between the donor and the recipient. It is also necessary to have information about the donor&amp;rsquo;s family system because potential donors are frequently under pressure to donate organs owing to role expectations. MSWs feel confident in their roles as professionals in the psychosocial evaluation of living organ donation since psychosocial evaluation is an essential skill to acquire in social work education. Furthermore, MSWs must ensure that potential donors&amp;rsquo;decisions are made freely and without any coercion, even though MSWs are not the only ones who respect and protect the donor&amp;rsquo;s rights to autonomy and self-determination during the psychosocial assessment process. Additionally, when donors are placed in oppressive situations during the donation decision-making process, MSWs must be aware of their vulnerability based on their gender, disability, or ethnicity to empower them to resist potential oppression or exploitation. In other words, the social work profession values the notion of social justice and emphasizes acknowledging service users&amp;rsquo;possible existence of the social injustice faced by disadvantaged groups. Psychosocial assessments of living donors help potential donors become aware of whether their characteristics, such as gender, ethnicity, or disability, cause them to be dominated and exploited. According to our findings, female family members, such as spouses, daughters, or daughters-in-law, are sometimes required to sacrifice themselves to donate living organs to other family members, especially when the female is financially reliant. &lt;br /&gt;Conclusion The results suggest that MSWs are expected to maintain consciousness of rights to protect the free will, autonomy, and self-determination freedom of potential living organ donors. Moreover, based on social justice, MSWs are expected to protect living organ donors from the pressures caused by interpersonal relationships and social roles. Consequently, the role of medical social workers in the psychosocial evaluation of living organ donations may be viewed as an advocate for human rights and social justice practitioners.

Complexity of needs in amyotrophic lateral sclerosis (ALS) patients using the ENP-E scale in the north-eastern region of Spain.

This study aimed to explore the clinical characteristics of amyotrophic lateral sclerosis (ALS) patients in Spain's north-eastern region, their inclusion in chronic care programmes, and their psychosocial and spiritual needs (PSNs). A longitudinal descriptive study in adult patients with ALS. We analyzed clinical variables and participation in chronicity and PSNs assessment using the tool Psychosocial and Spiritual Needs Evaluation scale in end-of-life patients (ENP-E scale). 81 patients (average age 65.6 ± 11.7) were studied. At the study's outset, 29.7% employed non-invasive ventilation (NIV), increasing to 51.9% by its conclusion. Initial percutaneous endoscopic gastrostomy (PEG) utilization was 14.8%, rising to 35.85%. Chronic care programme participation was as follows: home care (24.7% initially, 50.6% end), palliative care (16% initially, 40.7% end), case management (13.6% initially, 50.6% end), and advance care planning registration (6.2% initially, 35.8% end). At study start, 47.8% of patients (n = 46) showed moderate-to-severe complexity in PSNs assessment using the ENP-E scale, without showing differences in age, sex, and time of evolution; whereas, on the evolutionary analysis, it was 75% (n = 24). A higher evolutionary complexity was observed in males <60 and >70 years, with no PEG and evolution of ALS of <2 and ≥5 years, and not included in chronicity programmes. When assessing concerns, physical pain and family aspects stand out in all measurements. Forty-eight percent of patients at study start and 71% at end of study showed external signs of emotional distress. Most ALS patients showed a high degree of complexity and were not integrated in chronicity programmes. A "care path" is proposed to integrate ALS patients in these programmes and systematically assess their needs.

MULTIMODAL PREHABILITATION MAY IMPROVE SURGICAL OUTCOMES FOR PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Surgery is associated with loss of lean body mass and physical deconditioning, which can delay healing and lead to complications. Multimodal prehabilitation (PH) with nutrition optimization and physical therapy improves outcomes after cancer surgery. However, the effects of prehabilitation for inflammatory bowel disease (IBD) surgery are not established. We aimed to assess surgical outcomes among IBD patients exposed to prehabilitation relative to no prehabilitation. METHODS We conducted a case-controlled study of the impact of prehabilitation in patients with IBD who underwent major abdominal surgery for Crohn’s disease (CD) or ulcerative colitis (UC) between May 1st, 2022 and June 6th, 2023 at a tertiary care center. Cases were defined as those who participated in a multimodal PH program that included nutrition counseling (weight optimization, preoperative carbohydrate loading and perioperative immunonutrition), medication management, physical therapy, and psychosocial evaluation beginning 4 weeks prior to surgery; controls received standard of care (SOC) written preoperative surgical instructions without PH. We assessed postoperative complications (defined by the comprehensive complications index (CCI)), severe complications (CCI&amp;gt;20), reoperation rate, 30-day readmission, post operative length of stay (LOS) and post-operative opioid use (defined by daily morphine milligram equivalents (MME)). Statistical tests included linear and logistic regression, Mann-Whitney U test, Chi-Square test, and Fisher’s exact test, as appropriate. RESULTS A total of 68 patients were identified, including 20 PH (cases) and 48 SOC (controls). Among PH, 75% had CD with the remainder UC; surgeries included ileocecal resection (45%), colectomy with ileostomy (25%), ileal pouch-anal anastomosis (25%), and small bowel resection (5%). Among SOC, 31% had CD with the remainder UC, and surgeries included colectomy with ileostomy (60%), stage 2 IPAA (29%), and small bowel (6%) or ileal (4%) resections. Age, sex, race, and ethnicity was similar between groups. Overall and severe complication rates were similar between PH and SOC (mean CCI scores 13.42 PH vs 11.25 SOC (p = 0.58), and CCI &amp;gt; 20 in 40% PH patients vs 29% SOC (p = 0.56)). Median post-operative LOS was shorter among PH vs SOC (3.0 vs 3.5d, p=0.02), and median post-operative opioid use was lower among PH vs SOC (19.5 vs 20.8 MME, p = 0.04). Readmission within 30 days occurred in 30% of PH and 17% of SOC (p = 0.22). Reoperation within 30 days occurred in 5% of PH and 17% of SOC (p = 0.37). CONCLUSION: Multimodal prehabilitation may improve select surgical outcomes in IBD, including length of stay and opioid use after surgery. Larger, prospective, controlled studies may help to further clarify the impact of PH on surgical outcomes for IBD, including complications, readmissions, and functional status. Table 1. Patient Characteristics and Outcomes by Prehabilitation Exposure Status

Insomnia in Postmenopausal Women: How to Approach and Treat It?

Insomnia is one of the major complaints of menopausal women with advancing age and may be complexly related to a variety of causes. However, there is still a lack of standards on the general approach and treatment for insomnia in menopausal women. The aim of this review is to summarize recent pathogenic theories of sleep disturbance in the menopausal period and discuss the approach and management of insomnia in postmenopausal women. Sleep disturbances in menopausal women may be associated with physical and psychiatric factors and other comorbid diseases. Careful history taking and multidisciplinary physical and psychosocial evaluation are necessary and, in particular, comorbidities related to sleep disorders, such as obstructive sleep apnea, must be taken into consideration. A unique aspect of insomnia in postmenopausal women is that menopausal symptoms due to hormonal decline can be closely related to sleep disturbances. Therefore, menopausal hormone therapy (MHT) should be considered as the treatment of choice among pharmacological treatments following cognitive behavioral therapy, which is suggested as the first-line treatment in the general population insomnia treatment guidelines. Additionally, melatonin and 5HT-based drugs, which have fewer side effects, along with MHT should be preferentially recommended in menopausal women.

Psychological stress and cardiovascular risk among women in Brazilian communities: a cross-sectional study.

Psychosocial evaluations are rarely conducted with community-dwelling individuals, especially those with higher risk of cardiovascular disease. This study aims to evaluate the perceptual stress and cardiovascular risk among women in a large cross-sectional study performed in Brazilian communities. Subjects aged over 18 years were included out of 500 public basic health units (BHU) in Brazil. All subjects were subjected to a clinical consultation and questionnaires application. Data were used to identify healthy lifestyle, smoking status, and self-perception of psychological stress. The National Health and Nutrition Examination Survey (NHANES) risk score (NRS) was used to estimate cardiovascular risk. Ethnicity information was self-reported, considering white versus non-white (black, brown, and mixed-race) women. A total of 93,605 patients were recruited from a primary care setting, of which 62,200 (66.4%) were women. Intense and severe auto-perception of stress was higher within non-white women at home (p < 0.001), at work (p = 0.008), socially (p < 0.001), and financially (p < 0.001) compared to white women. Therefore, the NRS indicates that non-white women had higher cardiovascular risk, lower physical activity, and lower daily vegetables/fruits consumption compared to white women (p < 0.001). Non-white women in Brazilian communities are susceptible to increased stress and cardiovascular disease risk, which adds up to disparities in access to the public health system.

Facial Feminization: Perioperative Care and Surgical Approaches.

After studying this article, the participant should be able to: 1. Understand the regional anatomy involved in facial feminization surgery, the key differences between the male and female face, and surgical approaches for modification. 2. Appreciate the integration of preoperative virtual planning and nonoperative approaches for facial feminization care. 3. Understand the perioperative process and potential complications and sequela. 4. Understand the importance of transgender care acceptance as it pertains to clinical outcomes. Facial feminization surgery (FFS) is composed of a broad spectrum of gender-affirming surgical procedures with the goal of modifying specific facial features to create a more feminine appearance. As FFS continues to evolve as a subspecialty of transgender care, it is important to consider the psychosocial evaluation, evolving aesthetic tastes, nonoperative facial feminization care, preoperative virtual planning, specialized instrumentation, and potential complications/sequelae when performing these procedures. Computed tomographic imaging and virtual preoperative planning may be used to assist the surgeon with morphologic typing of the brow, supraorbital rim, chin, and lateral mandible regions and aid in performing safer, more efficient procedures. The increasing number of FFS procedures performed on transwomen annually has been supported by objective outcome studies that demonstrate progress in minimizing both misgendering in social environments and reducing dysphoric feelings.

OP23 Early Detection Tools For Emotional Distress In Adult Cancer Patients In Spain: A Health Technology Assessment Report

IntroductionPatient-reported outcome measures are being increasingly considered both in clinical practice and in the field of health technology assessment. Although emotional distress is currently recognized as the sixth vital sign in cancer care, its early detection and screening is not yet included in routine clinical practice in Spain. The main objective of this study was to assess the psychometric properties and diagnostic accuracy of validated tools for the early detection of distress among adults with cancer in the Spanish context, at the request of the Spanish National Health System (NHS) Cancer Strategy.MethodsA systematic review was carried out to analyze development and validation studies. The Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2) was used for the risk of bias assessment, and a multicriteria global assessment was used for the tests. Ethical and organizational aspects were also addressed.ResultsFifteen validation studies were included, corresponding to seven tests. The tools considered were the Distress Thermometer (DT), the Brief Symptom Inventory-18 (BSI-18), the Edmonton Symptom Assessment System-revised (ESAS-r), the Hospital Anxiety and Depression Scale (HADS), the Visual Analog Scale for Anxiety and Depression (VAS-AD), the Detection of Emotional Distress (DED) scale, and the Psychosocial and Spiritual Needs Evaluation (ENP-E) scale. Evidence of validity, reliability (internal consistency), and diagnostic accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve) were summarized. Three scales were rated as poor (VAS-AD, BSI-18, and ESAS-r), the ENP-E scale was rated as acceptable, and three scales were rated as moderate (DT, DED, and HADS).ConclusionsThe DT (single-item measure) stands out as an appropriate tool for early detection of emotional distress in the Spanish NHS. The use of this scale could be considered a first stage, to be combined later with a longer scale to improve screening specificity. The HADS scale could be utilized for this purpose. The use of these tools should be framed within a structured screening program that ensures further evaluation and subsequent psychological care when needed.

Psychosocial Evaluation Results of Children and Adolescents Followed within the Scope of Health Measure

Psychosocial Evaluation Results of Children and Adolescents Followed within the Scope of Health Measure

Reexamining "psychosocial clearance": A procedural framework for psychosocial evaluation in liver transplantation.

Psychosocial and "nonmedical" phenomena are commonly encountered in liver transplantation (LT) evaluations. They are simultaneously crucial decision-making factors and some of the most difficult and controversial clinical matters clinicians confront. Epidemiology, societal trends, and the preponderance of psychological and behavioral factors underpinning common end-stage liver diseases ensure that LT teams will continue to encounter highly complex psychosocial patient presentations. Psychosocial policies, practices, and opinions vary widely among clinicians and LT centers. Liver clinicians already report insufficient psychosocial expertise, which creates a large gap between the stark need for psychosocial expansion, improvement, and innovation in LT and the lack of accompanying guidance on how to achieve it. While the clinical domains of an LT psychosocial evaluation have been well-described, few articles analyze the procedures by which teams determine candidates' "psychosocial clearance" and no conceptual frameworks exist. This article proposes a framework of core domains of psychosocial evaluation procedures, common pitfalls, and practical improvement strategies.

Psychological Impact in Individuals with Monoclonal Gammopathy of Undetermined Significance and Smoldering Multiple Myeloma

BACKGROUND: Monoclonal gammopathy of undetermined significance (MGUS) and smoldering multiple myeloma (SMM) are medical conditions characterized by asymptomatic clonal plasma cell disorders that have the potential to develop into multiple myeloma (MM). The diagnosis of MGUS and/or SMM may be linked to psychological effects that can have a detrimental impact on patients' quality of life. The objective of our study was to evaluate the prevalence of adverse psychosocial effects among individuals with MGUS and/or SMM. METHODS: From August 2015 to February 2023, we conducted prospective interviews with all patients referred to the University of Arkansas for Medical Sciences who had newly diagnosed plasma cell dyscrasias, such as MGUS and SMM, before their consultation with the oncologist. Trained social workers performed an initial psychosocial evaluation and prepared a comprehensive narrative report for each patient referred during this period. Results: Our study consisted of 246 patients, with 115 having MGUS and 131 having SMM. The average age was 68 years, and 51.2% were male, with 80.5% identifying as white. Most patients (91%) were diagnosed incidentally through blood and/or urine tests, and 61.8% had a family history of cancer. Anxiety was found in 19.1% of patients, while 33.7% had a previous psychiatric disorder. Among those with a history of psychiatric disorders, 78.3% were taking medication, and 21.7% were receiving treatment from a psychiatrist/therapist. Anxiety or nervousness was reported by 22% of MGUS patients and 17% of SMM patients. About one third of patients had a history of psychiatric disorders, with 79% on medication and 26% seeing a psychiatrist/therapist. The presence of anxiety or a history of psychiatric disorders did not significantly differ between MGUS and SMM patients (p &amp;gt; 0.05). In our analysis, age, race, working status, and history of psychiatric disorders were significant risk factors for anxiety (p = 0.001, 0.033, 0.045, and &amp;lt;0.001, respectively). However, in the multivariable model, only race and history of psychiatric disorders remained significant (p = 0.037 and p = 0.006, respectively). White patients had 5 times higher odds of experiencing anxiety, while patients with a history of psychiatric disorders had 2.6 times higher odds (odds ratio: 5.1 and 2.7, respectively). The most common themes expressed by patients during interviews were 'fear, stress, and/or anxiety,' followed by 'emotional initial reaction' and ‘feeling upset.‘ Conclusion: In our study, about 20% of patients felt anxious about their diagnosis of MGUS or SMM, and around 33% reported previous psychiatric disorder. African American patients were less likely to feel anxious or nervous, while patients with a history of psychiatric disorders were more likely to feel anxious or nervous. Given that anxiety can negatively affect patients' well-being and quality of life, healthcare providers should prioritize comprehensive care that includes addressing and managing anxiety alongside the medical aspects of the disease.

The Online Assessment Tools of the MenPas 1.0 Platform, a Reliable and Sustainable Alternative for Psychosocial Research: A Literature Review

New technologies have improved the efficiency and sustainability of psychosocial research. However, online assessment tools may differ from traditional paper-based ones in different domains. This study aims to provide an updated perspective of the online assessment advantages of a psychosocial platform called MenPas 1.0. A literature review was conducted, choosing validated questionnaire studies located in the MenPas 1.0 platform, specifically, motivation and hypnosis questionnaires. A total of five studies showing the psychometric properties of psychosocial evaluation tools were analysed and compared with their previous paper-based studies. In addition, internet impact over the last 20 years was analysed according to gender, age, nationality, and employment status. Finally, a conclusion was drawn on the impact of these tools on sustainability. The results showed that online studies have a higher number of participants (5866 users in 5 studies versus 5623 participants in 11 studies) and higher reliability rates than those of previous paper-based ones. A decrease in the social gap over the years was also found and the contribution of online tools to sustainability was discussed. This study could show the importance of the analysis of psychometric properties in online tools, the need for further research, and encourage their use in psychosocial assessment.

Psychosocial evaluation of living liver donors-State of current practices in the United States.

We surveyed living donor liver transplant programs in the United States to describe practices in the psychosocial evaluation of living donors focused on (1) composition of psychosocial team; (2) domains, workflow, and tools of the psychosocial assessment; (3) absolute and relative mental health-related contraindications to donation; and (4) postdonation psychosocial follow-up. We received 52 unique responses, representing 33 of 50 (66%) of active living donor liver transplant programs. Thirty-one (93.9%) provider teams included social workers, 22 (66.7%) psychiatrists, and 14 (42.4%) psychologists. Validated tools were rarely used, but domains assessed were consistent. Respondents rated active alcohol (93.8%), cocaine (96.8%), and opioid (96.8%) use disorder, as absolute contraindications to donation. Active suicidality (97%), self-injurious behavior (90.9%), eating disorders (87.9%), psychosis (84.8%), nonadherence (71.9%), and inability to cooperate with the evaluation team (78.1%) were absolute contraindications to donation. There were no statistically significant differences in absolute psychosocial contraindications to liver donation between geographical areas or between large and small programs. Programs conduct postdonation psychosocial follow-up (57.6%) or screening (39.4%), but routine follow-up of declined donors is rarely conducted (15.8%). Psychosocial evaluation of donor candidates is a multidisciplinary process. The structure of the psychosocial evaluation of donors is not uniform among programs though the domains assessed are consistent. Psychosocial contraindications to living liver donation vary among the transplant programs. Mental health follow-up of donor candidates is not standardized.

H - 40 The Role of Neuropsychology in Solid Organ Transplantation Candidacy in a Patient with a Diverse Linguistic and Sociocultural Background.

Candidates for transplantation with end stage organ failure (ESOF) undergo extensive pre-surgical medical and psychosocial evaluations, however neuropsychology is rarely required. This is concerning, as patients with ESOF often have cognitive deficits that may impact their ability to safely manage post-transplant care and are at increased risk for morbidity/mortality. This case highlights the novel perspective a comprehensive neuropsychological evaluation provides, especially in patients of diverse sociocultural backgrounds. The patient is a 37-year-old monolingual Spanish-speaking woman referred for evaluation in the context of liver transplant candidacy due to apparent inability to follow medical guidance, medication adherence, and continued alcohol consumption. Medical history includes autoimmune hepatitis, multifocal hepatocellular carcinoma, and diabetes. The patient reported problems with remembering information from providers even with compensatory strategies. Her family assists heavily with scheduling and transportation. When asked about alcohol use, she reported recent use of a few beers due to very hot weather, limited access to clean water, and the death of a family member despite providers urging her to remain abstinent. She was not aware of the hazard that even minimal alcohol use presented to her candidacy. She did not meet criteria for a neurocognitive disorder. The etiology of her noncompliance was secondary to poor social support, limited coping skills, and feeling overwhelmed by team instructions. Conducting a culturally informed evaluation in the patient's native language provided clear evidence of intact cognition and a nuanced understanding of her limitations that would not be appreciated in a more limited evaluation.

In-Hospital Methadone Enrollment: a Novel Program to Facilitate Linkage from the Hospital to the Opioid Treatment Program for Vulnerable Patients with Opioid Use Disorder.

Methadone ameliorates opioid withdrawal among hospitalized patients with opioid use disorder (OUD). To continue methadone after hospital discharge, patients must enroll in an opioid treatment program (OTP) per federal regulations. Uncontrolled opioid withdrawal is a barrier to linkage from hospital to OTP. Describe a federally compliant In-Hospital Methadone Enrollment Team (IN-MEET) that enrolls hospitalized patients with OUD into an OTP with facilitated hospital to OTP linkage. Seven hundred-bed university hospital in Aurora, CO. A physician dually affiliated with a hospital's addiction consultation service and a community OTP completes an in-hospital, face-to-face medical assessment required by federal law and titrates methadone to comfort. An OTP-affiliated nurse with hospital privileges completes a psychosocial evaluation and provides case management by arranging transportation and providing weekly telephone check-ins. IN-MEETenrollments completed, hospital to OTP linkage, and descriptive characteristics of patients who completed IN-MEET enrollments compared to patients who completed community OTP enrollments. Between April 2019 and April 2023, our team completed 165 IN-MEET enrollments. Among a subset of 73 IN-MEET patients, 56 (76.7%) presented to the OTP following hospital discharge. Compared to community OTP enrolled patients (n = 1687), a higher percentage of IN-MEET patients were older (39.7years, standard deviation [SD] 11.2years vs. 36.1years, SD 10.6years) and were unhoused (n = 43, 58.9% vs. n = 199, 11.8%). Compared to community OTP enrolled patients, a higher percentage of IN-MEET patients reported heroin or fentanyl as their primary substance (n = 53, 72.6% vs. n = 677, 40.1%), reported methamphetamine as their secondary substance (n = 27, 37.0% vs. n = 380, 22.5%), and reported they injected their primary substance (n = 46, 63.0% vs. n = 478, 28.3%). IN-MEET facilitates hospital to OTP linkage among a vulnerable population. This model has the potential to improve methadone access for hospitalized patients who may not otherwise seek out treatment.

Higher-risk SIPAT score predicts increased risk of long-term mortality in orthotopic heart transplant recipients

BackgroundOrthotopic heart transplantation (OHT) improves survival in eligible patients. Organ scarcity necessitates extensive clinical and psychosocial evaluations before listing. The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) predicts risk for poor psychosocial outcomes and morbidity in the first year post-transplant, yet it is unknown whether it predicts long-term outcomes. MethodsBlinded examiners obtained data from a retrospective cohort of 51 OHT recipients from a high-volume center. Patients with “Excellent” or “Good” SIPAT score indicating low psychosocial risk for transplant (E/G) were compared with those who met “Minimum Acceptable Criteria” or were “High Risk” (MAC/HR). Associations were examined between SIPAT group and outcomes. ResultsMAC/HR versus E/G recipients had significantly reduced survival in the 10 years post-OHT (mean 6.7 vs 8.8 years, p = 0.027; 55% vs 82% survival proportions, p = 0.037). MAC/HR patients were more likely to live in a county with greater income inequality (p = 0.025) and have psychiatric history pre-OHT (p = 0.046). Both groups had otherwise similar demographics and medical history. A lower proportion of MAC/HR patients adhered to medications post-OHT and a greater proportion had psychiatric illness, though differences were not significant. ConclusionsHigher-risk SIPAT scores predict reduced long-term survival post-OHT. Further efforts are crucial to improve outcomes in higher-risk patients.