Improving quality of life, emotional states and medical compliance in recipients of kidney transplants

Quality of Life (QOL) amongst transplant patients has become an issue as a means to optimize the use of scarce resources and improve outcome. The relationship between QOL, medical compliance, psychosocial states and QOL is presented as follows:
Patient empowerment: Patient empowerment and compliance with medications in patients who experienced late acute rejection, was assessed using the Long-term Medication Behaviour Scale (LTMBS-scale). We demonstrated a relationship between late acute rejection and low confidence in taking medication and items relating to physical and psychological symptoms.
Effect of psychotherapeutic program on emotional states after kidney transplantation: Recurring emotional states as recalled by patients during psychotherapy sessions (e.g. loss of QOL) were analysed and used to formulate effective group and individual psychotherapy intervention. The Beck Depression Inventory (BDI) was utilised as a measure of change before, during and after treatment. There was significant improvement in psychological states after therapy contemplated as follows, (i) fear of rejection, (ii) feelings of paradoxical loss (iii) psychological integration of the transplant.
Randomised controlled study to determine the efficacy of individual or group psychotherapy amongst kidney transplant patients: Analysis of group and individual psychotherapy in recipients of kidney transplants versus control patients was
conducted. Improvement appeared to be more significant in the individual therapy compared to group therapy (p= 0.01). In both the individual and group therapy arm, lowering of scores was progressive and sustained (p=O.OI). However, individual
therapy resulted in the lowest BDI scores at the end of treatment period.
Coming to terms with the 'imagined past': After a successful transplant, patients may present with feelings of paradoxical loss (e.g. grief or low mood). We propose that paradoxical loss should be considered in terms of an imagined past (loss of life goals which have never been actualised as a result of chronic illness). Feelings of loss present an obstacle to a good QOL after transplantation as low mood may lead to ambivalence and subsequently to non-compliance.

Submitted in partial fulfilment of PhD requirements, Middlesex University, London, United Kingdom.