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Patient-Reported Self-Management in Lung Transplant Candidates

C. C. Kennedy1, M. Budev2, S. Chandrashekaran3, D. Erasmus4, E. D. Lease5, D. Levine6, K. Thompson1, E. Stevens1, R. Benzo1

1Mayo Clinic, Rochester, MN, 2Cleveland Clinic, Cleveland, OH, 3University of Florida- Gainesville, Gainesville, FL, 4Mayo Clinic, Jacksonville, FL, 5University of Washington, Seattle, WA, 6University of Texas Health Science Center San Antonio, San Antonio, TX

Meeting: 2019 American Transplant Congress

Abstract number: C332

Keywords: Lung transplantation, Psychosocial, Risk factors

Session Information

Date: Monday, June 3, 2019

Session Name: Poster Session C: Lung: All Topics

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Hall C & D

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*Purpose: Pre-transplant risk factors are strongly associated with worse post-transplant survival (e.g. frailty); however, effective pre-transplant strategies to improve outcomes are lacking. We hypothesize that interventions targeting candidates’ self-management skills may be an effective tool applied to risk factors such as frailty or obesity. Little is known about self-management in lung transplant candidates.

*Methods: This is an IRB-approved, multi-center survey of adult lung waitlisted patients. Patients were approached by mail and asked to complete self-administered surveys including the 30-item Self-Management Abilities Scale (SMAS-30). The Self-management of Well-being provides the theoretical basis for the SMAS-30, a well-validated self-management questionnaire (Cronbach’s alpha 0.9). The theory states that one must be able to manage internal and external resources in order to maintain physical and social well-being. Survey non-responders were approached three times before declaring non-participation.

*Results: One hundred and fifty-nine candidates completed surveys (48% participation rate). Respondents averaged 59 years old (standard deviation [SD]±9.5). Half were male. The majority of the patients had high school diploma or higher (92%), were married (74%), and were white (93.7%). Median wait time was 94 days with a mean lung allocation score (LAS) of 36.3. Overall median SMAS-30 score was 71.5 (interquartile range [IQR] 60,79.8). About 7.5% of lung transplant candidates had a total SMAS-30 score > 1 SD below expected values based on reported norms. Subdomains of Investment, Positive Frame of Mind, and Multi-Functionality were > 1 SD below expected for 8, 7, and 15% of lung candidates, respectively. Most concerning, the Variety subdomain score was > 1 SD lower than expected for 53% of lung candidates, median 45 (IQR 35, 60). The Variety subdomain represents the ability to maintain resources for the various dimensions of physical and social well-being.

*Conclusions: The Variety subdomain was lower than expected in lung transplant candidates on the waiting list. Such a deficit may reflect an opportunity for pre-transplant interventions targeting potentially modifiable risk factors. Deficiencies in overall score or other subdomains may prove important targets for select candidates.Self-management is a novel consideration for pre-transplant intervention. Future research targeting deficiencies in the Variety subdomain should be considered.

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To cite this abstract in AMA style:

Kennedy CC, Budev M, Chandrashekaran S, Erasmus D, Lease ED, Levine D, Thompson K, Stevens E, Benzo R. Patient-Reported Self-Management in Lung Transplant Candidates [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/patient-reported-self-management-in-lung-transplant-candidates/. Accessed March 6, 2021.

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