CONTEXT: Pediatric transplant clinicians note high rates of nonadherence with medications, appointment keeping, and laboratory tests and high rates of engagement in high-risk behaviors among older adolescents and young adult recipients. The caregivers also report symptoms of identity confusion, social immaturity, and failure to appreciate consequences of risky behavior among recipients. OBJECTIVE: To build on an earlier study that identified developmental characteristics that distinguish poor from good adherers. DESIGN: Qualitative methods were used to explore key themes identified in the first study with heart transplant recipients and their significant others. RESULTS: This research confirmed the themes of developmental maturity suggested by the first study: good adherers were able to integrate the transplant into sense of self, become independent adults, and achieve normalcy; poor adherers continued to "push away" the transplant experience and worried that they would never be normal. The good adherers, their parents, and friends had views of relationships that were congruent, acknowledging difficulties, discussing them, and moving toward mutual satisfaction. The poor adherers, their parents, and friends expressed incongruent views of the relationships, avoiding discussion of problems and idealizing relationships. DISCUSSION: Strategies for clinicians, family, and friends to increase maturity and independence among older adolescent and young adult heart transplant recipients are described.
CONTEXT: Pediatric transplant clinicians note high rates of nonadherence with medications, appointment keeping, and laboratory tests and high rates of engagement in high-risk behaviors among older adolescents and young adult recipients. The caregivers also report symptoms of identity confusion, social immaturity, and failure to appreciate consequences of risky behavior among recipients. OBJECTIVE: To build on an earlier study that identified developmental characteristics that distinguish poor from good adherers. DESIGN: Qualitative methods were used to explore key themes identified in the first study with heart transplant recipients and their significant others. RESULTS: This research confirmed the themes of developmental maturity suggested by the first study: good adherers were able to integrate the transplant into sense of self, become independent adults, and achieve normalcy; poor adherers continued to "push away" the transplant experience and worried that they would never be normal. The good adherers, their parents, and friends had views of relationships that were congruent, acknowledging difficulties, discussing them, and moving toward mutual satisfaction. The poor adherers, their parents, and friends expressed incongruent views of the relationships, avoiding discussion of problems and idealizing relationships. DISCUSSION: Strategies for clinicians, family, and friends to increase maturity and independence among older adolescent and young adult heart transplant recipients are described.
Authors: Bradley S Marino; Ryan S Tomlinson; Gil Wernovsky; Dennis Drotar; Jane W Newburger; Lynn Mahony; Kathleen Mussatto; Elizabeth Tong; Mitchell Cohen; Charlotte Andersen; David Shera; Philip R Khoury; Jo Wray; J William Gaynor; Mark A Helfaer; Anne E Kazak; Judy A Shea Journal: Pediatrics Date: 2010-08-30 Impact factor: 7.124