Advertisement

Exploring post-transplant life in kidney transplant recipients taking immunosuppressive medication: A phenomenological study

Published:September 29, 2022DOI:https://doi.org/10.1016/j.colegn.2022.08.011

      Abstract

      Background

      Adherence to immunosuppressive medication therapy is essential for long-term survival of kidney transplant recipients. This has major implications on quality of life.

      Aim

      We aimed to identify the nature of the experience of taking immunosuppressive medication and its implications on kidney transplant recipients.

      Methods

      The study used a descriptive phenomenological design, applying Giorgi's phenomenological method. In-depth interviews were conducted to collect data from 10 kidney transplant recipients. Giorgi's four-step method was used to analyse the data.

      Findings

      The structure of the kidney transplant recipients' experiences of immunosuppressive medication were classified into four themes: “reformulating to the condition,” “resetting one's framework for living in a changed world,” “tuning to prevent becoming unbalanced,” and “voluntary restraint for normalising one's new life,” which can be further divided into 11 subconstituents.

      Discussion

      As compared to previous studies, our study was novel as it had a patient-centred point of view and focused on the lives of participants after starting immunosuppressants. We found that these patients sought stability and normality in their lives and viewed adherence to pharmacotherapy as a prerequisite to life. Our results may be used by nurses and healthcare providers as data to understand the perspective of patients taking immunosuppressants after kidney transplantation.

      Conclusion

      This study provides a new perspective on the nature of patient experiences with immunosuppressive medication, instead of views on compliance and noncompliance. It also provides basic data for research to improve the quality of life and adaptation of kidney transplant recipients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Amro A.
        • Waldum-Grevbo B.
        • von der Lippe N.
        • Brekke F.B.
        • Miaskowski C.
        • Os I.
        Symptom clusters from dialysis to renal transplantation: A five-year longitudinal study.
        Journal of Pain and Symptom Management. 2016; 51: 512-519https://doi.org/10.1016/j.jpainsymman.2015.10.012
        • Belaiche S.
        • Décaudin B.
        • Dharancy S.
        • Noel C.
        • Odou P.
        • Hazzan M.
        Factors relevant to medication non-adherence in kidney transplant: A systematic review.
        International Journal of Clinical Pharmacy. 2017; 39: 582-593https://doi.org/10.1007/s11096-017-0436-4
        • Cannavò A.
        • Passamonti S.M.
        • Vincenti D.
        • Aurelio M.T.
        • Torelli R.
        • Poli F.
        • et al.
        Quality of life before and after transplantation in solid organ recipients referred to the North Italy Transplant program (NITp): A cross-sectional study.
        Transplantation Proceedings. 2019; 51: 1692-1698https://doi.org/10.1016/j.transproceed.2019.02.034
        • Chen Y.
        • Shi J.
        • Xia T.C.
        • Xu R.
        • He X.
        • Xia Y.
        Preservation solutions for kidney transplantation: History, advances and mechanisms.
        Cell Transplantation. 2019; 28: 1472-1489https://doi.org/10.1177/0963689719872699
        • Creswell J.W.
        • Poth C.N.
        Qualitative inquiry and research design: Choosing among five approaches.
        Sage Publications, Thousand Oaks, CA2016
        • Giorgi A.
        The theory, practice, and evaluation of the phenomenological method as a qualitative research procedure.
        Journal of Phenomenological Psychology. 1997; 28: 235-260https://doi.org/10.1163/156916297X00103
        • Global Observatory on Donation and Transplantation
        International report on organ donation and transplantation activity.
        2020
        • Guzel H.
        • Korkmaz M.
        Life quality and compliance after transplant: The case of Turkey.
        Transplantation Proceedings. 2019; 51: 1029-1037https://doi.org/10.1016/j.transproceed.2019.01.083
        • Hwang Y.H.
        • Park S.J.
        A concept analysis of compliance in kidney transplant recipient including compliance with immunosuppressive medication.
        Journal of Korean Biological Nursing Science. 2020; 22: 23-35https://doi.org/10.7586/jkbns.2020.22.1.23
        • Israni A.
        • Dean C.
        • Kasel B.
        • Berndt L.
        • Wildebush W.
        • Wang C.J.
        Why do patients forget to take immunosuppression medications and miss appointments: Can a mobile phone app help?.
        JMIR Public Health and Surveillance. 2016; 2: e15https://doi.org/10.2196/publichealth.5285
        • Ju M.K.
        • Son S.
        • Kim S.
        Adjustment experience of kidney transplantation recipients in Korea.
        Transplantation Proceedings. 2016; 48: 2434-2436https://doi.org/10.1016/j.transproceed.2016.02.098
        • Kidney Disease: Improving Global Outcomes (KDIGO) Transplant Work Group
        KDIGO clinical practice guideline for the care of kidney transplant recipients.
        American Journal of Transplantation. 2009; 9 (Suppl): S1-S155https://doi.org/10.1111/j.1600-6143.2009.02834.x
        • Kim C.D.
        Kidney transplantation.
        Korean Journal of Medicine. 2014; 86: 1-10https://doi.org/10.3904/kjm.2014.86.2.142
        • Korean Network for Organ Sharing
        Statistical yearbook of organ transplantation and human tissue donation in Korea. 2019. 2020
        • Lee J.A.
        • Kim Y.A.
        • Chung H.I.
        Factors affecting treatment adherence of kidney transplantation recipients.
        Journal of the Korea Contents Association. 2019; 19: 619-628https://doi.org/10.5392/JKCA.2019.19.02.619
        • Lee S.A.
        • Kim E.Y.
        • Chang S.O.
        A life where concealment and exposure coexist-The antiretroviral therapy adherence of people living with HIV infection: A phenomenological study.
        Journal of Advanced Nursing. 2020; 76: 1027-1036https://doi.org/10.1111/jan.14309
        • Lim M.A.
        • Kohli J.
        • Bloom R.D.
        Immunosuppression for kidney transplantation: Where are we now and where are we going?.
        Transplantation Reviews. 2017; 31: 10-17https://doi.org/10.1016/j.trre.2016.10.006
        • Maxwell J.A.
        Applied Social Research Methods Series.
        third edn. Qualitative research design: An interactive approach. 41. Sage Publications, Thousand Oaks, CA2013
        • Morse J.M.
        Analytic strategies and sample size.
        Qualitative Health Research. 2015; 25: 1317-1318https://doi.org/10.1177/1049732315602867
        • Nevins T.E.
        • Nickerson P.W.
        • Dew M.A.
        Understanding medication nonadherence after kidney transplant.
        Journal of the American Society of Nephrology. 2017; 28: 2290-2301https://doi.org/10.1681/ASN.2017020216
        • Pinter J.
        • Hanson C.S.
        • Chapman J.R.
        • Wong G.
        • Craig J.C.
        • Schell J.O.
        • et al.
        Perspectives of older kidney transplant recipients on kidney transplantation.
        Clinical Journal of the American Society of Nephrology: CJASN. 2017; 12: 443-453https://doi.org/10.2215/CJN.05890616
        • Piotrowski P.C.
        • Lutkowska A.
        • Tsibulski A.
        • Karczewski M.
        • Jagodziński P.P.
        Neurologic complications in kidney transplant recipients.
        Folia Neuropathologica. 2017; 55: 86-109https://doi.org/10.5114/fn.2017.68577
        • Sun K.
        • Corneli A.L.
        • Dombeck C.
        • Swezey T.
        • Rogers J.L.
        • Criscione-Schreiber L.G.
        • et al.
        Barriers to taking medications for systemic lupus erythematosus: A qualitative study of racial minority patients, lupus providers, and clinic staff.
        Arthritis Care and Research. 2021; ([Online ahead of print]): 1-9https://doi.org/10.1002/acr.24591
        • Sundler A.J.
        • Lindberg E.
        • Nilsson C.
        • Palmér L.
        Qualitative thematic analysis based on descriptive phenomenology.
        Nursing Open. 2019; 6: 733-739https://doi.org/10.1002/nop2.275
        • Suzuki R.
        • Nakamiya Y.
        • Watanabe M.
        • Ando E.
        • Tanichi M.
        • Koga M.
        • et al.
        Relationship between stress coping mechanisms and depression in kidney transplant recipients.
        Transplantation Proceedings. 2019; 51: 761-767https://doi.org/10.1016/j.transproceed.2018.12.034
        • Tong A.
        • Howell M.
        • Wong G.
        • Webster A.C.
        • Howard K.
        • Craig J.C.
        The perspectives of kidney transplant recipients on medicine taking: A systematic review of qualitative studies.
        Nephrology, Dialysis, Transplantation. 2011; 26: 344-354https://doi.org/10.1093/ndt/gfq376
        • Tong A.
        • Sainsbury P.
        • Craig J.
        Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups.
        International Journal for Quality in Health Care. 2007; 19: 349-357https://doi.org/10.1093/intqhc/mzm042
        • van Manen M.
        Researching lived experience: Human science for an action sensitive pedagogy.
        State University of New York Press, Albany, NY1990
        • Yang F.C.
        • Wang S.S.
        • Chen H.M.
        • Chen C.H.
        • Pong S.C.
        • Chen C.M.
        Adaptation process of male kidney transplant recipients during the difficult postoperative recovery stage at home.
        Transplantation Proceedings. 2020; 52: 3221-3225https://doi.org/10.1016/j.transproceed.2020.06.02