Literature widely supports the impact of psychosocial factors on outcomes for patients receiving advanced therapies in the management of advanced heart failure. The International Society for Heart and Lung Transplantation (ISHLT), in collaboration with the Academy of Psychosomatic Medicine (APM), American Society of Transplantation (AST), International Consortium of Circulatory Assist Clinicians (ICCAC), and Society for Transplant Social Workers (STSW), published a consensus in 2018 in which they identified psychosocial factors that were empirically supported as having an impact on patient outcomes and quality of life (QoL) (Dew, et al.). This consensus provided a consistent and subjective framework for assessing the psychosocial needs of patients that can be utilized across centers. The 2018 consensus identified four domains to be included in the psychosocial assessment of patients requiring cardiothoracic transplant or long-term mechanical circulatory support (MCS). These domains include (1) patient readiness, (2) social support system, (3) psychopathology, and (4) effects of substance use. These domains have been found to impact a patient’s ability to adhere to the strenuous demands of heart transplantation or mechanical circulatory support (MCS), and therefore, warrant assessment and intervention to mitigate risk and optimize outcomes. In 2023, ISHLT writes, “All MCS candidates should undergo a comprehensive psychosocial evaluation.” The goals outlined in that document were to (1) assess risk factors for poor post implantation outcomes; (2) collect information on factors related to patients’ knowledge, understanding, and capacity to engage in decision making about MCS; (3) collect information to characterize patients’ personal, social, and environmental resources and circumstances, including factors that may mitigate the impact of any psychosocial risk factors on post implantation outcomes; (4) evaluate patients’ knowledge about and capacity to operate the device. Additionally, a brief psychosocial evaluation may be required for patients in cardiogenic shock to exclude any major contraindications” (Saeed 2023). This chapter will identify commonly used assessment tools and review the psychosocial domains of the SIPAT, which is the most frequently used assessment tool across transplant centers. It will also examine the social worker’s role in identifying psychosocial risks and implementing interventions to meet candidacy requirements and enhance the quality of life for patients undergoing MCS implantation. There are similarities in program requirements for MCS and heart transplant as there are significant care demands for both modalities. Due to the extensive literature on transplantation and the overlap in patient experiences—such as patients being implanted as a bridge to transplant—this chapter will cite studies from both.

The Social Worker and Preimplantation Assessment

工具书词条
发表日期：

2025年

查看全文

Heather Donovan,
Kathleen Pickrel

摘要

Literature widely supports the impact of psychosocial factors on outcomes for patients receiving advanced therapies in the management of advanced heart failure. The International Society for Heart and Lung Transplantation (ISHLT), in collaboration with the Academy of Psychosomatic Medicine (APM), American Society of Transplantation (AST), International Consortium of Circulatory Assist Clinicians (ICCAC), and Society for Transplant Social Workers (STSW), published a consensus in 2018 in which they identified psychosocial factors that were empirically supported as having an impact on patient outcomes and quality of life (QoL) (Dew, et al.). This consensus provided a consistent and subjective framework for assessing the psychosocial needs of patients that can be utilized across centers. The 2018 consensus identified four domains to be included in the psychosocial assessment of patients requiring cardiothoracic transplant or long-term mechanical circulatory support (MCS). These domains include (1) patient readiness, (2) social support system, (3) psychopathology, and (4) effects of substance use. These domains have been found to impact a patient’s ability to adhere to the strenuous demands of heart transplantation or mechanical circulatory support (MCS), and therefore, warrant assessment and intervention to mitigate risk and optimize outcomes. In 2023, ISHLT writes, “All MCS candidates should undergo a comprehensive psychosocial evaluation.” The goals outlined in that document were to (1) assess risk factors for poor post implantation outcomes; (2) collect information on factors related to patients’ knowledge, understanding, and capacity to engage in decision making about MCS; (3) collect information to characterize patients’ personal, social, and environmental resources and circumstances, including factors that may mitigate the impact of any psychosocial risk factors on post implantation outcomes; (4) evaluate patients’ knowledge about and capacity to operate the device. Additionally, a brief psychosocial evaluation may be required for patients in cardiogenic shock to exclude any major contraindications” (Saeed 2023). This chapter will identify commonly used assessment tools and review the psychosocial domains of the SIPAT, which is the most frequently used assessment tool across transplant centers. It will also examine the social worker’s role in identifying psychosocial risks and implementing interventions to meet candidacy requirements and enhance the quality of life for patients undergoing MCS implantation. There are similarities in program requirements for MCS and heart transplant as there are significant care demands for both modalities. Due to the extensive literature on transplantation and the overlap in patient experiences—such as patients being implanted as a bridge to transplant—this chapter will cite studies from both.