Promoting medication adherence and self-management among kidney transplant recipients (MARS-trial): the development of an intervention protocol

D. Beck, M. Tielen, S.Y. Ismail, J. van de Wetering, T. van Gelder, C. Boonstra, J. Versteegh, K. Cransberg, W. Weimar, J.J. van Busschbach, J.L.C.M. van Saase, E.K. Massey

Thursday 15 march 2018

15:15 - 15:20h at Willem Burger Foyer

Categories: Nursing, Session (poster)

Parallel session: Poster session 1: Nursing

Introduction

After kidney transplantation patients must adhere to a lifelong immunosuppressive medication regime in combination with other lifestyle recommendations. Nonadherence to this regimen has been demonstrated to be substantial in all age groups, undermining optimal health outcomes. Current interventions to improve adherence have a few limitations and effective interventions are scarce. An important limitation of current interventions is addressing the patient in isolation in a hospital setting. We aimed to develop an intervention for enhancing adherence among nonadherent kidney transplant recipients anticipating shortcomings of current interventions.

Method

In order to develop an improved intervention, literature was reviewed to outline shortcomings of current interventions and assess known determinants for nonadherence. Based on these findings, evidence-based theories and methods were selected and translated to the population of nonadherent adolescent and adult kidney transplant recipients (ages > 12 yrs). Interventions based on principles of multisystemic / family therapy, which focus not solely on the patient but also involve the social network, and which are provided outside the hospital have been shown to be effective in enhancing adherence in other patient groups. Therefore, these principles in combination with behavior change techniques will be integrated in the current intervention.

Results

The developed intervention is outreaching (home-based) and multisystemic (involves social network of the transplant recipient). During the intervention sessions, determinants of nonadherence on various ecological levels will be assessed with the patient in dialogue with the social network and treatment goals will be formulated. Based on the intervention protocol, which specifies psychotherapeutic techniques per determinant, the patient works towards achieving treatment goals. Duration and frequency of the intervention are not determined a priori, but will be determined by the achievement of goals.

Conclusion

The intervention is designed to improve adherence to immunosuppressive medication and lifestyle recommendations based on the principles of multisystemic therapy and behavior change techniques derived from health behavior change theories. The intervention is unique in that it is outreaching, tailored to the needs and situation of each individual and addresses multiple ecological levels.