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Published on: September 21, 2021
A consensus-based framework for the psychosocial evaluation of pediatric candidates for cardiothoracic transplant and
Debra S Lefkowitz1, Kelli Triplett2, Lauren Schneider3
1Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Insights
This study introduces a new framework for psychosocial evaluations in pediatric heart and lung transplants and ventricular assist device (VAD) placements. It aims to standardize evaluations for children and their families, addressing unique pediatric considerations.
Area of Science:
- Pediatric Cardiology
- Transplantation Medicine
- Psychosocial Health
Background:
- Psychosocial evaluations are critical for pediatric thoracic organ transplantation and ventricular assist device (VAD) placement.
- Significant practice variations exist in the content and process of these evaluations, with a lack of recent guidelines.
- Pediatric evaluations differ from adult evaluations due to unique caregiver roles and decision-making dynamics.
Purpose of the Study:
- To develop the first consensus-based framework for the content and process of psychosocial evaluations in pediatric cardiothoracic transplantation/VAD.
- To address the need for standardized, yet flexible, evaluation guidelines specific to pediatric patients.
- To incorporate ethical, cultural, and health equity considerations into the evaluation framework.
Main Methods:
- A multidisciplinary writing committee of 25 experts in pediatric cardiothoracic transplantation/VAD was formed.
- A comprehensive literature review was conducted to inform the framework development.
- The framework was developed through a consensus-based approach involving multiple professional organizations.
Main Results:
- A novel, consensus-based framework for pediatric psychosocial evaluations in cardiothoracic transplantation/VAD has been established.
- This framework is the first of its kind, specifically addressing the unique aspects of evaluating children and their families.
- The framework emphasizes flexibility to accommodate diverse clinical settings while promoting consistency.
Conclusions:
- The developed framework provides essential guidance for consistent and comprehensive psychosocial evaluations in pediatric cardiothoracic transplantation/VAD.
- It acknowledges and integrates ethical, cultural, and health equity issues pertinent to pediatric evaluations.
- This initiative aims to improve the evaluation process for children and families undergoing complex cardiac therapies.
Abstract:
The psychosocial evaluation plays an essential role in the multidisciplinary assessment of pediatric patients for thoracic organ transplantation or ventricular assist device (VAD) placement. However, there is considerable practice variation with regard to the content and process of the evaluation, with no known recent published guidelines. Furthermore, the pediatric evaluation necessarily differs from the adult evaluation in a number of substantive ways, including caregiver roles and decision-making. A writing committee of 25 multidisciplinary experts in pediatric cardiothoracic transplantation/VAD was established, who conducted a comprehensive literature review which resulted in the development of this consensus-based framework. This framework, which is a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT), the International Pediatric Transplant Association (IPTA), the Pediatric Heart Transplant Society (PHTS), the Advancing Cardiac Therapies Improving Outcomes Network (ACTION), and Transplant Families, represents the first known framework specific to both the content and process of the psychosocial evaluation for pediatric cardiothoracic transplantation/VAD. Attention was paid to relevant ethical, cultural and health equity considerations inherent in the pediatric evaluation process. Rather than provide a proscriptive evaluation process, the goal was to create a flexible framework to encourage consistency across centers, while also acknowledging the complexities inherent in evaluating children and their families for cardiothoracic transplant and VAD.
