• Implementation of a High-Risk Alcoholism Relapse Scale Post-Liver Transplantation

      Tholen, Rebeca V.; Bundy, Elaine (2019-05)
      Background: Transplantation will reverse the complications of end-stage liver disease, but it does not treat underlying alcoholism or reduce the risk of relapse after transplant. Local Problem: In the United States, relapse rates are 20-50% among liver transplant recipients. Relapse after transplant has been identified as a problem among liver transplant recipients at a large urban academic transplant center. The purpose of this quality improvement project was to implement and evaluate the effectiveness of a High-Risk Alcoholism Relapse scale to screen and identify patients at high-risk for alcohol relapse post-transplant. Interventions: The scale was used to screen new adult liver transplant recipients prior to hospital discharge. The scale is a predictive tool designed to determine severity of alcoholism and risk of relapse after transplantation. The scale consists of three variables identified as having the highest predictive power for early relapse, including daily number of drinks, history of previous inpatient treatment for alcoholism, and the number of years of heavy drinking. Results: Descriptive statistics revealed 33 patients were screened with the scale. Forty percent of patients (n=13) were identified as being a high-risk for relapse and 60% low-risk (n=20). Fiftyfour percent reported drinking nine to 17 drinks per day, and zero patients consumed fewer than nine drinks per day. Fifty-four percent reported drinking more than 25 years. One third of highrisk patients received inpatient treatment for alcoholism at least once. Conclusions: Early identification and close monitoring of alcohol relapse is an essential determinant of long-term outcomes after liver transplantation. Findings validate the effectiveness of the scale to screen and identify patients at high-risk for post-transplant relapse. Results support the scale as a more efficient method to identify heavy alcohol use than other screening methods. Recommendations for future studies include performing a follow-up study to compare HRAR results with relapse rates, and modifying the scale to appropriately capture and identify young adults at high-risk for relapse after transplant. Recommendations to help maintain post-transplant sobriety include starting a transplant support group within the organization for all high-risk patients.
    • Naming the silences: A hermeneutic phenomenology of the dimensions of parental decision-making in pediatric oncology

      O'Neil, Joyce Anne; Belcher, Anne E.; Neal, Maggie T. (1996)
      The purpose of this study was to explore the experiences of parents as they made decisions when their child with cancer had a recurrence of the disease. The lived experiences of parents whose child's cancer had returned in the last six months was the source of text to uncover the meaning of decision making at this time in their lives. The meaning of decision making is embedded in the wholeness of the parents' journey through childhood cancer. The research methodology was interpretive. Nine parents were interviewed retrospectively on their experiences at the time of the recurrence. Using a reflective phenomenological process and hermeneutic analysis the uniqueness and commonalities of each parent's experience were disclosed. An overarching theme of Listen to Who I Am was brought forth. Two other significant themes of A Community that Cares and What do we do Next were also uncovered. Parents move through a maze of recurrence supported by family and friends. They search for health care professionals within whom to place their deep trust in the curative power of medicine. They desire a homelike atmosphere of loving care for themselves and their child. At recurrence they ask that they be listened to for who they are. They desire that the uniqueness of their being be recognized. In order not to lose their child they ask that treatment continue in order to save their child from death. In order to be comfortable with their decisions they require knowledge of all that is happening and planned for the treatment of their child. Implications for practice, research, and education are intended to enhance the moral community surrounding the child with cancer. More knowledge of parents' experiences at this tragic time is needed. Open dialogue, a naming of the silences between physician, nurse, and parents, will enhance parents' trust and create an atmosphere that will allow for the growth of the "home away from home" for all involved in the care of the child with cancer.