Psychological support for an adolescent awaiting heart transplantation: A case report on psychological intervention using the Stanford Integrated Psychosocial Assessment for Transplant.

Abstract

Background: Psychosocial factors significantly influence outcomes following heart transplantation (HT). In Japan, the prolonged waiting period for HT often requires a ventricular assist device (VAD), demanding strict adherence to self-care regimens to prevent complications. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) identifies psychosocial barriers to successful transplantation. This case report describes the use of SIPAT-guided psychological support for an adolescent awaiting HT.

Case presentation: A 16-year-old Japanese male with dilated cardiomyopathy underwent evaluation for HT. The SIPAT assessment revealed a total score of 25, with elevated scores in readiness for illness management (SIPAT A: 11) and social support (SIPAT B: 12), indicating challenges with understanding his condition and unstable family dynamics. Tailored interventions included psychotherapy and family psychoeducation. Following VAD implantation, initial nonadherence to self-care prompted further evaluation using the Wechsler Adult Intelligence Scale-Fourth Edition, which revealed deficits in processing speed and verbal comprehension. A transtheoretical model-guided intervention was then implemented to improve self-care behaviors. Periodic SIPAT assessments during routine check-ups facilitated ongoing monitoring and timely interventions. Over 25 months, the SIPAT scores improved (14 and 15) and no adverse outcomes, such as infections, emergency hospitalizations, or nonadherence behaviors, were observed.

Conclusion: This case highlights the effectiveness of early SIPAT-guided psychological support and multidisciplinary interventions in addressing complex psychosocial issues in adolescents during the VAD waiting period. It underscores the critical need for regular psychosocial assessments and individualized care to optimize transplantation outcomes.