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The use of psychosocial criteria in Australian patient selection guidelines for kidney transplantation

Anderson, Kate, Cass, Alan, Cunningham, Joan, Snelling, Paul L., Devitt, Jeannie and Preece, Cilla (2007). The use of psychosocial criteria in Australian patient selection guidelines for kidney transplantation. Social Science and Medicine,64(10):2107-2114.

Document type: Journal Article
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IRMA ID 10010xPUB38
Title The use of psychosocial criteria in Australian patient selection guidelines for kidney transplantation
Author Anderson, Kate
Cass, Alan
Cunningham, Joan
Snelling, Paul L.
Devitt, Jeannie
Preece, Cilla
Journal Name Social Science and Medicine
Publication Date 2007
Volume Number 64
Issue Number 10
ISSN 0277-9536   (check CDU catalogue open catalogue search in new window)
Start Page 2107
End Page 2114
Total Pages 8
Place of Publication United Kingdom
Publisher Pergamon
Field of Research 1601 - Anthropology
1608 - Sociology
1117 - Public Health and Health Services
HERDC Category C1 - Journal Article (DEST)
Abstract Psychosocial criteria are increasingly being included in practice guidelines for determining patient suitability for kidney transplantation. Although intended to promote evidence-based decision-making, if poorly defined, the inclusion of psychosocial criteria has the potential to reduce transparency in patient selection and equity of access. We reviewed all Australian practice guidelines concerning patient suitability for kidney transplantation and qualitatively analysed their inclusion of, and approach towards, psychosocial criteria.

Transplant Directors from all Australian adult transplant units were invited to submit their unit's guidelines for this national research audit. All 16 units (100%) submitted some form of documentation. We analysed only those documents that were purposely structured tools for directing patient selection (eight guidelines used in 10 transplant units). Content analysis was performed on the abstracted psychosocial criteria. Psychosocial criteria—particularly non-compliance and smoking—were commonly included. In general, the psychosocial criteria were ill-defined and lacking in substantiating evidence and recommendations for assessment or action.

Our results reveal that current Australian patient selection guidelines for kidney transplantation incorporate poorly defined psychosocial criteria that vary greatly. Furthermore, there appears to be a weak evidence base underpinning their inclusion. The use of psychosocial criteria in this manner decreases the transparency of patient selection and increases the potential for subjective estimates of social worth to influence patient selection. The priority given to such criteria in transplant guidelines requires attention and debate.
Keywords Healthcare rationing
Kidney transplantation
Patient selection
Practice guidelines
Psychosocial criteria
Australia
DOI http://dx.doi.org/10.1016/j.socscimed.2007.02.012   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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