Provider, Recipient and Caregiver Perspectives on Cardiovascular Disease and Related Risk Factors after Liver Transplantation: A Qualitative Study

Abstract

Introduction: Liver transplant (LT) is the only life-saving therapy for end-stage liver disease stemming from a multitude of causes though cardiovascular disease (CVD) is the leading cause of early (<1 year) mortality, and the third leading cause of late (> 1 year) mortality after LT. (1-5) This study examined liver transplant recipient (LTR), caregiver, and provider perspectives on CVD after transplant. Barriers to proper care have not been identified for each group and we do not know how each group would describe these barriers. Methods: We conducted seven focus groups to better understand these barriers. The focus groups lasted 90 minutes and were split based on LTR, caregiver, and provider-specialty. The transcriptions for these focus groups were coded. Results: Four major themes found across all groups and are as follows: the lack of awareness of CVD risk after LT, the lack of confidence in ability to provide proper care to LTRs, barriers to care without transplant center review, and barriers caused by having to touch base with multiple providers on the complex care team. Conclusions: Potential solutions to eliminate these barriers include increased education on the risk factors of CVD amongst LTRs done by the transplant team, EMR alerts for providers, increased utilization of the transplant coordinator and the transplant pharmacist, multidisciplinary team meetings to discuss patients care plans, and an additional document detailing the roles of each member of the LTRs care team.

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