ABSTRACT: DECISION CONTROL AND
ADHERENCE IN KIDNEY TRANSPLANTATION

A systematic review of 35 studies examining non-adherence to immunosuppressive therapy in kidney transplant patients between 1980 and 2001 revealed that rated ranged from 18%-26% with a median of 22% (Butler, Roderick, Mullee, Mason & Peveler, 2004).

Ten studies in this review examined the association of non adherence with graft loss and fond that 14% to 65% of graft losses were associated with non-adherence to immunosuppressive therapy. In addition, to placing greater demand on the scarce organ resources of the community and increasing health care costs, graft loss to the individual patient means returning to dependence upon dialysis and lower quality of life (Tomasz & Piotr, 2003).

Non-adherence to immunosuppressive therapy following kidney transplantation is the leading cause of rejection and graft loss (Chisholm et al. 2000). The presence of a supportive family member has been associated with increased medication adherence in kidney transplant recipients (Russell, 2003; DeGeest, 1995). However, what family members do to promote adherence has not been well described. If known, this information could be used by health professionals to better prepare families to support immunosuppressive therapy adherence.

Aims:
1. To explore patient and family perceptions of the family role in promoting patient immunosuppressive therapy adherence in a U.S. and Swiss population.
2. To describe patient and family member perceptions of elements of an effective intervention to promote family support of patient adherence to immunosuppressive therapy in US and Swiss population.
3. To evaluate instrument burden and establish reliability and content validity and validity related to response processes in European instruments used to measure transplantation symptom burden, immunosuppressive therapy adherence, and immunosuppressive therapy self-efficacy in a U.S. population.