(PS5-100) Posttraumatic Growth Among Pediatric Transplant Recipients and Their Caregivers: A Scoping Review

Background

Pediatric transplantation can be incredibly stressful for children and their caregivers as the children undergo major surgery and make significant lifestyle changes after the transplant including taking daily immunosuppressant medications. As a result, children and caregivers may experience posttraumatic stress symptoms (PTSS) that are known to impact quality of life and medical outcomes often associated with poor adherence. Conversely, children and caregivers may also experience positive emotional and psychological changes as a result of the transplant, known as posttraumatic growth (PTG). PTG encompasses five domains including new possibilities, personal strength, relating to others, appreciation of life, and spiritual change. The purpose of the present scoping review was to provide a first synthesis of the existing literature on PTG in pediatric transplant in order to determine potential targets for psychosocial interventions.

Method

We conducted a literature search of PsycINFO and Scopus in May 2023 on what is known about PTG among pediatric transplant recipients, their siblings, and caregivers. Eligible articles must have included a sample of solid organ transplant (SOT) or stem cell transplant (SCT) recipients under age 18, siblings of recipients, and/or caregivers; and must have examined PTG. Data from each study were extracted based on key categories including demographic characteristics, medical variables, and findings of PTG among transplant recipients, siblings, and caregivers.

Results

Twenty-three studies were identified, and nine studies met inclusion criteria and were included in the review (n = 5 cross sectional, n = 4 qualitative). Of the nine studies, one examined PTG among children only, seven examined PTG among parents or caregivers, one examined PTG among both children and caregivers, and none of the studies examined siblings. Cross-sectional studies examined demographic, mental health, and medical correlates of PTG in children and caregivers. PTG was correlated with PTSS and social support among caregivers. Qualitative studies identified themes along each of the five factors of PTG including stronger relationships with family, friends, and the child who received the transplant, personal strength, spiritual change and a stronger commitment to faith, appreciation of life, a desire to help others, empathy for others, and sharing experiences with others.

Conclusions

Findings overwhelmingly focused on caregiver PTG, and additional research is needed on child and sibling specific demographic, psychosocial, and medical correlates of PTG. This review found an association between PTSS and PTG, but this association has been mixed in previous studies and further research is needed to clarify this. None of the studies assessed the role of PTG in adherence to immunosuppressant medication post-transplant. Given the importance of adherence in preventing transplant rejection, understanding how the cognitive and behavioral aspects of PTG may influence quality of life and objective outcomes will be an important next step. This scoping review provides insight into positive change processes following a transplant among children and their caregivers.