Abstracts

MATURITY AND ADHERENCE IN ADOLESCENT HEART RECIPIENTS

Carol S. Stilley, Kathy Lawrence, Ann Bender, Ellen Olshansky, Steven A. Webber, Mary Amanda Dew, Nursing, Pediatrics, Psychology and Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA

Purpose: Pediatric transplant (txp) teams note high rates of nonadherence among adolescent recipients. Limited research reports identity confusion and social immaturity in this group. We describe adherence and maturity in a sample of heart recipients aged 15-31 transplanted in childhood or adolescence from 1-18 (med 10) years ago.

Procedures: Twenty-six subjects completed questionnaires on adherence and ego development. Nine, matched on age, transplanted 5-15 (median 13) years ago, were chosen in purposive sampling (5 good, 4 poor adherers) for interview based on the Being, Belonging, Becoming work on adolescent quality of life. Interviews were transcribed, themes identified, and differences noted by placing subjects on a continuum of 1-10 by an investigator blinded as to age and adherence.

Results: Of the 26 subjects, 23% missed medications; 58% missed appointments, 35% had tattoos; 54% had body piercings; 11.5% smoked; 11.5% used street drugs. Ego development ranged from Pre-Conformist to Individualistic. The core theme from the 9 interviews was attempting to achieve normalcy by integrating the txp experience into self-concept. Contributing themes were: trusting vs. doubt, supportive vs. protective family, connected vs. isolative, optimistic vs. fatalistic, long-term vs. immediate goals, integrating vs. separating transplant from self, changing vs. static. The cohort split consistently on these themes with poor adherers at the low (e.g., doubt) and good adherers at the high (e.g., trusting) ends of the continuum.

Conclusions: Adolescent heart recipients are nonadherent and engage in high-risk behaviors. Poor adherers are less mature; there are clear differences between the ways in which adherent and nonadherent adolescents view themselves, others and their futures.