Identifying the psychosocial experience of lung transplant recipients across the transplant trajectory: A systematic review and narrative synthesis.

Abstract

Patients who receive lung transplantation generally experience dramatically improved physical well-being. However, transplantation is associated with elevated psychosocial distress. Reduced quality of life related to distress may compromise the net benefit of lung transplantation. Patients' concerns likely vary across the illness trajectory, however a comprehensive synthesis that spans the full lung transplant trajectory is absent from the current literature. This review aimed to identify the psychosocial concerns reported by adult lung transplant candidates across the transplant trajectory. A systematic review and narrative synthesis approach was used. A systematic search of seven databases was undertaken from database inception to 29 April 2024, with articles appraised using the Critical Appraisal Skills Programme tool. Data were extracted to align with the lung transplant trajectory stages. Psychosocial concerns were thematically synthesised to align with each stage of the transplant trajectory. In all, 19 articles were eligible for inclusion. Lung transplant candidates experience a range of psychosocial issues beginning before discussions about transplant are initiated and continuing across the trajectory. The transplant experience is characterised by high uncertainty and ambiguity around decision-making, treatment experience and outcomes; with high threat to life, identity and relationships. This occurs alongside high symptom burden from pre-existing morbidity of end-stage respiratory disease and lung transplantation itself. Lung transplantation patients experience psychosocial concerns throughout the trajectory that evolve over time. Clinicians should ensure that patients are screened for psychosocial distress and needs regularly from commencement of transplant discussions, and offered tailored advice and support across the transplant trajectory.