A Mixed Method Pilot Feasibility Study of a Symptom Management Support Intervention for Heart Transplant Recipients With Chronic Pain and Extensive Symptom Distress

BACKGROUND: The aim of heart transplantation is prolonged survival and improved quality of life. Chronic pain is a common and distressing symptom after heart transplantation. To our knowledge, there are no person-centred interventions aimed at chronic pain and symptom distress after heart transplantation. The aim was to assess the feasibility and acceptability of systematic, person-centred symptom management support for heart recipients with chronic pain to reduce symptom distress. METHODS: A mixed method prospective pilot feasibility study. A one-group, pre-test/post-test design examined the effect of a symptom management support intervention by means of three consecutive 1-h person-centred supportive conversations about the heart recipient's experienced ability to manage her or his symptoms, self-efficacy and transplant-specific well-being. In total, 13 participants completed the intervention, 7 women and 6 men, with a mean age of 54.38 years. The feasibility was evaluated by semi-structured interviews analysed after the intervention in accordance with phenomenological hermeneutics, while four different instruments were used to quantitatively evaluate pain, self-efficacy, person-centeredness and transplant-specific well-being both before and after the intervention. RESULTS: The intervention constituted a profound experience of being taken seriously based on four themes. The heart recipients experienced both sameness and otherness through reduced asymmetry in the caring encounter; thus, their dignity as persons capable of interpreting their own health was restored. Transplant-specific well-being improved clinically after the intervention, while basic activities of daily life improved significantly (p = 0.014). Although there was no change in self-efficacy, the self-rated experience of being taken seriously improved. There was a moderate relationship between transplant-specific well-being and self-efficacy before the intervention, rho 0.52 (p = 0.066) and a strong relationship after the intervention, rho 0.84 (p = 0.001). CONCLUSION: Three 1-h consecutive person-centred conversations to support symptom management after heart transplantation constitute a relevant, feasible and effective intervention.