Date of Award

Fall 11-13-2021

Degree Type

Thesis

Degree Name

Doctor of Social Work (DSW)

First Advisor

Phyllis Solomon

Second Advisor

Robert Weinrieb

Abstract

Objective: The purpose of this exploratory pilot social work telemedicine study was to assess feasibility and preliminary outcomes as to whether Symptom Targeted Intervention (STI) was more effective in decreasing the symptoms of anxiety and depression, stress and alcohol use than social work monitoring and care coordination (SWCC) for the early liver transplant population (< 6 months). Assessing stress as an outcome measure is unique in the early post liver transplant research.

Methods: Twenty-seven early post liver transplant patients at Penn Medicine prescreened into the pilot randomized control trial and twenty-one were subsequently randomized into two groups, STI versus SWCC. Twenty-one completed pre and post measures, including Demographics, Quick Drinking Screen (QDS), Depression Anxiety Stress Scale (DASS-21) and Hospital Anxiety and Depression Scale (HADS). Due to the small sample size, and an inability to control for differences in higher screening scores in the treatment group, an exploratory analysis was conducted. This exploratory analyses utilized repeated measures t-tests to assess changes in the treatment and control group separately on DASS and HADS measures. Alcohol was not analyzed due to the lack of positive cases. Feasibility was measured by recruitment and attrition rate, completed sessions, patient engagement, along with social work fidelity and engagement.

Results: Feasibility measures were indicative of a promising pilot study, with ability to recruit a sample and 100% retention, 21 participants completing at least three and 17 completing six consecutive sessions, along with the posttests. Random observations matched weekly theme at 100% with 42.5 hours of total patient engagement. Evidence for the effectiveness of STI versus SWCC in the early liver transplant period to decrease stress and depression was found in the patterns of differences between groups at pre-test and post-test. The treatment group (n=10) but not the control group (n=11) showed a significant reduction in stress at post-test, with the treatment group’s mean stress score ~4 points lower at post-test than it was at pre-test [t(10)=3.58, p=0.003] while the control group’s post-test score was 2.36 points lower than at pre-test [t(11)=1.90, p=0.09]. Additionally, the control group increased in depression between pre and post while the treatment group decreased in depression, demonstrating a trend. Decreases in anxiety occurred in both groups measured by DASS. HADS anxiety results not significant, although arguably promising for STI group.

Conclusion: This pilot study demonstrates promising preliminary results in decreasing stress and depression. The feasibility findings of this study demonstrate the ability to implement STI for early post liver transplant patients by Master’s degree prepared transplant social workers and being delivered with encouraging results.

Available for download on Saturday, November 26, 2022

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