Self-Transcendence, Illness Distress, and Quality of Life among Liver Transplant Recipients
Bean, Kathy B. PhD, Rn, Cgrn, Aprn, Bc, Wagner, Kim Bsn, Rn, Ocn, Journal of Theory Construction and Testing
Liver transplantation is the treatment of choice for chronic liver disease. While quality of life has been reported to increase following liver transplantation, living with a transplanted organ offers many challenges to recipients including the spiritual challenge of finding meaning and purpose in the transplant experience. Self-transcendence, a complex developmental process reflecting spiritual growth and maturity, is associated with positive life outcomes. The purpose of this correlational cross-sectional design study (N = 471) was to explore relationships between self-transcendence and quality of life, illness distress, and selected demographic variables in liver transplant recipients.
Significant relationships were noted between self-transcendence and quality of life (r = .51), illness distress (r = - .36), self-reported health status (tau = .28), female gender (tau = .11), being employed (tau = .11), and time-since-transplant (r = -.11). Females reported higher self-transcendence scores across all time-since-transplant groups. Results suggest self-transcendence views and behaviors, which develop during the crisis of liver transplantation, may facilitate positive outcomes.
Key Words: end-of-own life experiences; liver transplantation; quality of life; spirituality; self-transcendence
Although liver transplantation is the only curative treatment for chronic liver disease, the experience of receiving a liver transplant is an overwhelming and frightening experience. Prior to transplantation, the individual faces the reality of impending death. Following transplantation, the transplant recipient must still face the possibility of organ rejection or associated complications that can still result in early death. As a result, liver transplant recipients often grapple with their mortality, leading to a heightened awareness of their spirituality (Thomas, 1993). The transplant recipient also struggles with the spiritual challenge of finding meaning and purpose in their transplant experience.
Self-transcendence is associated with positive life outcomes, particularly in people near the end of life (Chinen, 1986; Coward, 1990, 1991, 1994; Coward & Reed, 1996; Mellors, Riley, & Erlen, 1997; Reed, 1987, 1991b). Spiritual awareness precipitated by a life crisis or life challenge, such as liver failure, is theorized to precipitate the process of self-transcendence. Coward and Kahn (2005) found the loss of good health and fear of dying from cancer forced women diagnosed with breast cancer to "reach both inside and outside of themselves" to make meaning of their experience. Little is known, however, about the experience of self-transcendence in liver transplant recipients.
Illness distress associated with liver disease and transplantation involves every aspect of the individual's life (physical, psychological, social, and spiritual) and impacts the individual's quality of life, an important outcome measure of life satisfaction and well-being. Research has verified many liver transplant recipients experience a high level of quality of life following transplantation (Bravata & Keeffe, 2001; Karam et al., 2003; Kizilisik et al., 2003; Younossi et al., 2000). Studies regarding quality of life in the liver transplant population, however, are varied and difficult to compare due to differences in conceptualization and measurement of quality of life. As a result, explanations regarding the important influences on quality of life in liver transplant recipients remain unclear.
Spiritual domain issues are important to quality of life in other patient populations with advanced disease. For instance, self-transcendence is particularly relevant to quality of life during end-of-life experiences (Chinen, 1986; Coward, 1990, 1994; Haase, Britt, Coward, Kline Leidy, & Penn, 1992; Hanna, Giordano, Dupuy, & Puhakka, 1995; Mellors, Riley, & Erlen, 1997; Reed, 1991b). Because liver transplant recipients face impending death and an opportunity for continued life through receiving a transplanted organ, they may not demonstrate the same relationship between self-transcendence and quality of life. …