Caregiver perspectives on the everyday medical and social needs of long-term pediatric liver transplant patients

OBJECTIVE: Using in-depth interviews, we sought to characterize the everyday medical and social needs of pediatric liver transplant caregivers to inform the future design of solutions to improve care processes. APPROACH & RESULTS: Participants (parents/caregivers of pediatric liver transplant recipients) completed a survey (assessing socioeconomic status, economic hardship, health literacy, and social isolation). We then asked participants to undergo a 60-minute virtual, semi-structured qualitative interview to understand the everyday medical and social needs of the caregiver and their household. We intentionally oversampled caregivers who reported a social or economic hardship on the survey. Transcripts were analyzed using thematic analysis and organized around the Capability, Opportunity, Motivation-Behavior model. A total of 18 caregivers participated. 50% of participants reported some form of financial strain and about half had less than 4‚Äâyears of college education. Caregivers had high motivation and capability in executing transplant-related tasks but identified several opportunities for improving care. Caregivers perceived the health system to lack capability in identifying and intervening on specific family social needs. Caregiver interviews revealed multiple areas in which family supports could be strengthened, including around (1) managing indirect costs of prolonged hospitalizations (e.g., food and parking), (2) communicating with employers to support families' needs, (3) coordinating care across hospital departments, (4) clarifying care team roles around helping families reduce both medical and social barriers. CONCLUSIONS: This study highlights the caregiver perspective on barriers and facilitators to post-transplant care. Future work should identify whether these themes are present across transplant centers. Caregiver perspectives should help inform future interventions aimed at improving long-term outcomes for children after liver transplantation.