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Schulz T, Niesing J, Homan van der Heide JJ, Westerhuis R, Ploeg RJ, Ranchor AV. Changes of perceived control after kidney transplantation: a prospective study. J Adv Nurs 2017; 73:1712-1721. [PMID: 28122152 DOI: 10.1111/jan.13263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to determine if kidney transplantation is associated with increases of perceived control and how changes of perceived control affect the course of psychological distress until 1 year after transplantation. BACKGROUND Low levels of perceived control are associated with reduced well-being among dialysis patients. DESIGN Prospective longitudinal cohort study. METHODS Perceived control (Mastery Scale) and psychological distress (GHQ-12) were prospectively assessed before (T0; n = 470) and three (T1; n = 197), six (T2; n = 210) and twelve (T3; n = 183) months after transplantation. Differences between T1 and T0 perceived control were used to stratify the sample into three groups (control gain, stable control and control loss). Socio-demographic and clinical variables, including complications, were examined as potential correlates and the course of psychological was distress compared across groups. Data were collected between July 2008 - July 2013. RESULTS Perceived control showed a small increase overall, with 35·1%, 50·0% and 14·9% reporting gain, stable level and loss respectively. Patients with secondary schooling were overrepresented in the control loss group. The course of psychological distress varied across perceived control change groups, with patients in the control gain group experiencing a significant reduction in psychological distress. CONCLUSION A considerable number of patients report increased levels of perceived control after transplantation that are associated with a subsequent decrease in psychological distress. Results emphasize the importance of perceived control and could inform interventions to facilitate well-being after kidney transplantation.
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Affiliation(s)
- Torben Schulz
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Jan Niesing
- Department of Abdominal Surgery, University Medical Center Groningen, The Netherlands
| | | | | | - Rutger J Ploeg
- Nuffield Department of Surgical Sciences, Oxford Transplant Centre, Churchill Hospital, UK
| | - Adelita V Ranchor
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands
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Gibson EL, Held I, Khawnekar D, Rutherford P. Differences in Knowledge, Stress, Sensation Seeking, and Locus of Control Linked to Dietary Adherence in Hemodialysis Patients. Front Psychol 2016; 7:1864. [PMID: 27965605 PMCID: PMC5126042 DOI: 10.3389/fpsyg.2016.01864] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 11/10/2016] [Indexed: 02/01/2023] Open
Abstract
Patients with chronic kidney disease (CKD) often require regular hemodialysis (HD) to prolong life. However, between HD sessions, patients have to restrict their diets carefully to avoid excess accumulation of potassium, phosphate, sodium, and fluid, which their diseased kidneys can no longer regulate. Failure to adhere to their renal dietary regimes can be fatal; nevertheless, non-adherence is common, and yet little is known about the psychological variables that might predict this dietary behavior. Thus, this study aimed to assess whether dietary adherence might be affected by a variety of psychological factors including stress, personality, and health locus of control, as well as dietary knowledge, in chronic HD patients. Fifty-one patients (30 men; age range 25-85) who had undergone HD for at least 3 months and had been asked to restrict at least one of potassium, phosphate or fluid, were recruited from a hospital renal unit. Measures of adherence to each of potassium, phosphate, and fluid were derived from standard criteria for these physiological indices in renal patients. Knowledge of food/drink sources of these dietary factors, and their medical implications in relation to HD and CKD were assessed by a bespoke questionnaire. Psychological factors including stress, personality and health locus of control beliefs were measured by standardized questionnaires. Having to restrict a particular nutrient was associated with better knowledge of both food sources and medical complications for that nutrient; however, greater dietary knowledge was not linked to adherence, and knowledge of medical complications tended to be associated with poorer adherence to potassium and phosphate levels. Adherence to these two nutrient requirements was also associated with lower reported stress in the past week. Adherence was associated with differences in locus of control: these differences varied across indices although there was a tendency to believe in external loci. For potassium, phosphate, and fluid restriction, adherers were less likely to be sensation seekers but did not differ from non-adherers on impulsivity, anxiety sensitivity, or hopelessness. In conclusion, the links between dietary adherence and stress, locus of control and personality suggests that screening for such psychological factors may assist in managing adherence in HD patients.
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Affiliation(s)
- E Leigh Gibson
- Department of Psychology, Whitelands College, University of Roehampton London, UK
| | - Ines Held
- Renal Unit, Wrexham Maelor Hospital Wrexham, UK
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Alosaimi FD, Asiri M, Alsuwayt S, Alotaibi T, Bin Mugren M, Almufarrih A, Almodameg S. Psychosocial predictors of nonadherence to medical management among patients on maintenance dialysis. Int J Nephrol Renovasc Dis 2016; 9:263-272. [PMID: 27826207 PMCID: PMC5096770 DOI: 10.2147/ijnrd.s121548] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A number of reports suggest a link between depression and nonadherence to recommended management for end-stage renal disease (ESRD) patients on maintenance dialysis. However, the relationship between nonadherence and other psychosocial factors have been inadequately examined. OBJECTIVES To examine the prevalence of psychosocial factors including depression, anxiety, insecure attachment style, as well as cognitive impairment and their associations with adherence to recommended management of ESRD. METHODS A cross-sectional observational study was carried out from 2014 to 2015. Chronic dialysis patients were recruited conveniently from four major dialysis units in Riyadh, Saudi Arabia. Nonadherence was defined as decreased attendance in dialysis sessions, failure to take prescribed medications, and/or follow food/fluid restrictions and exercise recommendations. RESULTS A total of 234 patients (147 males and 87 females) were included in this analysis, with 45 patients (19.2%) considered as nonadherent (visual analog scale < 8). Approximately 17.9% of the patients had depression (Patient Health Questionnaire score ≥10), 13.2% had anxiety (Hospital Anxiety and Depression scale-anxiety >7), while 77.4% had cognitive impairment (Montreal Cognitive Assessment score <26). Nonadherence was significantly associated with depression and anxiety (p<0.001 for both) but not cognitive impairment (p=0.266). The Experiences in Close Relationships - Modified 16 (ECR-M16) scale score was 27.99±10.87 for insecure anxiety and 21.71±9.06 for insecure avoidance relationship, with nonadherence significantly associated with anxiety (p=0.001) but not avoidance (p=0.400). CONCLUSION Nonadherence to different aspects of ESRD continues to be a serious problem among dialysis patients, and it is closely linked to depression and anxiety. The findings from this study reemphasize the importance of early detection and management of psychosocial ailments in these patients.
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Affiliation(s)
| | - Mohammed Asiri
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saleh Alsuwayt
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Tariq Alotaibi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Saad Almodameg
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Taylor F, Hare J, Combes G. Exploring patients' attitudes to different intervention approaches for supporting psychosocial needs. J Ren Care 2016; 42:212-222. [PMID: 27753287 DOI: 10.1111/jorc.12182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many patients with end-stage kidney disease (ESKD) have significant psychosocial needs as a consequence of their illness and treatment. Unmet needs can impact negatively on their health and well-being. Patients want improved psychosocial support particularly in relation to coping and adjustment. Little is known about the relevance and applicability to patients of intervention approaches to support their psychosocial needs. OBJECTIVES To explore patients' attitudes to different intervention approaches that could be developed to help them cope with the psychosocial stressors of ESKD, and to assess the potential acceptability of these approaches. METHODS AND MATERIALS Qualitative interviews and mini-focus groups were undertaken with 15 patients who have ESKD. Different intervention approaches were shown to participants through use of audio-visual films. Constant comparative data analysis was employed to derive a framework of categories and themes, guided by stress and coping theory. RESULTS Psychosocial support was viewed by patients as an essential constituent of quality care. While some intervention approaches were more or less popular than others, responses were overall variable and individualistic, seemingly influenced by participants' personal coping strategies. Any perceived connection with depression could make an intervention approach less attractive; physical exercise was particularly acceptable because there was no explicit association with someone not coping. CONCLUSIONS There is value in clinicians making available a choice of appropriately timed and tailored interventions to meet patients' different psychosocial support needs at key points of distress across the ESKD pathway. Congruence between intervention features and patient coping style could stimulate interest and take-up.
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Affiliation(s)
- Francesca Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jennifer Hare
- Royal Wolverhampton NHS Trust, Renal Psychology Service, New Cross Hospital, Wolverhampton, UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Psychosocial Factors in End-Stage Kidney Disease Patients at a Tertiary Hospital in Australia. Int J Nephrol 2016; 2016:2051586. [PMID: 27807482 PMCID: PMC5078664 DOI: 10.1155/2016/2051586] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/02/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
Aim. This study seeks to review the psychosocial factors affecting patients with end-stage kidney disease (ESKD) from a tertiary hospital in Australia. Methods. We audited patients with ESKD, referred to social work services from January 2012 to December 2014. All patients underwent psychosocial assessments by one, full-time renal social worker. Patient demographics, cumulative social issues, and subsequent interventions were recorded directly into a database. Results. Of the 244 patients referred, the majority were >60 years (58.6%), male (60.7%), born in Australia (62.3%), on haemodialysis (51.6%), and reliant on government financial assistance (88%). Adjustment issues (41%), financial concerns (38.5%), domestic assistance (35.2%), and treatment nonadherence (21.3%) were the predominant reasons for social work consultation. Younger age, referral prior to start of dialysis, and unemployment were significant independent predictors of increased risk of adjustment issues (p = 0.004, <0.001, and =0.018, resp.). Independent risk factors for treatment nonadherence included age and financial and employment status (p = 0.041, 0.052, and 0.008, resp.). Conclusion. Psychosocial and demographic factors were associated with treatment nonadherence and adjustment difficulties. Additional social work support and counselling, in addition to financial assistance from government and nongovernment agencies, may help to improve adjustment to the diagnosis and treatment plans as patients approach ESKD.
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Ruiz García E, Latorre López LI, Delgado Ramírez A, Crespo Montero R, Sánchez Laguna JL. Adherencia al tratamiento farmacológico de los pacientes en hemodiálisis. ENFERMERÍA NEFROLÓGICA 2016. [DOI: 10.4321/s2254-28842016000300005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introducción: La mala adherencia a largo plazo es reconocida como uno de los principales problemas clínicos en la gestión de las enfermedades crónicas, y en concreto de la enfermedad renal crónica avanzada.
Objetivo: Conocer la producción científica sobre el grado de adherencia al tratamiento farmacológico en pacientes en hemodiálisis.
Metodología: Se ha realizado una revisión sistemática no metaanalítica mediante una búsqueda en las bases de datos de Scielo, PubMed y Google Académico. Se incluyeron artículos escritos en inglés y español. Se analizaron los artículos que trataban la adherencia al tratamiento en pacientes en hemodiálisis.
Resultados: Se han revisado 19 artículos, 6 revisiones y 13 estudios observacionales, publicados entre el 2007 y 2015. Se estudiaron variables sociodemográficas: edad, género, nivel socioeconómico y estudios, estado civil, raza y situación laboral; variables clínicas y psicosociales y, factores relacionados con la medicación. Se encontró que entre 15-72% de los pacientes en hemodiálisis presentan falta de adherencia al tratamiento farmacológico. La depresión se encuentra asociada a la falta de adherencia. La edad se asocia a mayor adherencia.
Conclusiones: Los pacientes en hemodiálisis presentan con frecuencia falta de adherencia al tratamiento farmacológico, aunque con una gran variabilidad,debido a las diferencias en la definición y medición de la falta de adherencia. La depresión parece ser el predictor más influyente en la falta de adhesión. Los factores demográficos y clínicos no están consistentemente asociados con la falta de adherencia, a excepción de la edad, siendo los pacientes de mayor edad los que presentan mayor adherencia.
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Norton JM, Moxey-Mims MM, Eggers PW, Narva AS, Star RA, Kimmel PL, Rodgers GP. Social Determinants of Racial Disparities in CKD. J Am Soc Nephrol 2016; 27:2576-95. [PMID: 27178804 PMCID: PMC5004663 DOI: 10.1681/asn.2016010027] [Citation(s) in RCA: 190] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Significant disparities in CKD rates and outcomes exist between black and white Americans. Health disparities are defined as health differences that adversely affect disadvantaged populations, on the basis of one or more health outcomes. CKD is the complex result of genetic and environmental factors, reflecting the balance of nature and nurture. Social determinants of health have an important role as environmental components, especially for black populations, who are disproportionately disadvantaged. Understanding the social determinants of health and appreciating the underlying differences associated with meaningful clinical outcomes may help nephrologists treat all their patients with CKD in an optimal manner. Altering the social determinants of health, although difficult, may embody important policy and research efforts, with the ultimate goal of improving outcomes for patients with kidney diseases, and minimizing the disparities between groups.
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Affiliation(s)
- Jenna M Norton
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Marva M Moxey-Mims
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul W Eggers
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Andrew S Narva
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Robert A Star
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul L Kimmel
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Griffin P Rodgers
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland Office of the Director and
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Taylor F, Taylor C, Baharani J, Nicholas J, Combes G. Integrating emotional and psychological support into the end-stage renal disease pathway: a protocol for mixed methods research to identify patients' lower-level support needs and how these can most effectively be addressed. BMC Nephrol 2016; 17:111. [PMID: 27484760 PMCID: PMC4971672 DOI: 10.1186/s12882-016-0327-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/28/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND As a result of difficulties related to their illness, diagnosis and treatment, patients with end-stage renal disease experience significant emotional and psychological problems, which untreated can have considerable negative impact on their health and wellbeing. Despite evidence that patients desire improved support, management of their psychosocial problems, particularly at the lower-level, remains sub-optimal. There is limited understanding of the specific support that patients need and want, from whom, and when, and also a lack of data on what helps and hinders renal staff in identifying and responding to their patients' support needs, and how barriers to doing so might be overcome. Through this research we therefore seek to determine what, when, and how, support for patients with lower-level emotional and psychological problems should be integrated into the end-stage renal disease pathway. METHODS/DESIGN The research will involve two linked, multicentre studies, designed to identify and consider the perspectives of patients at five different stages of the end-stage renal disease pathway (Study 1), and renal staff working with them (Study 2). A convergent, parallel mixed methods design will be employed for both studies, with quantitative and qualitative data collected separately. For each study, the data sets will be analysed separately and the results then compared or combined using interpretive analysis. A further stage of synthesis will employ data-driven thematic analysis to identify: triangulation and frequency of themes across pathway stages; patterns and plausible explanations of effects. DISCUSSION There is an important need for this research given the high frequency of lower-level distress experienced by end-stage renal disease patients and lack of progress to date in integrating support for their lower-level psychosocial needs into the care pathway. Use of a mixed methods design across the two studies will generate a holistic patient and healthcare professional perspective that is more likely to identify viable solutions to enable implementation of timely and integrated care. Based on the research outputs, appropriate support interventions will be developed, implemented and evaluated in a linked follow-on study.
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Affiliation(s)
- Francesca Taylor
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Celia Taylor
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS UK
| | - Johann Nicholas
- Renal Unit, New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP UK
| | - Gill Combes
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
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59
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Hudson JL, Moss-Morris R, Game D, Carroll A, Chilcot J. Improving Distress in Dialysis (iDiD): A tailored CBT self-management treatment for patients undergoing dialysis. J Ren Care 2016; 42:223-238. [DOI: 10.1111/jorc.12168] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Joanna L. Hudson
- Health Psychology Section; Institute of Psychiatry; Psychology and Neuroscience; King's College London UK
| | - Rona Moss-Morris
- Health Psychology Section; Institute of Psychiatry; Psychology and Neuroscience; King's College London UK
| | - David Game
- Renal Medicine; Guy's and St. Thomas’ NHS Foundation Trust; London UK
| | - Amy Carroll
- Renal Medicine; Guy's and St. Thomas’ NHS Foundation Trust; London UK
| | - Joseph Chilcot
- Health Psychology Section; Institute of Psychiatry; Psychology and Neuroscience; King's College London UK
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60
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Jayanti A, Foden P, Wearden A, Mitra S. Illness Beliefs in End Stage Renal Disease and Associations with Self-Care Modality Choice. PLoS One 2016; 11:e0154299. [PMID: 27368055 PMCID: PMC4930164 DOI: 10.1371/journal.pone.0154299] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background Interest in self-care haemodialysis (HD) has increased because it improves patients’clinical and quality-of-life outcomes. Patients who undertake self-management for haemodialysis may hold illness beliefs differently to those choosing institutional care at the time of making the modality choice or moulded by their illness and dialysis treatment experience. Illness perceptions amongst predialysis patients and in those undertaking fully-assisted and self-care haemodialysis are being investigated in a combined cross-sectional and longitudinal study. Study Design The study data are derived from the BASIC-HHD study, a multicentre observational study on factors influencing home haemodialysis uptake. 535 patients were enrolled into three groups: Predialysis CKD-5 group, prevalent ‘in-centre’ HD and self-care HD groups (93% at home). We explore illness perceptions in the cross-sectional analyses of the three study groups, using the revised Illness Perception Questionnaire (IPQ-R). Predialysis patients’ illness beliefs were reassessed prospectively, typically between 4 and 12 months after dialysis commencement. Results Illness belief subscales are significantly different between in-centre and self-care HD groups. In a step-wise hierarchical regression analysis, after adjustment for age, education, marital status, diabetes, dialysis vintage, depression, anxiety scores, and IPQ-R subscales, personal control (p = 0.01) and illness coherence (p = 0.04) are significantly higher in the self-care HD group. In the predialysis group, no significant associations were found between illness representations and modality choices. In prospectively observed predialysis group, scores for personal control, treatment control, timeline cyclical and emotional representations reduced significantly after commencing dialysis and increased significantly for illness coherence. Conclusions Illness beliefs differ between hospital and self-care haemodialysis patients. Patient’s affect and neurocognitive ability may have an important role in determining illness beliefs. The impact of modality upon illness representations may also be significant and remains to be explored.
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Affiliation(s)
- Anuradha Jayanti
- Department of Nephrology, Central Manchester Hospitals NHS Trust, Manchester, United Kingdom
- * E-mail:
| | - Philip Foden
- Department of Biostatistics, University of Manchester, Manchester, United Kingdom
| | - Alison Wearden
- School of Psychological Sciences, University of Manchester, Manchester, United Kingdom
| | - Sandip Mitra
- Department of Nephrology, Central Manchester Hospitals NHS Trust, Manchester, United Kingdom
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Freire de Medeiros CMM, Arantes EP, Tajra RDDP, Santiago HR, Carvalho AF, Libório AB. Resilience, religiosity and treatment adherence in hemodialysis patients: a prospective study. PSYCHOL HEALTH MED 2016; 22:570-577. [DOI: 10.1080/13548506.2016.1191658] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Taylor F, Combes G, Hare J. Improving clinical skills to support the emotional and psychological well-being of patients with end-stage renal disease: a qualitative evaluation of two interventions. Clin Kidney J 2016; 9:516-24. [PMID: 27274842 PMCID: PMC4886913 DOI: 10.1093/ckj/sfw017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Accepted: 02/25/2016] [Indexed: 11/13/2022] Open
Abstract
Background Many patients with end-stage renal disease (ESRD) need and want improved emotional and psychological support. Explicit attention to patients' emotional issues during consultations can help, yet renal consultants rarely address emotional problems. This qualitative study aimed to evaluate whether two different low-cost interventions could individually enable consultants to talk with patients about their emotional concerns during routine outpatient consultations. Method One intervention involved patients using a Patient Issues Sheet to identify two to three issues they would like to talk about in their consultation and the second involved consultants asking patients a direct question about their emotional feelings. Consultants were trained to handle any emotional issues raised. Semi-structured interviews were conducted with five consultants and 36 ESRD patients from two UK renal units. Interviews were transcribed verbatim and analysed using the constant comparative method. Results Although consultants and patients tended to use the two interventions in different ways, they expressed generally positive views about how helpful the interventions were in promoting discussion of emotional issues. Consultants appreciated the training for facilitating empathetic handling of patients' emotional disclosures and containment of discussion. Most patients who raised emotional concerns were satisfied with their consultant's responses, while others were dissuaded from more explicit discussion by their consultant's concentration on physical considerations. Conclusions These qualitative study findings suggest that both interventions are feasible and acceptable and have the potential to help consultants improve emotional and psychological patient care, providing cognitive and behavioural tools to enable discussion of emotional issues during routine outpatient consultations.
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Affiliation(s)
- Francesca Taylor
- Institute of Applied Health , University of Birmingham , Birmingham , UK
| | - Gill Combes
- Institute of Applied Health , University of Birmingham , Birmingham , UK
| | - Jennifer Hare
- Royal Wolverhampton NHS Trust, Renal Psychology Service, New Cross Hospital , Wolverhampton , UK
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63
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Howren MB, Kellerman QD, Hillis SL, Cvengros J, Lawton W, Christensen AJ. Effect of a Behavioral Self-Regulation Intervention on Patient Adherence to Fluid-Intake Restrictions in Hemodialysis: a Randomized Controlled Trial. Ann Behav Med 2016; 50:167-76. [PMID: 26631085 PMCID: PMC7362302 DOI: 10.1007/s12160-015-9741-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study is to evaluate the efficacy of a behavioral self-regulation intervention vs. active control condition using a parallel-group randomized clinical trial with a sample of center hemodialysis patients with chronic kidney disease. METHOD Participants were recruited from 8 hemodialysis treatment centers in the Midwest. Eligible patients were (a) fluid nonadherent as defined by an interdialytic weight gain >2.5 kg over a 4-week period, (b) >18 years of age, (c) English-speaking without severe cognitive impairment, (d) treated with center-based hemodialysis for >3 months, and (e) not living in a care facility in which meals were managed. Medical records were used to identify eligible patients. Patients were randomly assigned to either a behavioral self-regulation intervention or active control condition in which groups of 3-8 patients met for hour-long, weekly sessions for 7 weeks at their usual hemodialysis clinic. Primary analyses were intention-to-treat. RESULTS Sixty-one patients were randomized to the intervention while 58 were assigned to the attention-placebo support and discussion control. Covariate-adjusted between-subjects analyses demonstrated no unique intervention effect for the primary outcome, interdialytic weight gain (β = 0.13, p = 0.48). Significant within-subjects improvement over time was observed for the intervention group (β = -0.32, p = 0.014). CONCLUSIONS The present study found that participation in a behavioral self-regulation intervention resulted in no unique intervention effect on a key indicator of adherence for those with severe chronic kidney disease. There was, however, modest within-subjects improvement in interdialytic weight gain for the intervention group which meshes with other evidence showing the utility of behavioral interventions in this patient population. ClinicalTrials.gov Identifier: NCT01066949.
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Affiliation(s)
- M Bryant Howren
- VA Iowa City Healthcare System, Iowa City, IA, USA
- Department of Psychology, The University of Iowa, Iowa City, IA, USA
| | | | - Stephen L Hillis
- VA Iowa City Healthcare System, Iowa City, IA, USA
- Departments of Radiology and Biostatistics, The University of Iowa, Iowa City, IA, USA
| | | | - William Lawton
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Alan J Christensen
- Departments of Psychology and Internal Medicine, The University of Iowa, 11 Seashore Hall East, Iowa City, IA, 52242, USA.
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Taylor JM, Oladitan L, Degnan A, Henderson S, Dai H, Warady BA. Psychosocial Factors That Create Barriers to Managing Serum Phosphorus Levels in Pediatric Dialysis Patients: A Retrospective Analysis. J Ren Nutr 2016; 26:270-5. [PMID: 26993357 DOI: 10.1053/j.jrn.2016.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 02/03/2016] [Accepted: 02/06/2016] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Abnormal phosphorus homeostasis is among the medley of metabolic disturbances commonly associated with chronic kidney disease. We sought to determine the psychosocial factors that create barriers to controlling serum phosphorus levels in children on dialysis and to evaluate the perceptions of children and caregivers on the ease or difficulty of following a dietary phosphorus restriction and taking phosphorus binder medications. DESIGN Single center cross-sectional study. SETTING Pediatric dialysis unit at a children's hospital. SUBJECTS Forty-eight patients on chronic hemodialysis or peritoneal dialysis (mean age: 11.03 ± 6.88 years; 69% male). MAIN OUTCOME MEASURE Serum phosphorus levels were recorded from electronic health records and converted to a mean phosphorus standard deviation score (SDS) for each individual. Mean phosphorus SDS values were compared to each independent categorical variable using an analysis of variance test, continuous variables were analyzed using linear regression, and logistic regression was used to determine odds ratios. RESULTS There was a significant relationship between age and phosphorus SDS (P < .001), with patients over 13 years of age having the highest prevalence of hyperphosphatemia (88%). Patients and caregivers who identified phosphorus levels as "controlled" had lower phosphorus SDS values compared to the other subjects (P = .003). However, of the patients and caregivers who reported that serum phosphorus levels were "controlled," 46% were hyperphosphatemic. Furthermore, 73% and 87% of patients and caregivers reported that following a phosphorus-restricted diet and taking phosphorus binders were "easy"; yet, 40% and 49% of these patients were hyperphosphatemic, respectively. CONCLUSION In the present study, elevated serum phosphorus levels were most common in adolescent dialysis patients. There also appears to be a disconnect between the perceived ease of following a phosphorus-restricted diet and taking phosphorus binders and the achievement of normal serum phosphorus levels. These data further emphasize the importance of ongoing education regarding dietary and medical management requirements.
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Affiliation(s)
- Jacob M Taylor
- Department of Nutrition Services, Children's Mercy Hospital, Kansas City, Missouri 64108; KU Department of Dietetics & Nutrition, School of Health Professions, University of Kansas Medical Center, Kansas City, Kansas 66160.
| | - Leah Oladitan
- Department of Nutrition Services, Children's Mercy Hospital, Kansas City, Missouri 64108
| | - Angela Degnan
- Department of Social Work, Children's Mercy Hospital, Kansas City, Missouri 64108
| | - Sarah Henderson
- Department of Social Work, Children's Mercy Hospital, Kansas City, Missouri 64108
| | - Hongying Dai
- Department of Health Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri 64108
| | - Bradley A Warady
- Division of Pediatric Nephrology, Children's Mercy Hospital, Kansas City, Missouri 64108
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Howren MB, Cozad AJ, Christensen AJ. The interactive effects of patient control beliefs on adherence to fluid-intake restrictions in hemodialysis: Results from a randomized controlled trial. J Health Psychol 2016; 22:1642-1651. [PMID: 26908586 DOI: 10.1177/1359105316631813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined the interactive role of perceived control and preference for control on adherence in a sample of patients with chronic kidney disease. As part of a randomized controlled trial assessing adherence to fluid-intake restrictions, 119 hemodialysis patients completed measures of these constructs; results indicated that patients with high perceived control and high preference for control demonstrated the most favorable adherence. This suggests that patients who believe health-related outcomes are a function of one's own behaviors-and having the opportunity to exert control over aspects of treatment-may be most adherent to complex regimens in which self-management is key.
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Affiliation(s)
- M Bryant Howren
- 1 VA Iowa City Healthcare System, USA.,2 The University of Iowa, USA
| | - Ashley J Cozad
- 1 VA Iowa City Healthcare System, USA.,2 The University of Iowa, USA
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Descombes E, Martins F, Hemett OM, Erard V, Chuard C. Three-times-weekly, post-dialysis cefepime therapy in patients on maintenance hemodialysis: a retrospective study. BMC Pharmacol Toxicol 2016; 17:4. [PMID: 26846675 PMCID: PMC4743204 DOI: 10.1186/s40360-016-0048-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/27/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In hemodialysis patients, post-dialysis treatment with intravenous antibiotics permits even severe infections to be managed on an outpatient basis. Cefepime is a fourth-generation cephalosporin with a broad spectrum of action in monotherapy. We report on the pharmacokinetics of cefepime in post-dialysis therapy. METHODS Since June 2012, twelve infections were treated with post-dialysis cefepime in 9 patients on high-flux hemodialysis. The initial post-dialysis dose of cefepime was approximately 15 mg/kg. The following doses were adapted according to the trough serum levels obtained before the subsequent dialysis in order to be above the EUCAST breakpoints for susceptible organisms and above the MIC90. Residual plasma concentrations were determined before (n = 30) and after (n = 17) dialysis by liquid chromatography-mass spectrometry. RESULTS Overall, the mean ± SD dose of cefepime was 920 ± 270 mg (14.5 ± 5.1 mg/kg), but it was significantly lower before the 48 h interval (775 ± 210 mg or 12.7 ± 4.5 mg/kg) compared to the 72 h interval (1125 ± 225 mg or 17.2 ± 4.9 mg/kg) (p < 0.05). The mean trough pre-dialysis concentrations were 10.7 ± 3.9 mg/l and 11.3 ± 5.6 mg/l at 48 and 72 h, respectively. These levels always largely exceeded the EUCAST susceptibility breakpoints for all the targeted bacteria (>1 mg/l) with the exception of Pseudomonas aeruginosa (>8 mg/l). Cefepime concentrations were higher in anuric patients compared to those with preserved diuresis (15.6 ± 3.5 vs 9.25 ± 3.6 mg/l; p < 0.001) and decreased on average by 81 % during dialysis (from 10.5 ± 3.7 to 1.96 ± 1.2 mg/l; p < 0.001). The clinical outcome of all patients was good. CONCLUSIONS Outpatient treatment with cefepime administered post-dialysis three-times-weekly was effective and well-tolerated in our patients. According to our data, in patients infected by highly susceptible pathogens a fixed dose of cefepime of 1 g before every 48-h interval and of 1.5 g before every 72-h interval should be recommended, without need of routine monitoring of the cefepime blood levels. In patients having an infection with less susceptibles pathogens as P. aeruginosa, and particularly in those among them exhibiting residual renal function, higher initial doses are necessary (1.5 g before a 48-h interval and 2.0 g before a 72-h interval) with adaption according to the subsequent pre-dialysis trough serum levels.
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Affiliation(s)
- Eric Descombes
- Service of Nephrology, Department of Internal Medicine, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
| | - Filipe Martins
- Service of Nephrology, Department of Internal Medicine, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
| | - Ould Maouloud Hemett
- Service of Nephrology, Department of Internal Medicine, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
| | - Veronique Erard
- Service of Infectious Diseases, Department of Internal Medicine, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
| | - Christian Chuard
- Service of Infectious Diseases, Department of Internal Medicine, HFR Fribourg-Hôpital Cantonal, Fribourg, Switzerland.
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Norton J. Health Disparities in Chronic Kidney Disease. PHYSICIAN ASSISTANT CLINICS 2016. [DOI: 10.1016/j.cpha.2015.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Vélez-Vélez E, Bosch RJ. Illness perception, coping and adherence to treatment among patients with chronic kidney disease. J Adv Nurs 2015; 72:849-63. [DOI: 10.1111/jan.12873] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Esperanza Vélez-Vélez
- Fundación Jiménez Díaz School of Nursing - UAM; Jimenez Díaz Foundation IDC salud; Madrid Spain
| | - Ricardo J. Bosch
- Department of Biological Systems/Physiology; Alcala School of Medicine; Universidad de Alcalá; Alcalá de Henares Spain
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Ghimire S, Castelino RL, Lioufas NM, Peterson GM, Zaidi STR. Nonadherence to Medication Therapy in Haemodialysis Patients: A Systematic Review. PLoS One 2015; 10:e0144119. [PMID: 26636968 PMCID: PMC4670103 DOI: 10.1371/journal.pone.0144119] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 11/15/2015] [Indexed: 11/19/2022] Open
Abstract
Background End-stage kidney disease (ESKD) patients are often prescribed multiple medications. Together with a demanding weekly schedule of dialysis sessions, increased number of medicines and associated regimen complexity pre-dispose them at high risk of medication nonadherence. This review summarizes existing literature on nonadherence and identifies factors associated with nonadherence to medication therapy in patients undergoing haemodialysis. Methods A comprehensive search of PubMed, Embase, CINAHL, PsycInfo, and Cochrane Database of Systematic Reviews covering the period from 1970 through November 2014 was performed following a predefined inclusion and exclusion criteria. Reference lists from relevant materials were reviewed. Data on study characteristics, measures of nonadherence, prevalence rates and factors associated with nonadherence were collected. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was followed in conducting this systematic review. Results Of 920 relevant publications, 44 were included. The prevalence of medication nonadherence varied from 12.5% to 98.6%, with widespread heterogeneity in measures and definitions employed. Most common patient-related factors significantly associated with nonadherence were younger age, non-Caucasian ethnicity, illness interfering family life, being a smoker, and living single and being divorced or widowed. Similarly, disease-related factors include longevity of haemodialysis, recurrent hospitalization, depressive symptoms and having concomitant illness like diabetes and hypertension. Medication-related factors such as daily tablet count, total pill burden, number of phosphate binders prescribed and complexity of medication regimen were also associated with poor adherence. Conclusions A number of patient-, disease-, and medication-related factors are associated with medication nonadherence in haemodialysis patients. Clinicians should be aware of such factors so that adherence to medications can be optimised in haemodialysis patients. Future research should be directed towards well-designed prospective longitudinal studies developing standard definitions and validating available measurement tools, while focusing on the role of additional factors such as psychosocial and behavioural factors in predicting nonadherence to medications.
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Affiliation(s)
- Saurav Ghimire
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Ronald L. Castelino
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | | | - Gregory M. Peterson
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
| | - Syed Tabish R. Zaidi
- Unit for Medication Outcomes Research and Education, Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Australia
- * E-mail:
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Sherman RA, Ravella S, Kapoian T. A dearth of data: the problem of phosphorus in prescription medications. Kidney Int 2015; 87:1097-9. [DOI: 10.1038/ki.2015.67] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 11/09/2022]
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Pagels AA, Söderquist BK, Heiwe S. DIFFERENCES IN ILLNESS REPRESENTATIONS IN PATIENTS WITH CHRONIC KIDNEY DISEASE. J Ren Care 2015; 41:146-55. [PMID: 25753248 DOI: 10.1111/jorc.12117] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To explore the impact of chronic kidney disease (CKD) on individual illness representations, including symptoms and causal attributions. DESIGN AND MEASURES Fifty-four patients responded to the Illness Perception Questionnaire (IPQ-R) and a further seven patients undertook cognitive interviews regarding the IPQ-R. All respondents had CKD stage 2-5, not undergoing renal replacement therapy. RESULTS Those in earlier CKD stages and those with fewer symptoms perceived a significantly different understanding of their condition than those in more advanced disease stages or with more symptoms. Behavioural and psychological attributions were commonly referred to as contributing causes to CKD. These attributions were associated to negative illness representations. An uncertainty assessing symptoms attributed to CKD was indicated, especially in earlier disease stages. CONCLUSION Illness representations differ with CKD stages and symptom burden. The patients in earlier disease stages or with fewer symptoms did not hold as strong beliefs about their illness as being a threat as those in advanced stages or with more symptoms. Self-blame emerged as a common causal attribution. Patients did not always relate symptoms to CKD, therefore this study identifies a gap in patients' disease knowledge, especially in earlier stages of the condition.
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Affiliation(s)
- Agneta A Pagels
- Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | | | - Susanne Heiwe
- Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
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Efremova EV, Shutov AM, Borodulina EO. [Treatment motivation in patients with chronic cardiorenal syndrome]. TERAPEVT ARKH 2015; 87:13-17. [PMID: 26978412 DOI: 10.17116/terarkh2015871213-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To study treatment motivation in patients with chronic heart failure (CHF) and in those with CHF concurrent with chronic kidney disease (CKD). SUBJECTS AND METHODS A total of 203 patients (130 men and 73 women; mean age, 61.8±9.6 years) with CHF diagnosed and assessed in accordance with the National Guidelines of the All-Russian Research Society of Cardiology and the Heart Failure Society for the diagnosis and treatment of CHF (third edition, 2009) were examined. CKD was diagnosed according to the 2012 National Guidelines of the Research Nephrology Society of Russia. A group of patients with chronic cardiorenal syndrome (CRS) included those with CHF and CKD with a glomerular filtration rate (GFR) of <60 ml/min/1.73 m2. The clinical course of CHF, personality profile, and motivation for non-drug and drug treatments were assessed in patients with chronic CRS. RESULTS CFR was 67.7±17.2 ml/min/1.73 m2; chronic CRS was observed in 89 (44%) patients. Psychological functioning assessment showed that the patients with chronic CRS as compared with those with CHF without CKD had high anxiety and maladaptive disease attitudes. CHF treatment motivation (compliance with lifestyle modification and medication) was proved inadequate and detected only in 31 (15.3%) patients with CHF regardless of the presence of CKD. The specific features of psychological functioning, which affected treatment motivation, were seen in patients with chronic CRS: those who were lowly motivated had a euphoric attitude towards their disease (p=0.03); those who were satisfactorily motivated showed an emotive accentuation of character (p=0.002). CONCLUSION The presence of CKD aggravates the clinical course of CHF and negatively affects the psychological functioning of patients with CHF. The patients with chronic CRS are characterized by a low level of motivation for both drug and non-drug treatments, which should be taken into account when managing this cohort of patients.
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Affiliation(s)
- E V Efremova
- Institute of Medicine, Ecology, and Physical Education, Ulyanovsk State University, Ministry of Health of Russia, Ulyanovsk, Russia
| | - A M Shutov
- Institute of Medicine, Ecology, and Physical Education, Ulyanovsk State University, Ministry of Health of Russia, Ulyanovsk, Russia
| | - E O Borodulina
- Institute of Medicine, Ecology, and Physical Education, Ulyanovsk State University, Ministry of Health of Russia, Ulyanovsk, Russia
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The Preferences and Perspectives of Nephrologists on Patients’ Access to Kidney Transplantation. Transplantation 2014; 98:682-91. [DOI: 10.1097/tp.0000000000000336] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Meuleman Y, ten Brinke L, Kwakernaak AJ, Vogt L, Rotmans JI, Bos WJW, van der Boog PJM, Navis G, van Montfrans GA, Hoekstra T, Dekker FW, van Dijk S. Perceived Barriers and Support Strategies for Reducing Sodium Intake in Patients with Chronic Kidney Disease: a Qualitative Study. Int J Behav Med 2014; 22:530-9. [DOI: 10.1007/s12529-014-9447-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Wileman V, Farrington K, Wellsted D, Almond M, Davenport A, Chilcot J. Medication beliefs are associated with phosphate binder non-adherence in hyperphosphatemic haemodialysis patients. Br J Health Psychol 2014; 20:563-78. [PMID: 25209368 DOI: 10.1111/bjhp.12116] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 08/07/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Patients with end-stage kidney disease receiving haemodialysis (HD) are at risk of cardiovascular disease and bone disorders related to high levels of serum phosphate. We studied the association between medication beliefs and depressive symptoms, with non-adherence to phosphate binding medication in a group of HD patients at risk of complications due to hyperphosphatemia. DESIGN Cross-sectional design. METHODS Baseline data from 112 patients participating in a randomized controlled trial, evaluating an adherence intervention, are presented. All patients had serum phosphate levels >1.6 mmol/l at baseline. Adherence was measured by (1) serum phosphate and (2) Medication Adherence Report Scales (MARS). Beliefs about Medicines (BMQ) and depressive symptoms (PHQ-9) were also evaluated. RESULTS Beliefs about Medicines Questionnaire necessity, but not concerns, beliefs were found to correlate with serum phosphate (r = -.23, p < .05) and self-reported adherence (r = .35, p < .01). In regression models, controlling for demographic, clinical and psychological variables, necessity beliefs explained the variance of serum phosphate (β = -.22, p = .01) and self-reported adherence (β = .30, p ≤ .01). Both BMQ concerns and depressive symptoms were not related to non-adherence. CONCLUSION Patients' beliefs about the necessity of their prescribed phosphate binding medications explain variation in non-adherence levels, measured both subjective and objectively. Dialysis patient's medication beliefs are potentially modifiable targets for future interventions.
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Affiliation(s)
- Vari Wileman
- Centre for Lifespan and Chronic Illness Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | - David Wellsted
- Centre for Lifespan and Chronic Illness Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | | | - Andrew Davenport
- Center for Nephrology and Royal Free Hospital, University College London, UK
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