Clinical, sociodemographic, and psychological correlates of health-related quality of life in chronic hemodialysis patients

Coloring complex shapes decreases patient anxiety in three care environments: a pilot study with color analysis

Introduction

This study was conducted to determine the effectiveness of coloring activity of circular symmetrical shape with complex patterns, so-called mandala, on anxiety associated with chronic illness in three different ambulatory medical situations (general consultation, psychiatric day hospital, and hemodialysis session).

Methods

Thirty patients were included in three groups and came from three different ambulatory medical situations: a hemodialysis group (n = 10), a psychiatric day hospital group (n = 10), and a nephrology consultation group (n = 10). We asked the patients to fill STAI-S and STAI-T questionnaires before to color complex circular shape with complex patterns, then to fill the STAI-S questionnaire again and a questionnaire on the experience of the activity.

Results

The results show that the STAI-S score was significantly lower after coloring for the hemodialysis (p = 0.02) and psychiatric groups (p = 0.005) but not for the general consultation group (p = 0.26). STAI-T scores did not differ between groups. The distribution of colors in the mandala was different in the three groups of patients. A positive subjective experience of the activity was found in all groups.

Discussion

These results show the effectiveness of a coloring activity of a circular shape with complex patterns on anxiety associated with chronic illness in care environment. The different distribution of the colors of the mandala in the three groups raises the question of the influence of the context on the mood of the patients and the deeper meaning of the choice of colors and their placement in the mandala. Our study reinforces the multiple applications of art activities in different medical disciplines and encourages their development within healthcare settings.

Happiness of Older Adults in Haemodialysis: Findings from a Comparative Study

Happiness is related to longevity and better health; nevertheless, there is a lack of knowledge about the construct, understood as subjective well-being (SWB), of older adults undergoing hemodialysis. This cross-sectional study investigated the extent to which hemodialysis treatment affects the SWB of older adults, compared to non-dialysis older adults. Regarding this, a total of 126 participants have interviewed: all the older adults in the hemodialysis service, 42 patients, from a city in Brazil, and 84 older adults from the Community, age- and gender-matched, predominantly men (64.3%), aged between 60 and 81 years. Participants respond to pattern questionnaires about SWB (life satisfaction, positive affect, negative affect), depressive symptoms, sociodemographic characteristics, and physical health status. Analysis of variance presented in hemodialysis had no effect on SWB and depressive symptoms. Furthermore, participants in the hemodialysis had fewer years of schooling, and those in the community presented more diseases. The high number of illnesses and low educational level demonstrate effects on SWB, as well the length of hemodialysis is negatively associated with SWB. Therefore, hemodialysis by itself does not make older adults unhappier and depressive, but some variables depending on the socioeconomical status and length of treatment are associated with depression and worst SWB.

Are cultural or psychosocial factors associated with patient-reported outcomes at the conclusion of kidney transplant evaluation?

BACKGROUND

Kidney transplant evaluation (KTE) is a period marked by many stressors for patients, which may lead to poorer patient-reported outcomes (PROs). Research on the association of cultural and psychosocial factors with PROs during KTE is lacking, even though cultural and psychosocial variables may mitigate the relationship between acceptance status and PROs.

METHODS

Using a prospective cohort study of 955 adults referred for KTE, we examined whether cultural factors and psychosocial characteristics, assessed at the initiation of KTE, are associated with PROs at KTE completion, controlling for demographics and medical factors. Also, we analyzed whether these factors moderate the relationship between transplant acceptance status and PROs.

RESULTS

In multivariable regression models, a stronger sense of mastery was associated with higher physical and mental QOL. A stronger sense of self-esteem was associated with higher kidney-specific QOL. Depression was associated with a lower mental QOL, but only in those who were accepted for transplant. Having low levels of external locus of control was associated with better mental QOL in those who were not accepted for transplant. Higher anxiety was associated with poorer kidney-specific QOL among those who were not accepted for KT, but trust in physician was only associated with greater satisfaction in transplant clinic service for those who were accepted for KT.

CONCLUSIONS

Targeting interventions to increase patient mastery and external locus of control, and reduce depression and anxiety in patients undergoing kidney transplant evaluation may be useful approaches to improve their experience during this stressful period.

The Style of Coping with Stress, the Health-Related Locus of Control, and the Level of Mindfulness of Patients with Chronic Somatic Diseases in Comparison to Healthy People

Background: Psychological factors may be involved in both the development and treatment of somatic diseases. Our study aimed to evaluate the style of coping with stress, health-related locus of control, and level of mindfulness of adult patients with the most common chronic somatic diseases compared with healthy subjects. Methods: 502 chronically ill people were examined (M = 49.27; SD = 14.25), including 288 women and 214 men. The control group consisted of 117 healthy people (M = 45.66; SD = 17.86). The diagnostic survey involved using the Coping Inventory for Stressful Situations (CISS), Multidimensional Health Locus of Control Scale (MHLC), and Mindful Attention Awareness Scale (MAAS). Results: Differences between the clinical and control groups were demonstrated for MHLC: Internal (p < 0.001), Powerful Others (p < 0.05), and Chance (p < 0.001); CISS: Task (p < 0.001) and Avoidance (p < 0.05); and MAAS (p < 0.01). Conclusion: People with chronic somatic diseases, compared to healthy people, have a stronger external and weaker internal health-related locus of control, lower level of task and avoidance style for coping with stress, and lower level of mindfulness.

Impacts of mindfulness-based interventions in people undergoing hemodialysis: a systematic review

INTRODUCTION

Chronic kidney disease (CKD) is a serious public health problem worldwide, leading to a series of physical and psychological comorbidities, in addition to costly treatments, lifestyle and dietary restrictions. There is evidence that mindfulness-based interventions (MBIs) offer complementary treatment for people with chronic illnesses, including CKD, with the aim of improving overall health, reducing side effects and treatment costs. This review aims to investigate the MBIs impact on people with CKD undergoing hemodialysis, and to identify the methodological quality of the current literature in order to support future studies.

METHODS

We ran searches in five databases (MEDLINE via PubMed, PsycINFO, Embase, Web of Science and Scopus) in July 2020. The papers were selected and evaluated by two reviewers independently, using predefined criteria, including the Cochrane Group's risk of bias tool and its recommendations (CRD42020192936).

RESULTS

Of the 175 studies found, 6 randomized controlled trials met the inclusion criteria, and ranged from 2014 to 2019. There were significant improvements in symptoms of anxiety, depression, self-efficacy, sleep quality, and quality of life (n=3) in the groups submitted to the intervention, in addition to physical measures such as blood pressure, heart rate and respiratory rate (n=1).

CONCLUSIONS

MBIs can offer a promising and safe complementary therapy for people with CKD undergoing hemodialysis, acting on quality of life and physical aspects of the disease.

Health-related quality of life and long-term mortality in young and middle-aged hemodialysis patients

PURPOSE

The relationship of health-related quality of life (HRQoL) with mortality in young and middle-aged hemodialysis (HD) patients has scarcely been studied and remains unclear. The aim of the study was to examine whether physical and mental components of HRQoL are related to long-term risks of all-cause and cardiovascular (CV) death in this particular HD population.

METHODS

A long-term observational prospective study included 238 prevalent HD patients aged 18-64 years. The median follow-up was 50 (22, 96) months (maximum 13.9 years). HRQoL variables of the Short Form 36 Health Survey (SF-36), clinical, and demographic data were assessed at the time of inclusion. Associations of baseline HRQoL scores with all-cause and CV mortality were assessed using Kaplan-Meier survival plots and Cox regression analysis adjusted for clinical and demographic confounders.

RESULTS

The majority of HRQoL parameters were associated with outcomes in univariable analyses. In multivariable regression models adjusted for clinical and demographic confounders, Physical Functioning (PF) and Physical Component Summary Score (PCS) remained independently related to all-cause mortality [hazard ratio (HR) for a 1-point increase in PF and PCS were 0.981, 95% confidence interval (CI) 0.972-0.989 and 0.954, CI 0.929-0.980, respectively] and CV death (HR for a 1-point increase in PF and PCS were 0.975, CI 0.962-0.988 and 0.950, CI 0.915-0.985, respectively).

CONCLUSION

PF and PCS assessment seems to be relevant for refining the prognosis and clinical decision-making in young and middle-aged HD patients.

The Quality of Life, Depression Levels and Coping Styles of Patients on Kidney Transplant Waiting List

This study aims to understand the coping strategies, depression levels, sociodemographic characteristics of Turkish patients with hemodialysis, and the other factors explain quality of life levels. This research is a cross-sectional study. The convenience sampling consisted of 292 patients with hemodialysis. The data were collected using the brief COPE, QOL, Beck Depression Inventory and sociodemographic form. According to the research results, patients show mild (score range 10-16) depression symptoms. One of the most important findings of this study is that the coping strategies and level of depression with chronic kidney patients accounted for a significant amount of variance in their quality of life. The relationship between emotion-focused coping strategy and quality of life was not statistically significant. In addition, high level of depression in chronic renal failure patients significantly reduce the quality of life. As a result of the study, the relationship between the high quality of life of patients who use problem-focused coping strategy more intensively and patients with low depression levels was determined. The findings point to the importance of taking individual coping strategies into account when evaluating the impact of a disease on psychosocial wellbeing. Delineation of coping strategies might be useful for identifying patients in need of particular counseling and support. These patients should have frequent contact with a multidisciplinary team of health care givers, possibly allowing for early diagnosis and prompt treatment. Results suggest targeted interventions to stimulate future research regarding the psychological care of patients with chronic kidney disease.

The use of complementary and alternative medicines, and quality of life in patients under hemodialysis: A survey in southeast Iran

BACKGROUND

hemodialysis affects patients' quality of life and is associated with physical, psychological, occupational and social problems. These patients use relatively high levels of the complementary and alternative medicine. The current study aimed to investigate the relationship between complementary and alternative medicines usage, and quality of life in patients under hemodialysis.

MATERIALS AND METHODS

this cross-sectional correlational study was conducted in Kerman, southeast Iran, in 2019. The study subjects were 113 hemodialysis patients. The instrument used in this study consisted of three parts: clinical and demographic information, a researcher-conducted questionnaire on the use of complementary and alternative medicines, and KDQOL_SF to assess the quality of life of hemodialysis patients.

RESULTS

75.2 % of the samples used at least one type of complementary and alternative medicines in the past year. The most commonly used types of complementary and alternative medicines were prayer, and herbal medicines. The mean quality of life in hemodialysis patients was 52.81 ± 14.39. Only 13.3 % of the samples had a good quality of life. Among different methods of the complementary and alternative medicines, a significant relationship was found only between the use of relaxation and meditation techniques, and quality of life. In other words, those who used these methods had a higher quality of life than those who did not use them (P = 0.002).

CONCLUSION

many hemodialysis patients have a poor quality of life. The users of some types of complementary and alternative medicines including relaxation and meditation techniques had higher quality of life than non-users.

Relationship between quality of life, self-esteem and depression in people after kidney transplantation

OBJECTIVE

to assess the relationship between health-related quality of life with depression and self-esteem of people after kidney transplantation.

METHOD

a cross-sectional study of 47 outpatients from October 2016 to February 2017. The following tools were applied: The Medical Outcomes Study 36-Item Short-Form Health Survey, Beck Depression Inventory and Rosenberg Self-Esteem Scale. Descriptive statistics and Spearman correlation were used.

RESULTS

women had lower scores for health-related quality of life. Young adults, people with up to one and a half years of transplantation and those who had dialysis for more than one year had higher scores.

CONCLUSION

the health-related quality of life of people with chronic kidney disease after transplantation ranged from good to excellent. The presence of depression was not identified. The relationship of data indicates that the higher the quality of life, the better the self-esteem assessment.

[The contribution of an ethical concertation group in nephrology validated by a research protocol]

For more than 10 years, nephrologists in the Grenoble-region have sought advice from the Ethical Concertation Unit in Nephrology with regards to whether to stop or continue dialysis for patients under palliative care. This process deserves a multidisciplinary debate between health professionals and qualified non-health professionals. Thus, we organized a qualitative research protocol in three parts (medical, philosophical, judicial) to explore this issue. Our study aimed to assess the impact of Ethical Concertation Unit in Nephrology's discussions regarding perception, knowledge, and judicial and ethical considerations. The practical repercussions of decision-making within medical practice, its impacts on the patient and his/her family, as well as associated-health professionals, was assessed. To achieve this, two questionnaires and an interview were organized by three Ethical Concertation Unit in Nephrology-leaders to review the viewpoints of the 22 permanent Ethical Concertation Unit in Nephrology members that had participated in 10 Ethical Concertation Unit in Nephrology sessions between 2015 and 2016 to discuss 21 case-reports. Only 13 persons (4 physicians, 6 nurses, 3 non-health professionals) agreed to respond to the questionnaires, and six physicians agreed to participate in an interview. Overall, it was found that most affected patients' physicians agreed with the multidisciplinary discussion, which included judicial and ethical perspectives, and felt reassured with regards to Ethical Concertation Unit in Nephrology's final decision. However, our study showed that Ethical Concertation Unit in Nephrology's functioning could be improved by promoting its existence more widely, by making these decisions earlier within clinical situations, to make Ethical Concertation Unit in Nephrology more accessible to health workers, to make reports easier to understand, to re-examine a posteriori some clinical situations, and to broaden the scope of multidisciplinary skills.

The prevalence of mild-to-moderate distress in patients with end-stage renal disease: results from a patient survey using the emotion thermometers in four hospital Trusts in the West Midlands, UK

OBJECTIVES

To assess the prevalence of mild-to-moderate distress in patients with end-stage renal disease (ESRD) and determine the association between distress and patient characteristics.

DESIGN

Cross-sectional survey using emotion thermometer and distress thermometer problem list.

SETTING

Renal units in four hospital Trusts in the West Midlands, UK.

PARTICIPANTS

Adult patients with stage 5 chronic kidney disease who were: (1) On prerenal replacement therapy. (2) On dialysis for less than 2 years. (3) On dialysis for 2 years or more (4) With a functioning transplant.

OUTCOMES

The prevalence of mild-to-moderate distress, and the incidence of distress thermometer problems and patient support needs.

RESULTS

In total, 1040/3730 surveys were returned (27.9%). A third of survey respondents met the criteria for mild-to-moderate distress (n=346; 33.3%). Prevalence was highest in patients on dialysis for 2 years or more (n=109/300; 36.3%) and lowest in transplant patients (n=118/404; 29.2%). Prevalence was significantly higher in younger versus older patients (χ²=14.33; p=0.0008), in women versus men (χ²=6.63; p=0.01) and in black and minority ethnic patients versus patients of white ethnicity (χ²=10.36; p=0.013). Over 40% of patients (n=141) reported needing support. More than 95% of patients reported physical problems and 91.9% reported at least one emotional problem.

CONCLUSIONS

Mild-to-moderate distress is common in patients with ESRD, and there may be substantial unmet support needs. Regular screening could help identify patients whose distress may otherwise remain undetected. Further research into differences in distress prevalence over time and at specific transitional points across the renal disease pathway is needed, as is work to determine how best to support patients requiring help.

Coping mediates the relationship between sense of coherence and mental quality of life in patients with chronic illness: a cross-sectional study

PURPOSE

The aim of the present study was to investigate relationships between sense of coherence, emotion-focused coping, problem-focused coping, coping efficiency, and mental quality of life (QoL) in patients with chronic illness. A model based on Lazarus' and Folkman's stress and coping theory tested the specific hypothesis: Sense of coherence has a direct and indirect effect on mental QoL mediated by emotion-focused coping, problem-focused coping, and coping efficiency in serial adjusted for age, gender, educational level, comorbidity, and economic status.

METHODS

The study used a cross-sectional and correlational design. Patients (n = 292) with chronic diseases (chronic heart failure, end-stage renal disease, multiple sclerosis, stroke, and Parkinson) completed three questionnaires and provided background data. Data were collected in 2012, and a serial multiple mediator model was tested using PROCESS macro for SPSS.

RESULTS

The test of the conceptual model confirmed the hypothesis. There was a significant direct and indirect effect of sense of coherence on mental QoL through the three mediators. The model explained 39% of the variance in mental QoL.

CONCLUSIONS

Self-perceived effective coping strategies are the most important mediating factors between sense of coherence and QoL in patients with chronic illness, which supports Lazarus' and Folkman's stress and coping theory.

Dialysis and Depression in the Light of Suicide Attempt with Fruits

Depression is a common morbidity seen in chronic renal failure patients but it is often underdiagnosed and undertreated. Here we present a 36-year-old male dialysis patient who had undiagnosed severe depression and attempted to commit suicide with overconsumption of fruits. Fortunately, he was saved with emergent dialysis treatment and was referred to a psychiatry clinic for treatment and observation. In the light of this case we want to point out that diagnosing and treating psychiatric problems of dialysis patients is of vital importance to prevent suicides and also to improve quality of life.

Coping with kidney disease - qualitative findings from the Empowering Patients on Choices for Renal Replacement Therapy (EPOCH-RRT) study

Background

The highly burdensome effects of kidney failure and its management impose many life-altering changes on patients. Better understanding of successful coping strategies will inform patients and help health care providers support patients’ needs as they navigate these changes together.

Methods

A qualitative, cross-sectional study involving semi-structured telephone interviews including open- and closed-ended questions, with 179 U.S. patients with advanced chronic kidney disease (CKD), either not yet on dialysis ([CKD-ND], n = 65), or on dialysis (hemodialysis [HD], n = 76; or peritoneal dialysis [PD], n = 38) recruited through social media and in-person contacts from June to December 2013. Themes identified through content analysis of interview transcripts were classified based on the Coping Strategies Index (CSI) and compared across groups by demographics, treatment modality, and health status.

Results

Overall, more engagement than disengagement strategies were observed. “Take care of myself and follow doctors’ orders,” “accept it,” and “rely on family and friends” were the common coping themes. Participants often used multiple coping strategies. Various factors such as treatment modality, time since diagnosis, presence of other chronic comorbidities, and self-perceived limitations contributed to types of coping strategies used by CKD patients.

Conclusions

The simultaneous use of coping strategies that span different categories within each of the CSI subscales by CKD patients reflects the complex and reactive response to the variable demands of the disease and its treatment options on their lives. Learning from the lived experience of others could empower patients to more frequently use positive coping strategies depending on their personal context as well as the stage of the disease and associated stressors. Moreover, this understanding can improve the support provided by health care systems and providers to patients to better deal with the many challenges they face in living with kidney disease.

The Relationship Between Fatigue and Depression in Adults With End-Stage Renal Disease on Chronic In-Hospital Hemodialysis: A Scoping Review

CONTEXT

Fatigue and depression are two prominent concerns in patients on in-hospital hemodialysis (IHHD) that have recently been identified as research priorities in the nephrology community. Although they are often reported to co-exist, no synthesis of the literature examining their relationship is available.

OBJECTIVE

The aim of this study was to characterize the literature on the relationship between fatigue and depression in IHHD patients.

METHODS

A scoping review as described by Arksey and O'Malley was conducted. Seven electronic databases were searched for relevant literature using search terms pertaining to fatigue, depression, and IHHD. Key journals and article reference lists were also hand searched to identify relevant literature. Articles were examined for relevance, and data were extracted to describe the nature and scope of the literature and to characterize the relationship between fatigue and depression. Findings were grouped thematically and summarized descriptively.

RESULTS AND CONCLUSIONS

Current literature on this topic is dominated by cross-sectional studies, which support the existence of an association between fatigue and depression in IHHD patients in various practice settings and subpopulations. Numerous multivariable analyses have been performed which suggest the association remains after adjustment for confounding factors. However, there is generally a dearth of longitudinal or interventional literature to clarify the nature of the relationship over time. Current literature is sufficient to justify routine screening for depression in IHHD patients who present with fatigue. Future research should aim to clarify the nature of the relationship over time in IHHD patients, explore mediators and modifiers of the relationship, and investigate the effects of interventions.

Evolution of post-traumatic growth during the first 12 months of dialysis: A longitudinal study

BACKGROUND

Initiating dialysis can produce psychological benefits. These positive changes, most frequently referred to as posttraumatic growth (PTG), have not previously been explored in these patients.

OBJECTIVE

To identify patterns in the temporal course of PTG in patients during their first 12 months of dialysis, and to relate to perceived stress.

DESIGN

A prospective, longitudinal, observational study.

SETTING AND METHODS

The sample included 98 patients, aged from 18 to 70 years, who commenced dialysis in the nine nephrology units of the Basque Country, Spain. Three assessments were carried out at 1, 6 and 12 months, using a PTG questionnaire and the Perceived Stress Scale. ANOVAs with post-hoc analysis were performed to identify significant differences between the groups.

RESULTS

Four groups were established based on the observed changes in PTG over time: high, increasing, decreasing and low PTG. Maintaining high PTG and decreasing PTG levels was associated with moderate levels of perceived stress.

CONCLUSION

Four different patterns of PTG have been identified, contributing to our understanding of the dynamics of the process of growth and enabling us to identify patients who may be more vulnerable.

Brief cognitive behavioural intervention for depression and anxiety symptoms improves quality of life in chronic haemodialysis patients

OBJECTIVES

Psychological treatment of depression in end-stage renal disease (ESRD) has focused on severely depressed patients. We designed and tested a brief (5 weeks) cognitive behavioural intervention (CBI) to reduce mild and moderate depression and anxiety symptoms in patients with ESRD.

DESIGN

For the purpose of this study, a single-blind, randomized controlled design was used to compare patients with ESRD under haemodialysis treatment with and without the CBI.

METHODS

Depression and anxiety symptoms were screened in 152 subjects (18-60 years old, 84 male). Sixty participants (age 41.8 ± 14.7, 29 males) with mild or moderate scores of depression (Beck Depression Inventory) and anxiety (Beck Anxiety Inventory) were randomly assigned to CBI or the control group. CBI techniques consisted of positive self-reinforcement, deep breathing, muscle relaxation, and cognitive restructuring. Depression, anxiety, quality of life (QoL), and cognitive distortion scores were evaluated at baseline, after 5 weeks (end of treatment) and after 4-week follow-up. All scores were compared by ANOVA for repeated measures with post-hoc tests adjusted by Bonferroni's method (p < .05 was considered significant).

RESULTS

At follow-up, depression, anxiety, and cognitive distortions had decreased, and QoL had increased in the intervention group, and there were no changes in the control group. Clinical utility was 33% for depression and 43% for anxiety.

CONCLUSIONS

A brief CBI of 5 weeks is effective for decreasing mild or moderate depression and anxiety symptoms and improving QoL in ESRD haemodialysis patients.

PRACTITIONER POINTS

A brief, systematic and structured cognitive behavioural intervention (CBI) decreases anxiety and depression symptoms and improves quality of life in patients with end-stage renal disease (ESRD) who are being treated with haemodialysis. These benefits are not achieved when anxiety and depression symptoms are identified but not treated psychologically. This CBI consisted of cognitive restructuring of the distorted thoughts (perfectionism, catastrophic thinking, negative self-labelling, and dichotomous thinking) that are correlated with depression and anxiety symptoms and that can be assessed by a validated questionnaire designed for patients with ESRD. The handbooks that were developed for this study are structured and systematic. They could be valuable in supporting the efforts and participation of non-specialized health professionals in CBI such as nurses, physicians, social workers, and psychologists, raising the possibility of further application in a variety of clinical populations. Both the therapy and the client workbooks are available in Spanish upon request.

Depression in dialysis patients

Depression is the most common psychiatric illness in patients with end-stage renal disease (ESRD). The reported prevalence of depression in dialysis population varied from 22.8% (interview-based diagnosis) to 39.3% (self- or clinician-administered rating scales). Such differences were attributed to the overlapping symptoms of uraemia and depression. Systemic review and meta-analysis of observational studies showed that depression was a significant predictor of mortality in dialysis population. The optimal screening tool for depression in dialysis patients remains uncertain. The Beck Depression Inventory (BDI), Patient Health Questionnaire (PHQ) and Center for Epidemiologic Studies Depression Scale (CESD) have been validated for screening purposes. Patients who scored ≥14 using BDI should be referred to a psychiatrist for early evaluation. Structured Clinical Interview for DSM disorders (SCID) remains the gold standard for diagnosis. Non-pharmacological treatment options include cognitive behavioural therapy and exercise training programs. Although frequent haemodialysis may have beneficial effects on patients' physical and mental well-being, it cannot and should not be viewed as a treatment of depression. Selective serotonin reuptake inhibitors (SSRIs) are generally effective and safe in ESRD patients, but most studies were small, non-randomized and uncontrolled. The European Renal Best Practice (ERBP) guideline suggests a trial of SSRI for 8 to 12 weeks in dialysis patients who have moderate-major depression. The treatment effect should be re-evaluated after 12 weeks to avoid prolonging ineffective medication. This review will discuss the current understanding in the diagnosis and management of depression in dialysis patients.

Locus of control, quality of life, anxiety, and depression among Malaysian breast cancer patients: The mediating role of uncertainty

PURPOSE

The main objective of this study was to investigate the mediating role of uncertainty in the relationship between locus of control with quality of life, anxiety, and depression.

METHODS

A descriptive and correlational survey was conducted in a private hospital in Kuala Lumpur, Malaysia. A convenience sample of 118 Malaysian breast cancer patients voluntarily participated in the study and responded to a set of questionnaires including: socio-demographic questionnaire, the short form of Locus of Control Scale, the Functional Assessment of Cancer Therapy-Breast (FACT-B), the Hospital Anxiety and Depression Scale (HADS), and the Short-Form Mishel Uncertainty in Illness Scale (SF-MUIS).

RESULTS

The results revealed that breast cancer patients with higher internal locus of control and lower external locus of control experience a higher quality of life, lower anxiety, and lower depression. Also, uncertainty mediated the relationship between locus of control with quality of life and depression (quasi-significant).

CONCLUSIONS

The findings indicated the need for early, targeted psychological interventions seeking to gradually shift cancer patients' locus of control from external to internal in order to improve their quality of life and reduce their depression and anxiety. Moreover, health care providers by providing relevant information to cancer patients, especially for externally oriented patients, can reduce their uncertainty which in turn would improve their quality of life.

Anxiety in Patients Treated with Hemodialysis

Anxiety is a common yet frequently overlooked psychiatric symptom in patients with ESRD treated with hemodialysis (HD). Anxiety is characterized by disruptive feelings of uncertainty, dread, and fearfulness. A variety of common medical complaints may be manifestations of an anxiety disorder, including palpitations, tremors, indigestion, numbness/tingling, nervousness, shortness of breath, diaphoresis, and fear. It is essential for the clinician to rule out specific medical conditions, including cardiovascular, pulmonary, and neurologic diseases, before ascribing these symptoms to an anxiety disorder. In addition, there is considerable overlap between the symptoms of anxiety and those of depression and uremia. This psychiatric condition has a significant adverse impact on patients' perception of quality of life. Little is known regarding the prevalence and impact of anxiety disorders in patients with ESRD treated with HD; however, many of the seemingly irrational behaviors of patients, or behaviors which place them in conflict with staff and physicians, such as behavioral noncompliance, may be the expression of an underlying anxiety disorder. In this review, we present three clinical vignettes, highlighting the impact of anxiety disorders in patients with ESRD treated with HD.

Impact of end-stage renal disease on psychological status and quality of life

BACKGROUND

The aim of this study was to assess depression, anxiety, and quality of life (QOL) in a cohort of children and adolescents with end-stage renal disease (ESRD), to compare these findings with healthy controls, and to evaluate the association between these psychological symptoms, QOL, and clinical variables related to ESRD.

METHODS

Thirty-two children and adolescents 8-18 years of age were enrolled in the study. The sociodemographic data were evaluated. Questionnaires were used to evaluate the psychological status and QOL of the patients and healthy controls.

RESULTS

There was a significant difference in mean depression score, which was significantly higher for the ESRD patients. Mean state anxiety score was significantly lower for ESRD patients than for controls. Regarding QOL score, there were significant differences between the ESRD patients and control groups for both child-rated and parent-rated QOL scores, which were significantly lower for ESRD patients. Trait anxiety was a negative predictor of all subscales of the Pediatric Quality of Life Inventory 4.

CONCLUSIONS

End-stage renal disease was related to significant morbidity and poorer QOL. The assessment and enhancement of QOL and comorbid psychiatric disorders in ESRD should be a part of disease management.

Psychosocial predictors of nonadherence to medical management among patients on maintenance dialysis

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.

Psychological predictors for health-related quality of life and disability in persons with chronic obstructive pulmonary disease (COPD)

OBJECTIVE

Individuals with chronic obstructive pulmonary disease (COPD) exhibit low physical and mental health-related quality of life (HRQL) and high susceptibility to disability. We investigated the influence of psychological factors on HRQL and disability in COPD individuals recruited from the general population. In line with Leventhal's common sense model, we expected psychological factors to be associated with HRQL and disability even after controlling for medical status.

METHODS

Individuals with COPD (n = 502; 59.7 years old; GOLD grades were I: 3%, II: 17%, III: 34%, IV: 46%) were assessed through an online survey administered via COPD patient organisations in Germany. Individuals filled in the Short Form Health Survey (SF-12), COPD Assessment Test, Patient Health Questionnaire (modules: GAD-2, PHQ-15, PHQ-9), Brief Illness Perception Questionnaire, a questionnaire that assesses causal illness attributions, and the internal illness-related locus of control scale of the 'KKG questionnaire for the assessment of control beliefs about illness and health'. Multiple linear regressions were calculated.

RESULTS

The investigated factors explained high variances (disability = 56%, physical HRQL = 28%, mental HRQL = 63%, p ≤ .001). Better mental health, more optimistic illness perceptions, attribution to psychological causes, and stronger internal locus of control were associated with lower disability and better HRQL. Comorbid somatic symptoms contributed to high disability and low quality of life.

CONCLUSION

Psychological factors, such as illness perception, attribution and internal locus of control, were associated with disability and HRQL. These factors should be considered when designing treatments for individuals with COPD, and adequate interventions should be provided to enhance illness understanding and self-management skills.

Health status and mental health in patients after percutaneous coronary intervention

OBJECTIVE

to assess the association between perceived health status and the mental health of patients submitted to percutaneous coronary intervention after hospital discharge.

METHOD

a quantitative and cross-sectional study involving 101 participants. The following instruments were used: a sociodemographic and clinical characterization instrument, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Hospital Anxiety and Depression Scale (HADS). Participants were divided into three groups: no anxiety and no depression (G1); anxiety or depression (G2); and both (G3). The ANOVA test was used for the intergroup comparison of means on the SF-36 domains.

RESULTS

There was an association between perceived health status and mental health. The participants in G1 presented higher scores in all SF-36 domains in comparison with participants in G2 and G3.

CONCLUSION

Participants with no anxiety and depression presented better-perceived health status in comparison with those with anxiety or depression, or both.

The Impact of Anxiety and Depression on the Quality of Life of Hemodialysis Patients

Material and Methods:

The sample studied consisted of 395 hemodialysis patients. Data was collected by the completion of a specially designed questionnaire for the needs of the present study which apart from socio-demographic and clinical, it also included HAD_S scale to assess the level of anxiety and depression as well as the scale Missoula-VITAS Quality of Life Index (MVQOLI) to assess patients’ quality of life.

Results:

The results of this study showed that 47.8% had high anxiety levels and 38.2% had high levels of depression. The average total score of quality of life was found to be 17.14. It was also shown that the total score of quality of life presented statistically significant association with family status (p=0.007), educational level (p<0.001), the number of children (p=0.001), patients’ adherence to doctors’ orders (p=0.003) and proposed diet (p=0.002) and the relations of patients with healthcare professionals and the other patients (p<0.001). The multiple linear regression showed that the overall quality of life score was statistically associated with the levels of depression after adjusted for possible confounders. More specifically, it was found that total score of quality of life was 2.5 and 4.4 points lower for patients with moderate and high levels of depression, respectively, compared to patients with low levels of depression (p<0.001).

Conclusions:

Evaluation of anxiety and depression in conjunction with quality of life in hemodialysis patients should be an integral part of the therapeutic regimen.

Telephone-adapted mindfulness-based stress reduction (tMBSR) for patients awaiting kidney transplantation: Trial design, rationale and feasibility

BACKGROUND

Mindfulness-based stress reduction (MBSR) has demonstrated benefits for stress-related symptoms; however, for patients with burdensome treatment regimens, multiple co-morbidities and mobility impairment, time and travel requirements pose barriers to MBSR training.

PURPOSE

To describe the design, rationale and feasibility results of Journeys to Wellness, a clinical trial of mindfulness training delivered in a novel workshop and teleconference format. The trial aim is to reduce symptoms and improve quality of life in people waiting for a kidney transplant.

METHODS

The standard 8-week MBSR program was reconfigured for delivery as two in-person workshops separated in time by six weekly teleconferences (tMBSR). A time and attention comparison condition (tSupport) was created using the workshop-telephone format.

FEASIBILITY RESULTS

Kidney transplant candidates (N = 63) were randomly assigned to tMBSR or tSupport: 87% (n = 55) attended ≥ 1 class, and for these, attendance was high (6.6 ± 1.8 tMBSR and 7.0 ± 1.4 tSupport sessions). Fidelity monitoring found that all treatment elements were delivered as planned and few technical problems occurred. Patients in both groups reported high treatment satisfaction, but more tMBSR (83%) than tSupport (43%) participants expected their intervention to be quite a bit or extremely useful for managing their health. Symptoms and quality of life outcomes collected before (baseline, 8 weeks and 6 months) and after kidney transplantation (2, 6 and 12 months) will be analyzed for efficacy.

CONCLUSIONS

tMBSR is an accessible intervention that may be useful to people with a wide spectrum of health conditions. Clinicaltrials.gov: NCT01254214.

[Treatment motivation in patients with chronic cardiorenal syndrome]

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.

Quality of life in people with chronic hemodialysis: association with sociodemographic, medical-clinical and laboratory variables

AIM

determine the quality of life for people in chronic hemodialysis and its association with sociodemographic, medical-clinical and laboratory variables.

METHOD

exploratory, descriptive, cross-sectional study with stratified probability sampling. Quality of life was assessed using the KDQOL-36™. Data were analyzed using SPSS statistical software.

RESULTS

354 people in chronic hemodialysis had low scores on most dimensions of quality of life, mainly Burden of Disease, Physical and Mental Component. Age, sex, education, income, time on dialysis, etiology of the disease, smoking, hospitalizations, albumin, creatinine and transplants were related. The results reveal multiple factors related to quality of life.

CONCLUSION

there is a need to research on other aspects that permit focusing and optimizing the nursing care for these people.

Psychological factors associated with successful outcomes in home haemodialysis

AIM

Performing haemodialysis therapy at home has been associated with improved survival for end-stage kidney disease patients and can generally be delivered at a lower cost to the healthcare system when compared with centre and satellite unit dialysis. However, only a minority of dialysis dependent end-stage kidney disease patients successfully sustain haemodialysis at home. Current practice for determining dialysis treatment modality and location takes into account medical suitability and social situation, but infrequently formally examines the contribution of psychological factors. This study explores demographic, health, and psychological factors that may predict patients' ability to sustain home haemodialysis.

METHODS

One hundred and thirteen successful and unsuccessful home haemodialysis users were recruited to the study, and 55 responded to self-report measures. Demographic (age, gender, education level, carer support), health (comorbidities, diabetes, psychiatric condition) and psychological (locus of control beliefs, coping styles) information was used as predictor variables for the participants' time maintaining home therapy (Home Time).

RESULTS

In a three-step regression, the model explained 32% of variance in Home Time. Coping styles significantly contributed 16% of the variance in Home Time after accounting for other variables. Adaptive Coping was significantly correlated with the length of time sustaining home therapy.

CONCLUSION

Adaptive coping strategies are associated with improved ability to sustain home haemodialysis therapy. Evidence-based psychological approaches can help patients develop more adaptive coping strategies. More research is needed to assess whether instituting these psychological interventions will assist patients to adopt and sustain dialysis therapies which require increased patient self-management.

Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies

Prevalence estimates of depression in chronic kidney disease (CKD) vary widely in existing studies. We conducted a systematic review and meta-analysis of observational studies to summarize the point prevalence of depressive symptoms in adults with CKD. We searched MEDLINE and Embase (through January 2012). Random-effects meta-analysis was used to estimate the prevalence of depressive symptoms. We also limited the analyses to studies using clinical interview and prespecified criteria for diagnosis. We included 249 populations (55,982 participants). Estimated prevalence of depression varied by stage of CKD and the tools used for diagnosis. Prevalence of interview-based depression in CKD stage 5D was 22.8% (confidence interval (CI), 18.6-27.6), but estimates were somewhat less precise for CKD stages 1-5 (21.4% (CI, 11.1-37.2)) and for kidney transplant recipients (25.7% (12.8-44.9)). Using self- or clinician-administered rating scales, the prevalence of depressive symptoms for CKD stage 5D was higher (39.3% (CI, 36.8-42.0)) relative to CKD stages 1-5 (26.5% (CI, 18.5-36.5)) and transplant recipients (26.6% (CI, 20.9-33.1)) and suggested that self-report scales may overestimate the presence of depression, particularly in the dialysis setting. Thus, interview-defined depression affects approximately one-quarter of adults with CKD. Given the potential prevalence of depression in the setting of CKD, randomized trials to evaluate effects of interventions for depression on patient-centered outcomes are needed.

Estresse e ansiedade em pacientes renais crônicos submetidos à hemodiálise

A deficiência renal crônica é uma doença sistêmica que provoca a perda da autonomia do paciente, levando-o a limitações físicas, restrições laborais e também a perdas sociais. Pacientes com esse tipo de patologia geralmente são submetidos a sessões regulares de hemodiálise, um tratamento rigoroso e debilitante. O objetivo deste estudo foi investigar o nível de estresse e a ansiedade de pacientes submetidos à hemodiálise no Instituto do Rim de Natal, no estado do Rio Grande do Norte, Brasil. Para a coleta de dados, foram utilizados dois instrumentos: Inventário de Sintomas para Stress para Adultos de Lipp e Inventário de Ansiedade Traço-Estado. A amostra (n=100) apresentou homogeneidade em relação ao sexo, com média de idade de 46 anos e predominância de indivíduos casados, aposentados e com renda familiar baixa. Os resultados obtidos no primeiro instrumento revelaram que 71% dos pacientes encontravam-se estressados, dos quais 47% estavam na fase de resistência. Todos os pacientes entrevistados apresentaram ansiedade com níveis de moderado (66%) a severo (34%). Esses dados levam a descrever esse grupo de pacientes como altamente sujeitos ao estresse e à ansiedade.

The effect of empowerment on the self-efficacy, quality of life and clinical and laboratory indicators of patients treated with hemodialysis: a randomized controlled trial

BACKGROUND

Hemodialysis patients face numerous physical and psychological stresses that result in reduced health. The aim of this study is to determine the impact of an empowerment program on self-efficacy, quality of life, clinical indicators of blood pressure and interdialytic weight gain, and laboratory results in these patients.

METHODS

This randomized, controlled trial was conducted at Boo Ali Sina Dialysis Center, Shiraz, Iran. A total of 48 hemodialysis patients participated in this study. After acquisition of informed consent, eligible patients were randomly divided into two groups, control and experimental. Pre-test data were obtained by using a demographic data form and two questionnaires for self-efficacy and quality of life. Blood pressure and interdialytic weight gain were measured. We extracted laboratory data from patients' charts. A six-week empowerment intervention that included four individual and two group counselling sessions was performed for the experimental group. Six weeks after intervention, post-test data were obtained from both groups in the same manner as the pre-test. Data were analyzed by ANCOVA using SPSS v11.5.

RESULTS

There were no statistically significant differences in demographic variables between the groups. Pre-test mean scores for self-efficacy, quality of life, blood pressure, interdialytic weight gain and laboratory results did not differ between the groups. There was a significant difference between the experimental and control groups in terms of pre-to post-intervention changes in overall self-efficacy scores, stress reduction, and decision making, in addition to overall quality of life and all dimensions included within quality of life based on this questionnaire. Additionally, the pre- to post-intervention changes in systolic/diastolic blood pressures, interdialytic weight gain, hemoglobin and hematocrit levels significantly differed between the groups.

CONCLUSION

Our study demonstrates that a combination of individual and group empowerment counselling sessions improves self-efficacy, quality of life, clinical signs, and hemoglobin and hematocrit levels in hemodialysis patients. Empowerment of hemodialysis patients should be considered in hemodialysis centers to assist patients with the management of their health-related problems.

TRIAL REGISTRATION

Irct ID: IRCT138901172621N4.

The effect of empowerment on the self-efficacy, quality of life and clinical and laboratory indicators of patients treated with hemodialysis: a randomized controlled trial

BACKGROUND

Hemodialysis patients face numerous physical and psychological stresses that result in reduced health. The aim of this study is to determine the impact of an empowerment program on self-efficacy, quality of life, clinical indicators of blood pressure and interdialytic weight gain, and laboratory results in these patients.

METHODS

This randomized, controlled trial was conducted at Boo Ali Sina Dialysis Center, Shiraz, Iran. A total of 48 hemodialysis patients participated in this study. After acquisition of informed consent, eligible patients were randomly divided into two groups, control and experimental. Pre-test data were obtained by using a demographic data form and two questionnaires for self-efficacy and quality of life. Blood pressure and interdialytic weight gain were measured. We extracted laboratory data from patients' charts. A six-week empowerment intervention that included four individual and two group counselling sessions was performed for the experimental group. Six weeks after intervention, post-test data were obtained from both groups in the same manner as the pre-test. Data were analyzed by ANCOVA using SPSS v11.5.

RESULTS

There were no statistically significant differences in demographic variables between the groups. Pre-test mean scores for self-efficacy, quality of life, blood pressure, interdialytic weight gain and laboratory results did not differ between the groups. There was a significant difference between the experimental and control groups in terms of pre-to post-intervention changes in overall self-efficacy scores, stress reduction, and decision making, in addition to overall quality of life and all dimensions included within quality of life based on this questionnaire. Additionally, the pre- to post-intervention changes in systolic/diastolic blood pressures, interdialytic weight gain, hemoglobin and hematocrit levels significantly differed between the groups.

CONCLUSION

Our study demonstrates that a combination of individual and group empowerment counselling sessions improves self-efficacy, quality of life, clinical signs, and hemoglobin and hematocrit levels in hemodialysis patients. Empowerment of hemodialysis patients should be considered in hemodialysis centers to assist patients with the management of their health-related problems.

TRIAL REGISTRATION

Irct ID: IRCT138901172621N4.

The effect of empowerment on the self-efficacy, quality of life and clinical and laboratory indicators of patients treated with hemodialysis: a randomized controlled trial

Background

Hemodialysis patients face numerous physical and psychological stresses that result in reduced health. The aim of this study is to determine the impact of an empowerment program on self-efficacy, quality of life, clinical indicators of blood pressure and interdialytic weight gain, and laboratory results in these patients.

Methods

This randomized, controlled trial was conducted at Boo Ali Sina Dialysis Center, Shiraz, Iran. A total of 48 hemodialysis patients participated in this study. After acquisition of informed consent, eligible patients were randomly divided into two groups, control and experimental. Pre-test data were obtained by using a demographic data form and two questionnaires for self-efficacy and quality of life. Blood pressure and interdialytic weight gain were measured. We extracted laboratory data from patients’ charts. A six-week empowerment intervention that included four individual and two group counselling sessions was performed for the experimental group. Six weeks after intervention, post-test data were obtained from both groups in the same manner as the pre-test. Data were analyzed by ANCOVA using SPSS v11.5.

Results

There were no statistically significant differences in demographic variables between the groups. Pre-test mean scores for self-efficacy, quality of life, blood pressure, interdialytic weight gain and laboratory results did not differ between the groups. There was a significant difference between the experimental and control groups in terms of pre-to post-intervention changes in overall self-efficacy scores, stress reduction, and decision making, in addition to overall quality of life and all dimensions included within quality of life based on this questionnaire. Additionally, the pre- to post-intervention changes in systolic/diastolic blood pressures, interdialytic weight gain, hemoglobin and hematocrit levels significantly differed between the groups.

Conclusion

Our study demonstrates that a combination of individual and group empowerment counselling sessions improves self-efficacy, quality of life, clinical signs, and hemoglobin and hematocrit levels in hemodialysis patients. Empowerment of hemodialysis patients should be considered in hemodialysis centers to assist patients with the management of their health-related problems.

Trial registration

Irct ID: IRCT138901172621N4