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.

Psychometric Evaluation of the Vietnamese Hemodialysis Stressor Scale

The lack of a suitable assessment tool may limit optimal stress management and impair the health-related quality of life of patients undergoing hemodialysis. The purpose of the study was to examine latent constructs and psychometric properties of the Vietnamese Hemodialysis Stressor Scale (HSS-V). In total, 180 patients receiving hemodialysis were recruited. Psychometric properties of the HSS-V, including the construct validity, internal consistency, and test-retest reliability, were tested after the instrument translation. The exploratory factor analysis resulted in a 24-item HSS-V with four extracted factors, which explained 58.32% of the total variance. The construct validity was confirmed by significant negative correlations between scores on the HSS-V and Vietnamese-version Short Form-36. The internal consistency (Cronbach's α = .82-.91) and test-retest reliability (intra-class correlations coefficient = .91-.94) of the 24-item HSS-V were satisfactory. A simple structure and preliminary acceptable psychometric properties of the HSS-V were established and can serve as a basis for further studies.

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.

Stressors and coping strategies of 20-45-year-old hemodialysis patients

OBJECTIVES

This study attempted to describe stressors, levels of stress, and coping strategies of 20-45-year-old Taiwanese patients undergoing chronic hemodialysis.

METHODS

A cross-sectional descriptive design was used. A convenience sample of 88 patients with a mean age of 38.55 years was recruited at six dialysis centers in southern Taiwan. Data were collected using the Hemodialysis Stressor Scale and the Jalowiec Coping Scale.

RESULTS

The results show that this group of patients had higher levels of stress than those reported in previous studies. The three most frequently reported stressors were limitations of liquids, limitations of food, and fatigue. The two most frequent coping methods were trying to find meaning in the situation and trying out different ways of solving problems to see which works the best. These patients had more physiological stressors than psychosocial stressors and used more problem-oriented coping strategies than affective-oriented ones. Additionally, the longer the patients had received hemodialysis, the lower stress level they had, and patients with jobs, with partners, or with children used significantly more coping strategies than those without jobs, partners, or children. Gender differences were not found in the total stress level or coping strategies of these patients, except that female patients had greater psychosocial stressors than male patients.

CONCLUSIONS

The 20-45-year-old hemodialysis patients experienced considerable levels of stress and had a unique ranking order of stressors and coping strategies. These findings will provide healthcare professionals with detailed information to identify priority areas for future intervention development.

Factors Associated with Coping Mechanisms among Egyptian Patients with End Stage Renal Disease and on Haemodialysis

This study intends to identify factors that influence coping with physical and emotional impacts of haemodialysis on patients in Egypt. A questionnaire was administrated to a random sample of 162 participants, 87 men and 75 women, who had received outpatient treatment in health care clinics in seven Egyptian cities. A regression model was used with four independent variables (view of medical treatment, effect of pain, adjustment to treatment, and satisfaction with life) to explain variance in satisfaction with self and coping. Results show about half the variance in the patients' ability to cope and express satisfaction with the self was explained by the independent variables ( R2=–.55, R2=.45). Implications contributing to adjustment and coping are presented, showing the need to advance medical service and enhance patients' ability to develop effective strategies.

Effect on Anxiety of Education Programme about Care of Arteriovenous Fistula in Patients Undergoing Hemodialysis

Purpose

This study investigated the impact of education, provided to individuals, in whom AV fistula was preferred as a vascular access, regarding information and anxiety.

Methods

This experimental study was performed on 32 patients undergoing hemodialysis between November 2009 and February 2010 in the Nephrology Clinic of Sivas Cumhuriyet University Hospital. Patients' data was collected by means of Personal Information Form (PIF), AV Fistula Information Form (AV-FIF), and Beck Anxiety Inventory (BAI); education brochures were used in order to inform the individuals. Collected data were assessed with SPSS. Statistical analyses were used in order to assess the data: percentage account, paired samples t test.

Results

When comparing information and anxiety score of individuals prior to and following education about AV fistula care, it was seen that information and anxiety scores were low and high respectively, prior to the education. Following education, patients' information and anxiety scores became higher and lower respectively. All these results were statistically significant (P< 0.001).

Conclusions

Education about fistula increased the information level about fistula care and decreased anxiety in patients undergoing hemodialysis. It is important to perform patient education regularly, because it increases the level of orientation towards illness and interventions in patients.