Evaluating the illness perception questionnaire on patients with chronic kidney disease in Sweden

Impact of chronic kidney disease on illness perceptions, coping, self-efficacy, psychological distress and quality of life

Chronic kidney disease (CKD) negatively impacts psychological well-being and quality of life (QoL). Underpinned by the Common Sense Model (CSM), this study evaluated the potential mediating role of self-efficacy, coping styles and psychological distress on the relationship between illness perceptions and QoL in patients living with CKD. Participants were 147 people with stage 3-5 kidney disease. Measures included eGFR, illness perceptions, coping styles, psychological distress, self-efficacy and QoL. Correlational analyses were performed, followed by regression modelling. Poorer QoL was associated with greater distress, engagement in maladaptive coping, poorer illness perceptions and lower self-efficacy. Regression analysis revealed that illness perceptions predicted QoL, with psychological distress acting as a mediator. The proportion of variance explained was 63.8%. These findings suggest that psychological interventions are likely to enhance QoL in CKD, if they target the mediating psychological processes associated with illness perceptions and psychological distress.

The Multidimensional Illness Severity Questionnaire: Preliminary evaluation of a brief parent-reported measure of illness severity

AIM

This study describes the reliability and concurrent validity of the Multidimensional Illness Severity Questionnaire (MISQ), a five-item measure for capturing parents' reports of their child's illness severity.

METHODS

We conducted a cross-sectional survey of parents of children participating in a paediatric research study (n = 20). We assessed parents' perceptions of illness severity using five measures: (i) the MISQ, (ii) the Lansky Play Performance scale, (iii) the Severity of Illness Scale, (iv) subscales of the Parent Experience of Child Illness and (v) general health. We calculated the internal reliability of the MISQ using Cronbach's alpha and assessed concurrent validity through correlations between scores on the MISQ and other measures.

RESULTS

MISQ scores ranged from 6/21 to 17/21 (mean = 11.5). The MISQ had adequate internal consistency (Cronbach's α = 0.76) and correlated strongly with other measures.

CONCLUSION

Preliminary evaluation suggests that the MISQ is an easy-to-administer and internally consistent multidimensional assessment of parent-reported illness severity.

Patients,' Nephrologists,' and Predicted Estimations of ESKD Risk Compared with 2-Year Incidence of ESKD

BACKGROUND AND OBJECTIVES

The rate of progression to ESKD is variable, and prognostic information helps patients and physicians plan for future ESKD. We assessed the estimations of ESKD risk of patients with CKD and physicians and compared them with risk calculators and outcomes at 2 years.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This prospective observational study assessed 257 adult patients with CKD stages 3-5 and their nephrologists at University of California, San Diego and Veterans Affairs San Diego CKD clinics. Patients' and nephrologists' estimations of 2-year ESKD risk were evaluated, and objective estimation of 2-year risk was determined using kidney failure risk equations; actual incidence rates of ESKD and death were ascertained by chart review. Participants' baseline characteristics were compared across kidney failure risk equation risk levels and according to whether patients' estimations were more optimistic or pessimistic than physicians' estimations. We examined correlations between estimations and compared estimations with outcomes using c statistics and calibration plots.

RESULTS

Average age was 65 (±13) years old, and eGFR was 34 (±13) ml/min per 1.73 m². Overall, 13% reached ESKD, and 9% died. About one quarter of patients gave estimates that were >20% more optimistic than physicians, and more than one in ten gave estimates that were >20% more pessimistic. Physicians' and kidney failure risk equation estimations had the strongest correlation (r=0.72; P<0.001) compared with 0.50 (P<0.001) between physicians and patients and 0.47 (P<0.001) between patients and kidney failure risk equation. Although all three estimations provided reasonable risk rankings (c statistics >0.8), physicians and patients overestimated risk compared with actual outcomes; no patient whose physician estimated a risk of ESKD <15% reached ESKD at 2 years. The kidney failure risk equation was best calibrated to actual ESKD risk.

CONCLUSIONS

Compared with actual ESKD incidence, the kidney failure risk equation outperformed patients' and physicians' estimations of ESKD incidence. Patients and physicians overestimated risk compared with the kidney failure risk equation.

DIFFERENCES IN ILLNESS REPRESENTATIONS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

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.

Exploring the relationships between health status, illness perceptions, coping strategies and psychological morbidity in a chronic kidney disease cohort

BACKGROUND

Using the common sense model of illness adjustment, this study aimed to explore the impact of chronic kidney disease (CKD) on individual illness perceptions, coping styles and psychological well-being.

METHODS

Eighty individuals (50 men and 30 women) with an average age of 62.66 years (standard deviation, 11.98) were included in the study. All participants were under the care of the Renal Unit of a metropolitan tertiary referral hospital. Twenty-nine patients (36%) had CKD stage 3b-4, and 51 (64%) had CKD stage 5 (or end stage kidney disease [ESKD]). Disease severity was evaluated using the health perceptions questionnaire, coping styles assessed with the Carver brief COPE scale, illness perceptions explored with the brief illness perceptions questionnaire and anxiety and depression measured using the hospital anxiety and depression scale.

RESULTS

The hospital anxiety and depression scale assessment revealed 13 patients (16.3%) with moderate or severe anxiety and 6 (7.5%) with moderate depression. Consistent with the common sense model, disease activity had a significant direct influence on illness perceptions, while, in turn, illness perceptions had a significant direct influence on depression and anxiety. Adaptive and maladaptive coping were found to mediate the relationship between illness perceptions, and anxiety and depression.

CONCLUSIONS

The results provide evidence that it is the perception of an illness rather than the actual symptoms themselves that best account for adaption to CKD. These findings suggest that intervention strategies aimed at increasing psychological well-being need to focus on changing illness perceptions rather than improving symptoms of CKD or coping mechanisms.

Course of symptoms and health-related quality of life during specialized pre-dialysis care

Background

Concerns are present on the limited value of renal function alone in defining the optimal moment to start dialysis. Disease-related symptoms and health-related quality of life (HRQOL) may have additional clinical value in defining this moment, but little is known about how these parameters change during pre-dialysis care. The aims of our study were to describe the course of symptoms and HRQOL during pre-dialysis care and to investigate their association with poor health outcomes.

Methods

In the prospective PREPARE-2 cohort, incident patients starting specialized pre-dialysis care were included when referred to one of the 25 participating Dutch outpatient clinics (2004–2011). In the present analysis, 436 patients with data available on symptoms and HRQOL were included. Clinical data, symptoms (revised illness perception questionnaire), and HRQOL (short form-36 questionnaire; physical and mental summary score) were collected every 6-month interval. A time-dependent Cox proportional hazard model was used to associate symptoms and HRQOL with the combined poor health outcome (i.e. starting dialysis, receiving a kidney transplant, and death).

Results

All symptoms increased, especially fatigue and loss of strength, and both the physical and mental summary score decreased over time, with the most pronounced change during the last 6–12 months of follow-up. Furthermore, each additional symptom (adjusted HR 1.04 (95% CI, 1.00–1.09)) and each 3-point lower physical and mental summary score (adjusted HR 1.04 (1.02–1.06) and 1.04 (1.02–1.06) respectively) were associated with a higher risk of reaching the combined poor health outcome within the subsequent 6 months.

Conclusions

The number of symptoms increased and both the physical and mental HRQOL score decreased during pre-dialysis care and these changes were associated with starting dialysis, receiving a kidney transplant, and death. These results may indicate that symptoms and HRQOL are good markers for the medical condition and disease stage of pre-dialysis patients.

Symptom burden in chronic kidney disease: a review of recent literature

BACKGROUND

People living with chronic kidney disease (CKD) experience multiple symptoms due to both the disease and its treatment. However, these symptoms are often underrecognised. In addition, the majority of studies have focused on an individual symptom; however, these symptoms rarely occur in isolation and may instead occur in clusters.

AIM OF REVIEW

To investigate the total symptom burden in advanced CKD (Stages 4 and 5) and to identify the key instruments that are used to assess multiple symptoms.

METHODS

A literature search from 2006 to 2012 was undertaken and a total of 19 articles were included.

RESULTS

The most common CKD symptoms were fatigue or lack of energy, feeling drowsy, pain and pruritus. However, symptom assessment instruments varied between studies, often with inconsistent or inadequate symptom dimensions.

CONCLUSION

People with CKD experience a high symptom burden, although little is known about the burden for people with CKD Stage 4 and for those with CKD Stage 5 receiving peritoneal dialysis. This review recommends that a full range of symptoms be assessed for those at different stages of CKD. Improved understanding of the burden of symptoms can be used as the basis for treatment choices and for identifying priorities which are likely to contribute to a better quality of life and improve the quality of care.