Association between Satisfaction with Dialysis Treatment and Quality of Life: A Cross-Sectional Study

The Patient's Perspective: Does It Align with Dialysis Adequacy?

Key Points

This study showed variation in satisfaction and quality of life between three dialysis centers, suggesting local factors influence outcomes. One center linked better dialysis to less satisfaction, but fully grasping satisfaction differences between sites warrants additional study.

Background

The concept of patient-centered care puts the individual's health needs and desired health outcomes as the driving forces behind medical decision making and quality assessment in the health care system. Patients with ESKD treated by hemodialysis require frequent encounters with the dialysis facility to survive. Therefore, their satisfaction with care and perceived patient experience are important aspects that might affect their adherence to the care regimen. The aim of this study was to evaluate patient satisfaction and its association with perceived patient experience and objective clinical quality parameters, across three hemodialysis clinics.

Methods

A prospective cohort study analyzed the data of 126 patients with ESKD receiving chronic hemodialysis over 9 months in three different care facilities. Sociodemographic characteristics, medical history, treatment details, and dialysis adequacy (measures as STDKt/V) were collected. Perceived quality of care, patient satisfaction, and clinical outcomes were assessed.

Results

Patients differed significantly between sites by age, diabetes status, and biochemical parameters. Satisfaction scores varied significantly for 12/14 survey questions and at the site-level, with site 2 scoring the highest. Overall satisfaction did not correlate with Kt/V. At site 1, a moderate negative correlation was found between satisfaction and Kt/V. Kt/V correlated positively with age but inversely with satisfaction. Hospitalization rates were similar regardless of satisfaction. Mortality trended lower in the highest Kt/V quartile.

Conclusions

Achieving clinical quality while optimizing patient satisfaction requires multifactorial approaches tailored to the unique population of the hemodialysis facility. Further research is needed to fully understand factors influencing satisfaction and perceived quality.

Attachment and parental bond: impact on psychopathology, mental health and quality of life of hemodialysis patients: a cross-sectional study

BACKGROUND

Attachment theory represents a reference model for understanding better how pre-existing personality factors can influence the coping with some chronic conditions. The onset of a chronic disease can represent a "threat" to the relationships between the subject and parental figures according to the type of bond that already exists. The aim of our study was to explore attachment styles in a sample of hemodialysis patients, hypothesizing that a secure attachment bond can constitute a protective factor for the quality of life and mental health in this type of patients.

DESIGN

We used a cross-sectional design.

METHODS

Fifty hemodialysis patients were given the following tests: Attachment Style Questionnaire (ASQ) to assess attachment styles, Parental Bonding Instrument (PBI) to assess parental bonding, Short Form Health Survey-36 (SF-36) for perceived quality of life and Middlesex Hospital Questionnaire (MHQ) to detect key psychological symptoms and relevant traits.

RESULTS

The results showed that secure attachment style correlated with good general health (r = 0.339; p < 0.05), good mental health (r = 0.547; p < 0.001) and mental component scale (r = 0.373; p < 0.05) of SF-36. Secure attachment was also significantly associated with mental health (B = 1.104; p = .002) of the SF-36.

CONCLUSIONS

The results confirmed the positive role of a secure attachment style for adequate psychological health. Early identification of patients with dysfunctional attachment styles will make it possible to offer them targeted interventions to improve their ability to accept, adapt and manage the disease and to maintain adequate psychological well-being.

Psychometric Properties and Effects on Health Outcomes of the Patient Assessment of Chronic Illness Care (PACIC) in Korean Hemodialysis Patients

Background: The satisfaction of patients receiving integrated care with End-Stage Renal Disease (ESRD) is widely advocated and patients with ESRD have special health needs, but few studies have investigated whether integrated care was associated with health outcomes. Our aims were to evaluate the psychometric properties of the Korean-translated patient assessment of chronic illness care (PACIC) in patients with ESRD, and to evaluate whether PACIC evaluated by patients was associated with health outcomes. Methods: ESRD patients on hemodialysis (n = 172) at 2 dialysis centers. Data quality, internal consistency and correlation between items and scales were assessed. To test the external validity, the association between PACIC and the health behaviour and outcomes of hemodialysis patients was analyzed. Results: The mean score of the PACIC items was 3.0. The item-scale correlation (0.67–0.85) and test-retest correlation (0.72–0.82) regarding scales for internal consistency showed excellent consistency. Total PACIC score was significantly associated with dietary self-efficacy (β = 0.22) and serum potassium (Exp(B) = 1.65). Higher overall PACIC score was significantly associated with higher physical health status (β = 3.52). Conclusions: The Korean-translated PACIC questionnaire is a tool with reliability and validity. Comprehensive treatment strategies for ESRD patients may improve their health behaviors and outcomes.

The Influence of an Unexpected Switch of Hemodialysis Facilities on the Quality of Life (QOL) in Hemodialysis Patients

Background

Patients and Methods

Results

Conclusion

Electronic Patient-Reported Outcomes in Nephrology: Focus on Hemodialysis

The success of hemodialysis (HD) treatments has been evaluated using objective measures of analytical parameters, or machine-measured parameters, despite having available validated instruments that assess patient perspective. There is an emerging interest regarding the use and relevance of patient-related outcomes (PROs). Electronic PROs (ePROs) involve the use of electronic technology, provide rapid access to this information, and are becoming more widely used in clinical trials and studies to evaluate efficacy and safety. Despite the scarce literature, this review suggests that ePROs are useful in providing a more customized and multidimensional approach to patient management and in making better clinical decisions in relevant aspects such as vascular access, duration and frequency of dialysis sessions, treatment of anemia, mental health, fatigue, and quality of life. The purpose of this review is to raise interest in the systematic use of ePROs in HD and to promote the development of studies in this field, which can respond to the gaps in knowledge and contribute to the implementation of the use of ePROs through new technologies, helping to improve the quality of health care.

The impact of the SARS-CoV-2 pandemic on the mental health of hemodialysis patients in Lebanon

Hemodialysis is a necessary treatment for end-stage kidney disease patients. It imposes undergoing three sessions of dialysis per week in a specialized center. Amid the SARS-CoV-2 pandemic, precautionary measures were mandatory in all dialysis facilities and may have negatively impacted patients' well-being. This study aimed to uncover the scale of this effect. We performed a cross-sectional study of all patients undergoing chronic hemodialysis in two dialysis units (one urban and another rural). Patients with Alzheimer's disease were excluded. Patients filled a questionnaire including information on socio-demographics, factors related to the dialysis facility, and the impact of the COVID-19 epidemic on their mental health. A total of 72 patients responded. Their median age was 70 (60.79) years. Of them, 68% were males, 71% were married, and 10% were living alone. Following the pandemic, 35% felt more anxious, with a higher incidence of anxiety in the rural unit (p=0.021). Half of them felt very limited in their relationships, and 29% were isolated from their families. In total, 98% of patients were satisfied with the staff support. The imposed preventive measures were perceived as very strict in 27% of the surveyed patients. The majority of the urban group were bothered for not eating during the session, and they felt significantly more stress than the rural group (p=0.001). The SARS-CoV-2 pandemic increased anxiety among hemodialysis patients from a rural setting. Stress was more prevalent in the urban group and most probably related to limitations in eating during sessions. The majority were satisfied with staff support.