Elucidating issues stressful for patients in predialysis and dialysis: from symptom to context

Physical activity and posttraumatic growth in patients receiving maintenance hemodialysis: A prospective study

This study used a prospective design to examine the association between self-reported physical activity and posttraumatic growth (PTG) over a 1-year period among 150 patients receiving maintenance hemodialysis. Transport-related, household, and leisure-time physical activity were positively associated with PTG at baseline and follow-up. Total physical activity could predict higher levels of PTG at follow-up, after controlling for baseline PTG and other covariates. The findings indicate that daily physical activity could be a modifiable behavioral factor associated with PTG among patients receiving maintenance hemodialysis. Further study is needed using a randomized controlled design and objective measures of physical activity.

The Influence of Coping and Personality Styles on Satisfaction with Life in Patients with Chronic Kidney Disease

The objective of this ex post facto study was to find out how different coping and personality styles influence satisfaction with life in a group of 55 people with chronic kidney disease, 34 of whom were receiving haemodialysis and 21 had undergone a kidney transplant. The participants completed three questionnaires, the SWLS, CAEPO and MIPS. The results showed the relationship between active coping strategies and satisfaction with life in haemodialysis patients, kidney transplant recipients and the total sample. A Pleasure-Enhancing personality style was significantly related to Satisfaction with Life, both in the total sample, and in the two groups separately. There were no significant differences in Satisfaction with Life between the haemodialysis patients and kidney transplant recipients. The theoretical repercussions of these results are discussed, highlighting their applications to clinical practice, in which training in active coping is essential.

Living with moderate to severe renal failure from the perspective of patients

Background

Within healthcare, almost no attention is given to patients with moderate-to- severe chronic kidney disease, having a with GFR between 20 and 45 while the presumption exists that these patients already experience several problems in their lives during the course of their illness.

Methods

A team of academic researchers and a renal patient participated in a qualitative study. Individual interviews (n = 31) and focus groups (10 participants in total) with patients having moderate-to-severe chronic kidney disease were conducted to gain insight into their everyday problems.

Results

Participants mentioned several experiences that can be divided into physical, social, societal and psychological aspects as well as aspects related to healthcare. The most important findings, following under each of these categories are: 1) the experience of fatigue (physical aspects) 2) the search for acknowledgment of complaints/not enough attention given to complaints leading to overcompensation and secrecy (societal aspects) 3) work problems (societal aspects) and 4) the wish to control the disease but not receiving enough support for this (healthcare). Patients feel in general that healthcare professionals do not take them seriously in their complaints and problems.

Conclusions

This study offers important new insights into an expanding group of patients having moderate-to-severe chronic kidney disease. Healthcare professionals should acknowledge their problems instead of ignoring or rejecting them and they should support patients in finding a way to deal with them. The assumptions of Personalised Care Planning could be used to support patients.

The effect of holiday haemodialysis treatments on patient mood, adverse symptoms and subjective wellbeing using the Big Red Kidney Bus

BACKGROUND AND AIMS

People with end-stage kidney disease receiving haemodialysis are restricted to holidays where dialysis services are readily available. Holiday dialysis in regional, rural and remote areas is particularly challenging. The aims of this study were to evaluate the wellbeing of those who received dialysis in a holiday haemodialysis bus and to measure patient well-being with that of a comparable cohort of haemodialysis patients.

METHODS

A three machine haemodialysis bus, the Big Red Kidney Bus, was built to enable people, their families and carers to take holidays across a range of tourist destinations in Victoria, Australia. Measures included pre-post subjective well-being, dialysis symptoms and mood questionnaires complemented by post semi-structured telephone interviews.

RESULTS

Participating holidaymakers were positive about the haemodialysis bus service and the standard of care experienced. They reported decreased dialysis side effects of fatigue, muscle cramp and dry skin. The overall number of reported symptoms decreased, and the perceived level of bother associated with symptoms also decreased. No changes in subjective well-being and mood were detected. Mean Personal Wellbeing Index scores were significantly higher than in a comparative haemodialysis sample.

CONCLUSION

The Big Red Kidney Bus provided a safe and feasible holiday dialysis service. Holidaymakers' well-being was reflected by the decreased dialysis patient side effects.

Choosing dialysis modality: decision making in a chronic illness context

BACKGROUND

Patients with chronic kidney disease (CKD) are encouraged to make an informed decision about dialysis. Survival rates for dialysis are equivalent yet there is wide variation in peritoneal dialysis uptake in the adult UK population. It is unclear how much is attributable to variations in patients' preferences. Kidney function usually declines over months and years; few studies have addressed how a chronic illness context affects choice. This study describes patients' decision making about dialysis and understands how the experience of CKD is associated with treatment choice.

METHOD

Survey employing interview methods explored 20 patients' views and experiences of making their dialysis choice. Data were analysed using thematic framework analysis to provide descriptive accounts of how patients experienced their illness and made treatment decisions.

RESULTS

Patients talked about challenges of living with CKD. Patients were provided with lots of information about treatment options in different formats. Patients did not distinguish between different types of dialysis and/or have an in-depth knowledge about options. Patients did not talk about dialysis options as a choice but rather as a treatment they were going to have.

CONCLUSION

Most patients perceived their choice as between 'dialysis' and 'no dialysis'. They did not perceive themselves to be making an active choice. Possibly, patients feel they do not need to engage with the decision until symptomatic. Despite lots of patient information, there were more opportunities to encounter positive information about haemodialysis. A more proactive approach is required to enable patients to engage fully with the dialysis treatment options.

Psychological stress in transplantation: a unified concept? What is measured and how: a literature review

This article describes how the concept of stress is studied in the field of solid-organ transplantation. Sixty-five articles or reviews of scientific research on stress are analyzed. The question addressed was how stress is explored and defined in transplant research, as it is often referred to as affecting psychological and/or physical transplant outcomes.

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.

Empowerment in outpatient care for patients with chronic kidney disease - from the family member's perspective

Background

Family members of persons with pre-dialysis chronic kidney disease may experience feelings of vulnerability and insecurity as the disease follows its course. Against this background, the aim of the present study was to explore empowerment in outpatient care as experienced by these family members.

Methods

An inductive approach for qualitative data analysis was chosen. The study sample comprised 12 family members of pre-dialysis patients at an outpatient kidney clinic. Two interviews with each family member were subjected to content analysis to gain an understanding of empowerment from the family members' perspective.

Results

Having strength to assume the responsibility was the main theme that emerged from the following five sub-themes: Being an involved participant, Having confirming encounters, Trusting in health-care staff, Comprehending through knowledge, and Feeling left out. Four of these five sub-themes were positive. The fifth subtheme illuminated negative experience, indicating the absence of empowerment.

Conclusions

Family members' experience of empowerment is dependent on their ability to assume the responsibility for a relative with chronic kidney disease when needed. The findings emphasise the need for a family perspective and the significance of a supportive environment for family members of persons in outpatient care.

Pre-dialysis patients' perceived autonomy, self-esteem and labor participation: associations with illness perceptions and treatment perceptions. A cross-sectional study

BACKGROUND

Compared to healthy people, patients with chronic kidney disease (CKD) participate less in paid jobs and social activities. The aim of the study was to examine a) the perceived autonomy, self-esteem and labor participation of patients in the pre-dialysis phase, b) pre-dialysis patients' illness perceptions and treatment perceptions, and c) the association of these perceptions with autonomy, self-esteem and labor participation.

METHODS

Patients (N = 109) completed questionnaires at home. Data were analysed using bivariate and multivariate analyses.

RESULTS

The results showed that the average autonomy levels were not very high, but the average level of self-esteem was rather high, and that drop out of the labor market already occurs during the pre-dialysis phase. Positive illness and treatment beliefs were associated with higher autonomy and self-esteem levels, but not with employment. Multiple regression analyses revealed that illness and treatment perceptions explained a substantial amount of variance in autonomy (17%) and self-esteem (26%). The perception of less treatment disruption was an important predictor.

CONCLUSIONS

Patient education on possibilities to combine CKD and its treatment with activities, including paid work, might stimulate positive (realistic) beliefs and prevent or challenge negative beliefs. Interventions focusing on these aspects may assist patients to adjust to CKD, and ultimately prevent unnecessary drop out of the labor market.

"I need to lead my own life in any case"--a study of patients in dialysis with or without a partner

OBJECTIVE

To elicit psychological and psychosocial problems existing in patients in dialysis and their partners, its being felt that the diversity involved has important implications for how service in dialysis units is delivered to patients and their partners.

METHODS

The results of a series of interviews of 39 patients in dialysis and 21 partners of theirs, each interview individual, concerning their ways of thinking and their feelings and the behaviour, were analyzed in qualitative and content-oriented terms.

RESULTS

Five basic themes could be identified: importance of treatment being individualized, dependency on an apparatus, consequences of the disease and its treatment, hopes for the future, and thoughts concerning life and death. Diversities relating to age, civil status, cultural and gender matters were disclosed.

CONCLUSION

The interview approach illustrated the importance of extended professional and individualized support in handling psychological and psychosocial disparities and needs in order to make treatment regimes more acceptable to the persons involved.

PRACTICE IMPLICATIONS

Suggestions are made concerning efforts to improve the care of patients receiving dialysis, and the importance of working with the patients and those closest to them in multidisciplinary teams.

Perspectives that lay persons with and without health problems show toward coronary heart disease: An integrated biopsychosocial approach

OBJECTIVE

We studied what patients with acute coronary heart disease (CHD) considered the three most stressful factors experienced during the month before testing and what they attributed their heart disease to.

METHODS

We studied the occurrence and severity of physiologic, psychologic, and psychosocial stressors in 117 patients with acute CHD and 117 referents, not diagnosed with CHD, matched by age, sex, and municipality. The subjects were first to select the factors they considered stressful from a list of potentially stressful factors. They were then to select the three they regarded as most stressful and to provide situational accounts of these.

RESULTS

The patients with CHD were found to less frequently live with a partner, to more frequently have a body mass index higher than 30.0, and to report a greater number of stressors. The stressors best differentiating them from the referents were fatigue, shortness of breath, pain, and high blood pressure. The causal factors they most frequently named were heart problems, smoking, heredity, high workload, and poor eating habits.

CONCLUSIONS

The situational accounts the patients provided illustrate the biopsychosocial complexities involved in the various categories of stressful factors.