Quality of life, self-care ability, and sense of coherence in hemodialysis patients: a comparative study.
ABSTRACT The number of patients treated for end-stage renal disease has increased in Sweden as in the rest of the world. During the last 6 years, more than 1000 people per year started renal replacement therapy in Sweden. Today hemodialysis (HD) patients have the opportunity to choose from different treatment modalities, home HD, self-care dialysis or conventional dialysis. The aim of the study was to investigate whether there are differences in the way HD patients view their quality of life, self-care ability and sense of coherence if they dialyze themselves at home, dialyze themselves in center (self-care), or if they are dialyzed by nurses in an outpatient dialysis unit. The instruments consisted of the Short Form 36 (SF-36) health survey, the Appraisal of Self-Care Agency questionnaire and the Sense of Coherence questionnaire. Nineteen patients participated in the study (5 patients on home HD, 6 self-care patients and 8 patients on conventional in center dialysis). There was a tendency for those who dialyzed at home to score higher on quality of life, self-care ability and sense of coherence than those who dialyzed themselves in center. Since the number of participants in this study was low, it is necessary for future studies to include more patients to verify the results.
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ABSTRACT: In this study perceived well-being and functioning in 28 uraemic patients (14 women and 14 men, mean age 54 years) were measured in the predialysis stage during conservative renal therapy and 3-9 months after having started maintenance dialysis treatment. The patients had participated in a patient education programme in the predialysis stage. Disease-specific symptoms, perceived health (Health Index), functional (SIP) and emotional (STAI) status were analysed. The results showed that there were no significant differences in the patients' correction of uraemia, frequency of symptoms or anxiety prior to and after having started dialysis. After having started dialysis treatment, fatigue, lack of energy and functional disability in work increased while disability in recreation and pastime decreased. Standard bicarbonate correlated significantly to the symptoms of leg cramps and itching. Serum albumin correlated significantly to eating dysfunction in the SIP. There was a large variation within the group with regard to their self-rated disturbances. Some patients reported a relatively intact quality of life, some reported a moderate influence, and some a severe decrease in quality of life irrespective of whether they were in the predialysis state or on maintenance haemodialysis or CAPD. In conclusion, dialysis treatment resulted in increased fatigue and lack of energy, while disease-specific symptoms, functional disability and anxiety did not increase during the first months on dialysis. The symptoms of itching and leg cramps correlated significantly with level of metabolic acidosis, and eating disability correlated with serum albumin levels, indicating that biochemical variables should be combined with patient assessment of health and well-being in order to optimize treatment and care. Moreover, the wide range of scores in all the research variables indicates that assessment of quality of life can be helpful in allocating support to those patients in need of it.Scandinavian Journal of Caring Sciences 02/1997; 11(3):159-66. · 0.89 Impact Factor
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ABSTRACT: The aim of this study was to describe patients' experiences of suffering from end-stage renal disease (ESRD). The rationale was to investigate how persons find meaning or make sense of their situation and how they experience suffering. The theoretical basis for the study was to view suffering at three levels. The first level was related to sickness and treatment. The second level was related to the care provided and the third level was related to each person's unique life experience and existence. Data were collected by interviews focusing on questions concerning daily life, needs, and expectations for the future. A qualitative interpretative content analysis was used. Fifteen patients between the ages of 50-86 participated in the study. Two main themes were identified describing these patients suffering. The first theme, 'the haemodialysis machine as a lifeline' consisted of three subthemes: 'loss of freedom', 'dependence on the caregiver', and 'disrupted marital, family and social life'. The second theme 'alleviation of suffering' consisted of two subthemes: 'gaining a sense of existential optimism' and 'achieving a sense of personal autonomy'. This study indicated that, in the lives of patients on haemodialysis, the main areas of suffering were related to loss of freedom expressed as dependence on the haemodialysis machine as a lifeline and, the caregivers. This time-consuming and tiring dependence affected marital, family and social life. Alleviation of suffering could be achieved by accepting dependence on the haemodialysis machine and maintaining autonomy by being seen as an individual by the caregivers.Journal of Advanced Nursing 05/2001; 34(2):196-202. · 1.53 Impact Factor
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ABSTRACT: We sought to determine whether lower mortality rates reported with hemodialysis (HD) at home compared to hemodialysis in dialysis centers (center HD) could be explained by patient selection. Data are from the United States Renal Data System (USRDS) Special Study Of Case Mix Severity, a random national sample of 4,892 patients who started renal replacement therapy in 1986 to 1987. Intent-to-treat analyses compared mortality between home HD (N = 70) and center HD patients (N = 3,102) using the Cox proportional hazards model. Home HD patients were younger and had a lower frequency of comorbid conditions. The unadjusted relative risk (RR) of death for home HD patients compared to center HD was 0.37 (P < 0.001). The RR adjusted for age, sex, race and diabetes, was 44% lower in home HD patients (RR = 0.56, P = 0.02). When additionally adjusted for comorbid conditions, this RR increased marginally (RR = 0.58, P = 0.03). A different analysis using national USRDS data from 1986/7 and without comorbid adjustment showed patients with training for self care hemodialysis at home or in a center (N = 418) had a lower mortality risk (RR = 0.78, P = 0.001) than center HD patients (N = 43,122). Statistical adjustment for comorbid conditions in addition to age, sex, race, and diabetes explains only a small amount of the lower mortality with home HD.Kidney International 05/1996; 49(5):1464-70. · 7.92 Impact Factor