Covic Adrian, Seica Anca, Gusbeth-Tatomir Paul, Gavrilovici Ovidiu, Goldsmith David J A
Dialysis and Transplantation Center, C I Parhon Hospital, 50 Carol 1st Blvd, Iasi 6600, Romania.
Nephrol Dial Transplant. 2004 Aug;19(8):2078-83. doi: 10.1093/ndt/gfh254. Epub 2004 Jun 22.
Health-related quality of life (QoL) in haemodialysis (HD) patients is a significant predictor of mortality and hospitalization. Patients' adaptation to a chronic disease is determined by their beliefs about illness and treatment. In this cross-sectional study we examined the impact of illness representations on QoL of HD patients and the influence of HD duration on this relationship.
Eighty-two clinically stable HD patients completed the Short Form-36 Health Survey (mean age 47.9+/-12.1, mean treatment duration 72+/-50.6, 53.6% males). Illness representations were assessed by a structured interview containing questions derived from The Revised Illness Perception Questionnaire.
Our results indicate a relatively low QoL of HD patients, with an important proportion of patients scoring less than 43 for the physical component summary (65.9%) and less than 51 for the mental component summary (58.5%). HD patients consider their illness as having a chronic course, which they understand and control quite well. A higher personal control is associated with a lower emotional response and a better understanding of the disease. However, the perceived negative consequences of the disease upon patients' personal lives are considerable, as is their emotional response. Four of the six components of illness representations were strongly related to QoL parameters. On multiple regression analysis, between 15 and 31% in the variance of the physical and mental component of QoL was explained by three dimensions of illness representations: the perceived course of the disease, personal control and emotional response. Only the emotional response dimension of the illness representations is related to treatment duration (r = -0.48, P<0.01).
Our study demonstrates important relationships between illness representations and QoL in end-stage renal disease patients treated by HD. Future research will have to plan for interventions that could alter illness representations in order to confirm the real impact of illness representations upon patients' QoL.
血液透析（HD）患者的健康相关生活质量（QoL）是死亡率和住院率的重要预测指标。患者对慢性病的适应程度取决于他们对疾病和治疗的信念。在这项横断面研究中，我们考察了疾病认知对HD患者生活质量的影响以及HD治疗时长对这种关系的影响。
82例临床稳定的HD患者完成了简明健康状况调查问卷（36条目）（平均年龄47.9±12.1岁，平均治疗时长72±50.6个月，男性占53.6%）。通过结构化访谈评估疾病认知，访谈问题源自修订后的疾病认知问卷。
我们的结果表明HD患者的生活质量相对较低，相当一部分患者的躯体健康成分总结得分低于43分（65.9%），心理健康成分总结得分低于51分（58.5%）。HD患者认为他们的疾病呈慢性病程，他们对疾病有较好的理解和控制。更高的个人掌控感与更低的情绪反应以及对疾病更好的理解相关。然而，疾病对患者个人生活的负面影响相当大，他们的情绪反应也是如此。疾病认知的六个成分中有四个与生活质量参数密切相关。在多元回归分析中，疾病认知的三个维度：疾病的感知病程、个人掌控感和情绪反应，解释了生活质量躯体和心理成分方差的15%至31%。只有疾病认知的情绪反应维度与治疗时长相关（r = -0.48，P<0.01）。
我们的研究表明在接受HD治疗的终末期肾病患者中，疾病认知与生活质量之间存在重要关系。未来的研究将必须规划能够改变疾病认知的干预措施，以证实疾病认知对患者生活质量的实际影响。
