de Vries Alicia M, Schulz Torben, Westerhuis Ralf, Navis Gerjan J, Niesing Jan, Ranchor Adelita V, Schroevers Maya J
Department of Health Psychology, University Medical Center Groningen, University of Groningen, The Netherlands.
Dialysis Center Groningen, The Netherlands.
Br J Health Psychol. 2017 Sep;22(3):524-541. doi: 10.1111/bjhp.12243. Epub 2017 May 22.
Renal transplantation (RTx) is considered the treatment of choice for end-stage renal disease (ESRD) given its association with lower mortality, and improved overall quality of life and psychological functioning compared to dialysis. However, much less is known about which factors underlie these psychological improvements across RTx. Goal theory suggests that experienced disturbances in important goals are related to lower psychological functioning. This study aimed to (1) identify the most disturbed and most important goals for patients before RTx, (2) to examine changes in goal disturbance and goal importance pre/post-RTx, and (3) to examine whether changes in goal disturbance are associated with changes in psychological distress over time, and whether this relationship is mediated by changes in perceived control.
In this longitudinal study, 220 patients completed questionnaires before and after RTx, including questionnaires to assess goals (GOALS questionnaire), psychological distress (GHQ-12), and perceived control (Mastery scale).
End-stage renal disease affected both general and disease-specific goals. Approximately 30% of the patients indicated to experience high or very high disturbance before transplantation. Goal disturbance generally decreased significantly pre- to post-RTx, whereas goal importance did not change significantly pre- to post-RTx. No mediation effect of perceived control was found. Instead, both changes in goal disturbance and perceived control showed independent effects on changes in distress.
Intervention strategies targeting attainable and realistic goal setting, and perceived control in RTx recipients who do not benefit optimally from RTx, might enhance psychological functioning in this population. Statement of contribution What is already known on this subject? Kidney transplantation improves patients' psychological functioning. Experienced disturbances in important life goals are related to lower psychological functioning in chronic illness. What does this study add? Goal disturbance decreases after renal transplantation, and this is related to a decrease in distress over time. Perceived control does not mediate the relationship between goal disturbance and distress pre/post-transplantation. Changes in perceived control have an additional main effect on changes in distress.
鉴于肾移植（RTx）与较低的死亡率相关，且与透析相比能改善总体生活质量和心理功能，它被视为终末期肾病（ESRD）的首选治疗方法。然而，对于肾移植过程中这些心理改善背后的因素，我们了解得要少得多。目标理论表明，重要目标方面经历的干扰与较低的心理功能有关。本研究旨在：（1）确定肾移植前患者中受干扰最大和最重要的目标；（2）研究肾移植前后目标干扰和目标重要性的变化；（3）研究目标干扰的变化是否随时间与心理困扰的变化相关，以及这种关系是否由感知控制的变化介导。
在这项纵向研究中，220名患者在肾移植前后完成了问卷调查，包括评估目标（目标问卷）、心理困扰（GHQ - 12）和感知控制（掌握量表）的问卷。
终末期肾病影响了一般目标和疾病特定目标。约30%的患者表示在移植前经历了高或非常高的干扰。肾移植前后目标干扰总体上显著降低，而目标重要性在肾移植前后没有显著变化。未发现感知控制的中介作用。相反，目标干扰和感知控制的变化都对困扰的变化显示出独立影响。
针对肾移植后未获得最佳受益的患者，采取旨在设定可实现和现实目标以及感知控制的干预策略，可能会改善该人群的心理功能。贡献声明关于该主题已知的内容有哪些？肾移植可改善患者的心理功能。重要生活目标方面经历的干扰与慢性病患者较低的心理功能有关。本研究增加了什么内容？肾移植后目标干扰减少，这与随时间困扰的减少有关。移植前后，感知控制并未介导目标干扰与困扰之间的关系。感知控制的变化对困扰的变化有额外的主要影响。
