Illés A, Bugán A, Kovács S, Ladányi E, Szegedi J, József B, Szabó R, Nemes B
Division of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
Division of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
Transplant Proc. 2017 Sep;49(7):1517-1521. doi: 10.1016/j.transproceed.2017.06.013.
Kidney transplantation is generally considered to be the best treatment for end-stage renal disease. Not every patient can be operated, but many of suitable patients refuse this possibility. We aimed to explore the attitudes of patients with chronic kidney disease towards renal replacement therapies to recognize motives, thoughts, and feelings concerning accepting or refusing the treatment. We studied the attitudes towards the illness and the treatment, the appearance of depression, and the disease burden during different stages of the disease.
For this study we implemented a questionnaire that we developed (which has been described in an earlier publication of this journal) with 99 pre-dialysis patients, 99 dialysis patients, and 87 transplantation patients. We completed the attitude questionnaire designed by our team to include disease burden and depression questionnaires.
We used discriminant analysis to describe different stages of the disease. There was a significant difference in the following factors between the three patient groups: accepting the new kidney, lack of confidence in transplantation therapy, fear of surgery, accepting self-responsibility in recovery, dependency on the transplanted kidney, confidence in recovery, subjective burden of dialysis, and denial of personal responsibility in maintaining the transplanted kidney. Significant differences were also detected in these three groups regarding the level of depression and disease burden: we measured the highest value among the dialysis patients, and the lowest value among the pre-dialysis patients. Comparing patients accepting and refusing transplantation, we found a correlation between the refusal of transplantation and the attitudes towards the illness and treatment.
Most patients remain unmotivated to change treatment modality and refuse transplantation. Misbelief about transplantation shows a correlation with the motive of refusal. Dissemination of information may facilitate a change in the situation.
肾移植通常被认为是终末期肾病的最佳治疗方法。并非每个患者都能接受手术，但许多合适的患者却拒绝这种可能性。我们旨在探讨慢性肾病患者对肾脏替代疗法的态度，以了解他们接受或拒绝治疗的动机、想法和感受。我们研究了患者在疾病不同阶段对疾病和治疗的态度、抑郁的表现以及疾病负担。
在本研究中，我们对99名透析前患者、99名透析患者和87名移植患者实施了一份我们自行编制的问卷（该问卷已在本杂志的早期出版物中有所描述）。我们完成了由我们团队设计的态度问卷，其中包括疾病负担和抑郁问卷。
我们使用判别分析来描述疾病的不同阶段。三组患者在以下因素上存在显著差异：接受新肾脏、对移植治疗缺乏信心、害怕手术、在康复中承担自我责任、对移植肾的依赖、对康复的信心、透析的主观负担以及在维持移植肾方面否认个人责任。在抑郁水平和疾病负担方面，这三组之间也检测到显著差异：我们测得透析患者中的数值最高，透析前患者中的数值最低。比较接受和拒绝移植的患者，我们发现拒绝移植与对疾病和治疗的态度之间存在相关性。
大多数患者仍缺乏改变治疗方式的动力并拒绝移植。对移植的错误观念与拒绝的动机相关。信息传播可能有助于改变这种状况。
