Institute for Rehabilitation Medicine, Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Center for Health Sciences of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Nephrol Dial Transplant. 2018 Jul 1;33(7):1235-1244. doi: 10.1093/ndt/gfx361.
Social relationships are important determinants of health-related outcomes for patients with chronic conditions. However, the effects of social networks and social support on health outcomes of dialysis patients in different treatment modalities have been under studied.
We surveyed peritoneal dialysis (PD) and haemodialysis (HD) patients in the Choice of Renal Replacement Therapy project about their social relationships and health-care outcomes at baseline and 1-year follow-up. Two propensity score-matched groups (n = 353; HD = 200, PD = 153) with similar age, comorbidity level, education and employment status were compared. We used an ego-centred Network Generator to assess quantitative and qualitative aspects of social networks and the Berlin Social Support Scales to evaluate dimensions of social support, and analysed the effects of the social variables on anxiety, depression, autonomy preferences, and physical and psychological quality of life.
Over time, the non-family networks (e.g. friends) of both groups decreased (P = 0.04) and the absolute number of types of relationships increased (P = 0.01). The family-network size, quality of relationships and social support remained stable. Larger social networks were associated with higher participation-seeking preferences (B = 1.39, P = 0.002) and lower anxiety (B = -0.11, P = 0.03). Closer and more satisfying relationships were associated with better psychological well-being (B = 3.41, P = 0.003). PD patients had larger networks, more types of relationships and received more social support than HD patients (P ≤ 0.05).
These differences may reflect the degree of autonomy and self-care associated with the different treatment modalities. In practice, our findings suggest that the early identification and inclusion of persons providing social support for patients may have a positive effect on different aspects of their care and quality of life.
社会关系是影响慢性病患者健康相关结局的重要决定因素。然而，不同治疗模式下的透析患者的社会网络和社会支持对其健康结局的影响仍研究不足。
我们在 Choice of Renal Replacement Therapy 项目中调查了腹膜透析（PD）和血液透析（HD）患者，在基线和 1 年随访时调查了他们的社会关系和医疗结果。通过倾向评分匹配，比较了两组具有相似年龄、合并症水平、教育和就业状况的患者（n=353；HD=200，PD=153）。我们使用以自我为中心的网络生成器评估社会网络的定量和定性方面，以及柏林社会支持量表评估社会支持的维度，并分析了社会变量对焦虑、抑郁、自主选择以及身体和心理生活质量的影响。
随着时间的推移，两组患者的非家庭网络（如朋友）减少（P=0.04），关系类型的绝对数量增加（P=0.01）。家庭网络规模、关系质量和社会支持保持稳定。更大的社会网络与更高的参与寻求偏好相关（B=1.39，P=0.002），焦虑程度更低（B=-0.11，P=0.03）。更紧密和更令人满意的关系与更好的心理幸福感相关（B=3.41，P=0.003）。PD 患者的网络更大，关系类型更多，社会支持更多，与 HD 患者相比差异具有统计学意义（P≤0.05）。
这些差异可能反映了不同治疗模式下与自主和自我护理相关的程度。在实践中，我们的研究结果表明，早期识别和纳入为患者提供社会支持的人员可能会对其护理和生活质量的不同方面产生积极影响。
