Schrauben Sarah J, Rivera Eleanor, Bocage Claire, Eriksen Whitney, Amaral Sandra, Dember Laura M, Feldman Harold I, Barg Frances K
Renal, Electrolyte-Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Kidney Int Rep. 2021 Nov 9;7(1):46-55. doi: 10.1016/j.ekir.2021.10.021. eCollection 2022 Jan.
Self-management is an integral component of CKD treatment. Nevertheless, many patients with CKD do not adequately engage in self-management behaviors, and little is known on the underlying reasons. We aimed to identify and describe the factors that influence self-management behaviors from the perspective of adults with CKD.
We conducted 30 semistructured interviews with adults with CKD stage 3 or 4 from an academic nephrology clinic in the United States. Interviews were analyzed thematically.
The following are the 3 key phases of CKD self-management behavior engagement identified: (i) prioritization, (ii) performance, and (iii) maintenance. Prioritization was favorably influenced by optimism, stress management, and patient-provider communication and hampered by fatalism and competing priorities. Behavior performance was facilitated by motivating factors, self-efficacy, and support resources and impeded by comorbid conditions that caused treatment burden and adverse symptoms. Behavior maintenance relied on effective routines, influenced by similar factors as behavior performance, and reinforced by memory aids, goal setting, self-monitoring, and proactive preparation.
We identified modifiable facilitators and barriers that influence the incorporation of CKD self-management into daily life. Our findings have important implications for the care of patients with CKD by providing a framework for providers to develop effective, tailored approaches to promote self-management engagement.
自我管理是慢性肾脏病（CKD）治疗的一个重要组成部分。然而，许多CKD患者并未充分参与自我管理行为，且其潜在原因鲜为人知。我们旨在从成年CKD患者的角度识别并描述影响自我管理行为的因素。
我们对美国一家学术肾脏病诊所的30名3期或4期成年CKD患者进行了半结构化访谈。对访谈进行了主题分析。
确定了CKD自我管理行为参与的以下3个关键阶段：（i）优先级确定，（ii）行为实施，以及（iii）维持。乐观、压力管理和医患沟通对优先级确定有积极影响，而宿命论和相互冲突的优先事项则会阻碍其进行。激励因素、自我效能感和支持资源有助于行为实施，而导致治疗负担和不良症状的合并症则会阻碍行为实施。行为维持依赖于有效的日常习惯，受与行为实施类似因素的影响，并通过记忆辅助工具、目标设定、自我监测和积极准备得到强化。
我们确定了影响将CKD自我管理融入日常生活的可改变的促进因素和障碍。我们的研究结果对CKD患者的护理具有重要意义，为医疗服务提供者制定有效的、量身定制的方法以促进自我管理参与提供了一个框架。
