Fissell Rachel B, Wild Marcus G, Schlundt David, Nair Devika, Umeukeje Ebele M, Mueller Claudia, Guide Andrew, Greevy Robert, Cavanaugh Kerri L
Division of Nephrology, Vanderbilt University Medical Center, USA.
Department of Psychology, Vanderbilt University, USA.
SM J Nephrol Kidney Dis. 2024;5(1). Epub 2024 Aug 21.
Many patients who start peritoneal dialysis (PD) transition to hemodialysis (HD) after a PD-related complication. Patient psychological factors may influence clinical outcomes. One possible factor is health mindset, or patient belief that their health knowledge and ability can change. The goal of this study is to evaluate the longitudinal associations of baseline health mindset with patient outcomes after one year.
The Health Mindset Scale (HMS, score 3-18) was administered on paper during clinic to a convenience sample of 100 adult PD patients, to quantify patient mindset along a continuum from fixed mindset (lower scores) to growth mindset (higher scores). Participants were 31% African American, 4% Hispanic, and 64% White American. Demographic and comorbid information were abstracted from medical records. Outcomes assessed at 1 year were death, transition to HD, renal transplant, and maintaining PD.
HMS scores were highest in patients who subsequently received a renal transplant (mean 15, SD 2.1), indicating a growth mindset. HMS scores in patients who died were lower (mean 10, SD 5.2) suggesting a more fixed mindset. Among those who maintained PD, HMS scores were between fixed and growth mindset (mean 12.8, SD 4.2) and similar to those who transitioned to HD (mean 13, SD 4.2). One-way ANOVA for difference in HMS scores by clinical outcome was p = 0.042.
This initial longitudinal study suggests associations between mindset and clinical outcomes. The HMS is a novel and easily administered instrument that quantifies one patient psychological component that could contribute to patient outcomes, and that could also be modified. The HMS may identify individuals who could benefit from specific interventions to favor a growth mindset, with the goal of supporting optimal clinical outcomes.
许多开始腹膜透析（PD）的患者在出现与PD相关的并发症后会转为血液透析（HD）。患者的心理因素可能会影响临床结局。一个可能的因素是健康思维模式，即患者相信自己的健康知识和能力可以改变。本研究的目的是评估基线健康思维模式与一年后患者结局之间的纵向关联。
在门诊期间，对100名成年PD患者的便利样本进行纸质版健康思维模式量表（HMS，评分3 - 18）测试，以量化患者从固定思维模式（低分）到成长思维模式（高分）连续体上的思维模式。参与者中31%为非裔美国人，4%为西班牙裔，64%为美国白人。人口统计学和合并症信息从病历中提取。1年后评估的结局包括死亡、转为HD、肾移植和维持PD。
随后接受肾移植的患者HMS评分最高（平均15分，标准差2.1），表明具有成长思维模式。死亡患者的HMS评分较低（平均10分，标准差5.2），表明思维模式更固定。在维持PD的患者中，HMS评分介于固定思维模式和成长思维模式之间（平均12.8分，标准差4.2），与转为HD的患者相似（平均13分，标准差4.2）。按临床结局对HMS评分差异进行的单因素方差分析结果为p = 0.042。
这项初步的纵向研究表明思维模式与临床结局之间存在关联。HMS是一种新颖且易于实施的工具，可量化可能影响患者结局的一个患者心理因素，并且该因素也可以被调整。HMS可能识别出那些可从有利于成长思维模式的特定干预措施中获益的个体，目标是支持实现最佳临床结局。
