Brownbridge G, Fielding D M
Department of Paediatrics, St James's University Hospital, Leeds, UK.
Pediatr Nephrol. 1994 Dec;8(6):744-9. doi: 10.1007/BF00869109.
Sixty children and adolescents in end-stage renal failure who were undergoing either haemodialysis or continuous ambulatory peritoneal dialysis at one of five United Kingdom dialysis centres were assessed on psychosocial adjustment and adherence to their fluid intake, diet and medication regimes. Parental adjustment was also measured and data on sociodemographic and treatment history variables collected. A structured family interview and standardised questionnaire measures of anxiety, depression and behavioural disturbance were used. Multiple measures of treatment adherence were obtained, utilising children's and parents' self-reports, weight gain between dialysis, blood pressure, serum potassium level, blood urea level, dietitians' surveys and consultants' ratings. Correlational analyses showed that low treatment adherence was associated with poor adjustment to diagnosis and dialysis by children and parents (P < 0.01), self-ratings of anxiety and depression in children and parents (P < 0.001), age (adolescents tended to show poorer adherence than younger children, P < 0.001), duration of dialysis (P < 0.05), low family socioeconomic status (P < 0.05) and family structure (P < 0.01). These findings demonstrate the importance of psychosocial care in the treatment of this group of children. Future research should develop and evaluate psychosocial interventions aimed at improving treatment adherence.
在英国五个透析中心之一接受血液透析或持续性非卧床腹膜透析的60名终末期肾衰竭儿童和青少年，接受了心理社会适应情况以及对液体摄入、饮食和药物治疗方案依从性的评估。同时也对父母的适应情况进行了测量，并收集了社会人口统计学和治疗史变量的数据。采用了结构化家庭访谈以及焦虑、抑郁和行为障碍的标准化问卷调查。利用儿童和父母的自我报告、透析期间的体重增加、血压、血钾水平、血尿素水平、营养师调查和顾问评级等多种方法来获取治疗依从性的测量结果。相关性分析表明，治疗依从性低与儿童和父母对诊断和透析的适应不良有关（P < 0.01），与儿童和父母的焦虑和抑郁自评有关（P < 0.001），与年龄有关（青少年的依从性往往比年幼儿童差，P < 0.001），与透析时间有关（P < 0.05），与家庭社会经济地位低有关（P < 0.05），与家庭结构有关（P < 0.01）。这些发现表明了心理社会护理在治疗这组儿童中的重要性。未来的研究应开发并评估旨在提高治疗依从性的心理社会干预措施。
