Effectiveness of prehemodialysis preparatory program on improving coping among chronic kidney disease patients.

Abstract

Diagnosis of chronic kidney disease (CKD) and initiation of dialysis treatment is reported to be stressful for patients. It is essential that patients use effective coping strategies to deal with these stressors, since ineffective coping could have several adverse effects on various treatment-related as well as personal aspects of life, thereby lowering the quality of life in these patients. The study used a quasi-experimental design. The study population comprised 100 adult patients with Stage 3 and Stage 4 CKD whose glomerular filtration rate was deteriorating and required to undergo hemodialysis (HD) treatment. Carver's Brief Cope Scale was used to assess coping strategies used. The study was carried out in a tertiary care hospital in Bengaluru, India. Patients in the intervention group received pre-HD preparatory program and those in the control group received standard care. Postassessment for coping strategies used was carried out two weeks after the delivery of intervention. Highly significant statistical differences were observed in the use of certain adaptive coping strategies among the experimental group as compared to the control group after implementation of pre-HD preparatory program. These adaptive coping strategies included self-distraction (P = 0.011), active coping (P = 0.000), planning (P = 0.026), acceptance (P = 0.001), and religion (P = 0.005). The intervention was not found to be significant in reducing use of maladaptive coping strategies (P = 0.095). In India, 61%-66% of patients who present to nephrologists are already in end-stage renal disease. These patients hardly receive any organized education that would prepare them to understand their disease and enable them to manage it to the best of their abilities. An ongoing patient education and counseling program led by trained nurse educator will help patients cope effectively with the diagnosis of CKD and its treatment.