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Title: Measurement of quality of life for end stage renal patients
Authors: Luk, Suet-ching Weety
Degree: Ph.D.
Issue Date: 2001
Abstract: Patients undergoing dialysis experience problems with disease-specific symptoms. As a consequence of the regular usage of dialysis and the dependence on machinery, chronic dialysis patients commonly have a wide range of physical and cognitive difficulties. The combination of a decrease in energy, the unavoidable emergence of socioeconomic problems and emotional reactions, compounds the stress facing the patient. This has an impact on the quality of life of a dialysis patient. The continuous expansion of renal replacement therapy for end stage renal failure in terms of patient numbers and cost, further raises the need to measure the quality of life of this group of patients. The concept of health-related quality of life is relatively complex. Most definitions have attempted to operationalise the term for measurement purposes, yet there is currently no consensus on a definition. A single global quality of life measure that is both reliable and valid for dialysis patients has yet to be developed. The lack of consistency in definitions and measures of the various quality of life dimensions makes it difficult to compare findings across various studies. Quality of life as a specific outcome variable has not been systematically and satisfactorily studied in Chinese dialysis patients in Hong Kong. More information is needed to establish how patients can be helped to enjoy more productive lives. Although many questions still surround the elements and measurement of quality of life, it is generally agreed that it is a multidimensional concept with individual subjective components. This paper firstly describes the process by which the Chinese Dialysis Quality of Life Scale was developed, and the preliminary testing and psychometric evaluation of the scale in a sample of dialysis patients. Secondly this study set out to investigate the quality of life of Hong Kong dialysis patients, and to understand the relationship between the demographic data and the quality of life of the subjects. Thirdly, the domains which constitute quality of life as perceived by Chinese dialysis patients in Hong Kong was identified. A convenience sampling method was used to recruit patients from any dialysis center in Hong Kong. Interviews were used to explore patients' perception of quality of life and the possible dimensions contributing to the construct of quality of life of dialysis patients in Hong Kong. A list of key issues was first derived from an in-depth literature review, then verified by semi-structured interview on seven patients. The initial list of 87 items was then further refined through two rounds of content analysis. The remaining 50 items were finalized by a pilot test on seven patients. Of the refined 40 items, face validity was performed by a team including one professor and ten patients. The 40-item scale was further evaluated for stability, internal consistency and criterion validity. The data obtained were treated as interval data. The total scores were an arithmetic sum of respective items, with a lower score indicating greater negative impact of dialysis and a higher score indicating higher satisfaction perceived on quality of life by patients. To compare whether there was a difference in the average quality of life scores obtained between different groups of each demographic variables, one way ANOVA followed by Tukey's post-hoc analysis were used. Pearson's product moment correlation was used to examine the relationships between the demographic variables and the overall quality of life score. The data were further analysed by means of principal component analysis and varimax rotation. In order to attain the best fitting structure and the correct number of factors, Kaiser's criterion and Scree slope were used. Cronbach's alpha and inter-item analysis were used to evaluate the internal consistency of each factor. Rules were adopted for item selection and interpretation. Of the 180 scales distributed, 164 were returned, giving a response rate of 91%. The scale demonstrated high internal consistency, good test-retest reliability and criterion validity when used. The psychometric evaluations suggested that the instrument is worthy of further development. Continued validation of this scale on a larger sample and a Chinese population living outside Hong Kong, has the potential to provide nurse with a valid assessment and treatment guide, and the researcher with a reliable measurement tool. The mean of the total score was 132.5 with SD 16.68, varying between 97 and 179. The item mean score was 3.31. Patients undergoing dialysis in this study expressed little satisfaction with life in general. They experienced multiple physical, social, economic and psychological changes. The variable related to health and functioning is the area with which dialysis patients in Hong Kong were the least satisfied. Marital status, type of modalities, and age appear to have no relationship to quality of life. Data represented by the eight-factors with eigenvalues greater than 1.00 (n=164) was found less-meaningful and manageable if compared to the four extracted factors. The four factor Varimax rotation accounted for 40.761 of the variability. The Cronbach's alpha for the 4 domains varied between 0.83 to 0.57. Several items which ranked low in quality of life (interest toward opposite sex, closeness with friend, sleep disturbance, money left for social entertainment, fatigue, skin itching, decrease in work capability), may be amenable to interventions. These variables can be used as a reference to assist dialysis patients with coping, and in maintaining and strengthening the support system for the patient and in understanding that the quality of their lives has direct consequences for the rehabilitation and management of the dialysis treatment for end stage renal failure patients.
Subjects: Hemodialysis -- Patients -- China -- Hong Kong
Quality of life -- China -- Hong Kong
Hong Kong Polytechnic University -- Dissertations
Pages: xii, 210, [7] leaves ; 30 cm
Appears in Collections:Thesis

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