Date Published: July 25, 2017
Publisher: Public Library of Science
Author(s): Kakuya Niihata, Shingo Fukuma, Tadao Akizawa, Shunichi Fukuhara, Joseph Chilcot.
Hemodialysis patients are exposed to disease- and treatment-related stresses, and use various coping strategies to deal with these stresses. Although some studies have reported the association of coping strategies with mortality or health-related quality of life (QOL) in some populations, the effect of coping strategies on clinical outcomes in hemodialysis patients remains unclear. We investigated the association in a longitudinal design among Japanese hemodialysis patients.
We examined Japanese hemodialysis patients who participated in the Dialysis Outcomes and Practice Patterns Study (DOPPS) IV, which was conducted between 2009 and 2012. The exposure variable was stress coping strategy, as assessed using subscales in Coping Strategies Inventory Short Form: problem-focused engagement, problem-focused disengagement, emotion-focused engagement, and emotion-focused disengagement. Hazard ratios were estimated using Cox proportional hazard model for all-cause mortality and mean differences for change in health-related QOL in 1 year were estimated using a regression model.
Among 1,354 patients, only problem-focused engagement was significantly associated with longer survival; other subscales were not associated with all-cause mortality after adjustment for potential confounding factors. In terms of health-related QOL, the subscale of problem-focused engagement was also associated with improvement in physical functioning and mental health among 1,045 patients. Emotion-focused disengagement was associated with deterioration in mental health, but not with change in physical functioning. The other subscales were not associated with change in physical functioning or mental health.
Among hemodialysis patients, “problem-focused engagement” coping strategies were associated with longer survival and also with improvement in physical functioning and mental health. To achieve greater longevity and improve QOL in hemodialysis patients under ongoing stresses, problem-focused engagement should be encouraged.
Hemodialysis patients are exposed to chronic stresses due to their specific symptoms and treatments, including itching, fatigue, and fluid and diet restrictions. In addition, hemodialysis patients usually need to receive dialysis therapy three times weekly, which places limitations on their social life[1,2]. Certain coping strategies may alleviate these stresses. Among several other populations, such as patients with cancer or chronic heart failure, some coping strategies have been reported to be associated with improvements in clinical outcomes, including mortality and health-related quality of life[4–6]. We hypothesized that coping strategies could also influence outcomes for hemodialysis patients, and have therefore sought to clarify the association between coping strategies and clinical outcomes.
This is the first longitudinal analysis to investigate the associations of coping strategies with mortality and HR-QOL in hemodialysis patients. First, we found a significant association between problem-focused engagement and longer survival. Second, we found that problem-focused engagement was also associated with improvement in physical functioning and mental health. These results suggest that problem-focused coping may improve survival and HR-QOL in hemodialysis patients.