Psychological and relational factors in ESRD hemodialysis treatment in an underserved community

Abstract

Objective: The researchers investigated the association of depression with treatment adherence, and examined the possible moderating roles of social support and of the physician-patient working alliance (PPWA) on treatment adherence, satisfaction with treatment, and quality of life.

Methods: The current study sampled ninety-five patients with End Stage Renal Disease who were receiving outpatient hemodialysis (HD) treatment.

Results: Findings indicated that higher levels of depression were significantly associated with lower ratings of adherence, quality of life, and social support. In contrast, higher levels of social support and of the PPWA were significantly associated with higher ratings of adherence, satisfaction with treatment, and quality of life. Analyses of moderation showed no effect for PPWA between depression and adherence, satisfaction, or quality of life; however, there was a significant moderation effect for social support.

Conclusion: There are mild but significant associations between PPWA and social support. Positive associations between the PPWA and social support on adherence, satisfaction, and quality of life indicate that each one, PPWA and social support, plays its own role on patients' experiences of and behavior in treatment. Affective social support significantly limits the negative influence of depression on adherence.

Practice implications: Assessment of depression and social support is essential in hemodialysis treatment.

Keywords: Adherence; Depression; End-stage renal disease; Physician-patient working alliance; Quality of life; Social support.