Health-Related Quality of Life - Literature review Example

INFORMING PRACTICE WITH EVIDENCE: REVIEW OF ARTICLES Main Concepts/Definitions The perception of quality of life is very subjective. Hence, the question on this study is why does the quality of life assessment important in those who have end stage chronic kidney disease? Evidence-based Framework Table 1. Patients Interventions Comparisons Outcomes (PICO) Q Patients Interventions Comparisons Outcomes Type Ideal Study 1 patients with renal failure Single-center dialysis acceptable criterion standard for diagnosis of renal failure assessment of quality of life prognosis monitoring the client’s vital signs, and on important markers for health such as heart sounds, lung sounds, pulses, blood pressure, pain, temperature, mentation, and ability to respond 2 haemodialysis patients haemodialysis acceptable criterion standard for diagnosis of renal disease assessment of health-related quality of life and clinical indicators, morbidity and mortality diagnosis monitoring the client’s vital signs, and on important markers for health such as heart sounds, lung sounds, pulses, blood pressure, pain, temperature, mentation, and ability to respond 3 incident patients haemodialysis acceptable criterion standard for diagnosis of renal disease assessment of health status and quality of life diagnosis monitoring the client’s vital signs, and on important markers for health such as heart sounds, lung sounds, pulses, blood pressure, pain, temperature, mentation, and ability to respond 4 incident patients peritoneal dialysis acceptable criterion standard for diagnosis of renal disease assessment of health status and quality of life diagnosis monitoring the client’s vital signs, and on important markers for health such as heart sounds, lung sounds, pulses, blood pressure, pain, temperature, mentation, and ability to respond 5 incident patients dialysis acceptable criterion standard for diagnosis of renal disease assessment of quality of life and clinical variables diagnosis symptom clusters analysis and assessment of client’s vital signs and important markers for health 6 patients with kidney disease dialysis acceptable criterion standard for diagnosis of renal disease assessment of quality of life-short form diagnosis cross-sectional study of a dialysis-targeted health measure A complete map of foreground questions for the purpose of efficient location of clinical evidence includes the use of the Patients-Interventions-Comparisons-Outcomes (PICO) format, the identification of the question type, and consideration of the study designs corresponding to the highest level of evidence likely to exist. This is shown by using six (6) questions pertaining to patients with renal disease: 1. Does single-center dialysis improve the quality of life of patients with renal failure? 2. Does haemodialysis improve the quality of life, morbidity and mortality of patients with renal disease? 3. Does haemodialysis improve the quality of life and health status incident patients with renal disease? 4. Does peritoneal dialysis improve the quality of life and health status incident patients with renal disease? 5. Does dialysis improve the quality of life and clinical variables of incident patients with renal disease? 6. Does dialysis improve the quality of life-short form of patients with renal disease? Relevant Aspects Through the analysis of the table above, there are two main factors that determine the quality. One is the feeling that the patient is being taken care of. The second factor is that the patient does not really understand his or her situation. Renal failure is not a simple disease but neither a terminal one. In few other diseases, there is so much hope and desperation occupying the mood of the patient in an increasing spiral feeling. Moreso, it becomes our duty to increase the quality of life of these patents. Analysis Five articles related to the above were analyzed. As shown by Carmichael, et al. (2000), health-related quality of life (HRQOL) is a valid marker of outcome for chronic dialysis therapy. A wide range of questionnaires are now available which assess different aspects of an individual's health. Appreciation of those factors that contribute to explaining HRQOL items remains poorly defined. The development of disease-specific questionnaires such as KDQOL-SFTm, should allow for such questions to be better answered. In this study, a cross-sectional analysis of the chronic dialysis population was made using the KDQOL-SFTm questionnaire. By multiple linear regression analysis demographic, clinical and dialysis-related factors were assessed for their contribution to the HRQOL in this population. Also assessed was the HRQOL of the one hundred forty-six (146) patients against a general population sample. Results revealed that the haemodialysis as well as the peritoneal dialysis patients exhibited similar characteristics with respect to most demographic, clinical as well as dialysis variables except. However, haemoglobin and albumin showed to be signi®cantly (p < 0.05) greater in the peritoneal and haemodialysis populations, respectively. Compared to the general population, the HRQOL of dialysis patients was impaired for all SF-36 subscales. Use of the disease-specific components of KDQOL-SFTm discriminated between dialysis modality for our dialysis population. Multiple linear regression analysis demonstrated that 27.5 to 42.7% of the variance in the SF-36 subscales could be explained. Satisfactory sleep, dialysis related symptoms, effect of kidney disease on lifestyle and burden of kidney disease were found to be the most important determinants of HRQOL for this population. On the other hand, the aim of the research of Ca´ ssia, et al. (2006) is to verify the link between the morbidity and the quality of life and morbidity, and the clinical indicators and mortality patients who undergone haemodialysis. Results of the experiment revealed that the quality of life may be the most important outcome for haemodialysis patients. Furthermore, quality of life has been associated with clinical indicators, morbidity and survival in haemodialysis patients. The design of the study is based on the descriptive cohort study of patients undergoing haemodialysis at the Nephrology Hemodialysis Unit of the Hospital de Clı´nicas in Porto Alegre, Brazil. Forty haemodialysis patients were followed for 12 months and evaluated for demographics, time on dialysis, diabetes mellitus, clinical indicators (dose of dialysis – Kt/V, haematocrit and serum albumin) and comorbidities. The comorbidities were evaluated with the end-stage renal disease severity index and healthrelated quality of life with The Medical Outcomes Study 36 (SF-36). Results revealed that men present higher health-related quality of life scores in the energy and fatigue component (P ¼ 0Æ04). Patients treated for over one year at the beginning of follow up and patients with less schooling had better results in General Health Perception (P < 0Æ05). The health-related quality of life evaluation of patients who later died showed that they already had a worse perception of physical functioning as compared to the survivors (P ¼ 0Æ05). Patients with diagnosed diabetes perceived their physical functioning more negatively compared with those with other etiologies of end-stage renal disease (P ¼ 0Æ045). The researchers found a correlation between physical functioning and serum albumin (r ¼ 0Æ341, P < 0Æ05) and between physical functioning and haematocrit (r ¼ 0Æ317, P < 0Æ05). The end-stage renal disease severity index was more strongly related to physical functioning (r ¼ _0Æ538, P < 0Æ001). Comparing the patients’ results to the indicators above and below the established targets, the researchers found a trend to worse health-related quality of life in patients. Quality of life and morbidity and mortality revealed a close relationship. The research proved that the haematocrit and the albumin exhibited the most effect on the quality of life. Relevance to clinical practice. Haemodialysis patients experience various problems that may adversely influence their quality of life. Special care must be given to those who have diabetes mellitus, high morbidity scores, low serum albumin and low haematocrits. As explained by Kutner, et al. (2005), it has been suggested that there are no large differences in the quality of life of incident patients starting on haemodialysis (HD) and peritoneal dialysis (PD), but few studies have addressed this issue. Association of modality with incident patients’ health status and quality of life scores was investigated with propensity score (PS) analysis and also with traditional multivariable regression analyses. Kutner et al. (2005) analyzed the patient's reported quality of life health status scores after a year of therapy. The participating patients remained on the same modality. They have likewise completed the socio-demographic and clinical information needed to create a PS indicating their expected probability of starting on PD. One year scores on the majority of health status and quality of life measures were not significantly different for HD and PD patients within propensity-matched quintiles. PD patients’ scores were higher than HD patients’ scores on effects of kidney disease, burden of kidney disease, staff encouragement and satisfaction with care in some quintiles, and traditional regression analyses confirmed that dialysis modality was associated with patients’ scores on these variables. This study provides support for making the choice of PD more widely available as an option to patients initiating chronic dialysis therapy. Patient lifestyle opportunities associated with use of PD, a home-based and self-care therapy, may also apply to home-based HD or in-centre self-care HD. Patients’ expectations regarding treatment and their attitudes toward management of their health may interact with treatment modality to shape patient-reported experience on dialysis; this is an important focus for future studies. Based on the study by Thong, et al. (2008), the researchers found that the pathophysiology underlying symptoms is still not clear. Study on symptom management demonstrates that identification of related clusters of symptoms could give information about underlying determinants. These are found to be linked with numerous symptom experience. The researchers' aim in this study was to determine the symptom clusters in incident dialysis patients via the Karnofsky Index and quality of life. 1553 haemodialysis (HD) and peritoneal dialysis (PD) patients completed theKidneyDiseaseQuality of Life Short Formsymptom/problem list at 3 months after the start of dialysis. Principal component analysis using varimax rotation was used to identify symptom clusters. Patients were bothered by an average of 2.8 (±2.4) symptoms of ‘moderate bother’ or more. The results of this research indicated that only the clinical variables serum albumin and haemoglobin were associated with all clusters in HD patients, and Kt/Vurea (−0.089 to −0.125) in PD patients. In a similar study by Veena et al. (2010), the prevalence of end-stage renal disease (ESRD) and the number of people on dialysis is increasing in Singapore. The impact of ESRD on patient quality of life has been recognized as an important outcome measure. The Kidney Disease Quality Of Life-Short Form (KDQOL-SF™) has been validated and is widely used as a measure of quality of life in dialysis patients in many countries, but not in Singapore. The study was aimed at determining the reliability and validity of the KDQOL-SF™ for haemodialysis patients in Singapore. Cronbach’s alpha coefficient to determine internal consistency reliability, correlation of the overall health rating with kidney disease-targeted scales to confirm validity, and correlation of the eight sub-scales with age, income and education to determine convergent and divergent validity. Of the 1980 haemodialysis patients, 1180 (59%) completed the KDQOL-SF™. Full information was available for 980 participants, with a mean age of 56 years. The sample was representative of the total dialysis population in Singapore, except Indian ethnicity that was over-represented. The instrument designers’ proposed eight sub-scales were confirmed, which together accounted for 68.4% of the variance. All sub-scales had a Cronbach’s a above the recommended minimum value of 0.7 to indicate good reliability (range: 0.72 to 0.95), The overall health rating was shown to be positively correlated with kidney disease-targeted scales. General health subscales were found to have significant associations with age, income and education, confirming convergent and divergent validity. The psychometric properties of the KDQOL-SF™ resulting from this first-time administration of the instrument support the validity and reliability of the KDQOL-SF™ as a measure of quality of life of haemodialysis patients in Singapore. It is, however, necessary to determine the test-retest reliability of the KDQOL-SF™ among the haemodialysis population of Singapore.. Arguments Monitoring the vital signs play an important role because even the so well-educated patients spend many hours alone with machines, sound heartbeat, clear sound of the lung, the blood pressure and the pulse become their companion and calming companions in the long hours. Knowing that the only "miracoulus" cure is a transplant leaves little control to the patient. As long as the patient is fit for haemodialysis, there is hope. There is hope to have enough time to get a donor organ. The monitoring of the vital signs are like the sand in an hour glass, but as long as there are signs there is hope. Still depending on the location of the nearest dialysis center it involves a lot of time. Actually a time alone is essential, even if the patient can see that he is not the only one suffering from this condition. The less common peritoneal dialysis enables the treatment at home with all the advantages and disadvantages. As compared to the haemodialysis the patient is more alone and sees less fellow sufferers. He or she is more in the care of the family. This can be a more loving situation, but also bears the disadvantage that the family members my not be able to go into a professional distance and hence makes it more difficult for the patient to have a distance to its status. The time needed for the peritoneal dialysis helps the patient to adjust to his/her situation while still living a "normal" life, as opposed to the haemodialysis where the machinery required to be in a dialysis center, and often left alone with the fears, that creep in. The higher costs of the treatment and the need for a good sanitary situation in the home limit the usage to people that are better off. Often this class of people is better educated, which as stated before makes it more difficult for them to deal with their situation. The positive side is the needs of self treatment. Meaning, the patient is not in a purely victim role but his/her own doing improves his/her health. If it really improves the quality of life for these incident patients, more depends on the personality than on the technique(s). Family-oriented or even -dependent people for sure profit from it. But even for family oriented-patient, the situation might be difficult if the "help" of the family prevents the self-help of the patient to deal with the situation. Relevance of the Argument So far we were looking at the situation from the patients point of view. Of course the well-being and trust and hope, to a large degree, depend on the doctors and the health care personnel. Peritoneal dialysis patients do not have this "external family", not the fellow sufferers to share with. They also do not develop the sensitivity to see from the reaction of the medical personnel (through the body language) when their situation worsens. At the same time, if they are (constanty) moody, the doctors can treat them in a friendlier manner becasue there were less similar incidents. Knowing the probably terminal situation is important for doctors and healthcare workers, which include the drivers of the ambulance. It is good to keep a professional distance. For some sensitive characters this is felt as coldness, whereas, the patients with a less empathic nature do not feel the gap. Patients regularly coming to a dialysis center become "family". This feeling makes the patient on the other hand to look forward to the dialysis and not only see it as must. REFERENCES Carmichael, P., Popoola, J. John, I., Stevens, P.E. and Carmichael, A. R. 2000. Assessment of quality of life in a single centre dialysis population using the KDQOL-SFTm questionnaire. Quality of Life Research, 9: 195-205. Netherlands: Kluwer Academic Publishers. Ca´ ssia, Maria Morsch, Goncalves, Luiz Felipe and Barross, Elvino. 2006. Health-related quality of life among haemodialysis patients – relationship with clinical indicators, morbidity and mortality. Brazil: Blackwell Publishing Ltd. p. 498. Kutner, Nancy G., Zhang, Rebecca, Barnhart, Huiman and Collins, Allan J. 2005. Health status and quality of life reported by incident patients after 1 year on haemodialysis or peritoneal dialysis. Nephrol Dial Transplant, 20: 2159–2167. Minneapolis: Advance Access Publication. Thong, Melissa S. Y., Dijk, Sandra van, Noordzij, Marlies, Boeschoten, Elisabeth W., Krediet, Raymond T., Dekker, Friedo W. and Kaptein, Adrian A. 2008. Symptom clusters in incident dialysis patients: associations with clinical variables and quality of life. Nephrol Dial Transplant (2009) 24: 225–230. Amsterdam: Advance Access Publication. Joshi1, Veena D., Mooppil, Nandakumar and Lim, Jeremy F.Y. 2010. Validation of the Kidney Disease Quality of Life-Short Form: a cross-sectional study of a dialysis-targeted health measure in Singapore. BMC Nephrology, 11:36. BioMed Central. . Read More