National University of Singapore
Adherence is critical to the success of haemodialysis in the treatment of ESRD patients. Researchers have discovered that mortality rates are highest in patients’ first year of haemodialysis. This study aims to study adherence in incident haemodialysis patients. The author also examines the variables that may be related to adherence in incident patients such as self-efficacy, depression and anxiety. It was found that self-efficacy was not related to adherence in incident patients but predicted adherence in prevalent patients, suggesting that self-efficacy was not a good predictor of adherence in incident patients. The results also showed that anxiety was negatively correlated with adherence in both incident and prevalent patients. Anxiety showed stronger negative correlations with adherence in the incident group than the prevalent group, suggesting that anxiety was a stronger predictor of adherence in incident patients. Taken together, the results of this study provide precursory evidence that anxiety may be a better predictor of adherence in incident haemodialysis patients than self-efficacy. This idea runs in contrast to the general belief that self-efficacy is a strong predictor of adherence behaviours in most patient populations. Keywords: haemodialysis, adherence, incident, prevalent, anxiety, self-efficacy.
End-stage renal disease (ESRD) is a complex chronic disease that will cause drastic changes, which inevitably reduce a patient’s quality of life (Finkelstein, Wuerth & Finkelstein, 2009). Haemodialysis, a renal replacement therapy (RRT) used to manage ESRD, depends upon two core processes: the removal of waste in the blood through dialysis and the restriction of nutrients and fluid (Denhaerynck et al, 2007). Patient adherence to the regimen is thus vital to treatment success. (Kutner, 2001; Leggat et al, 1998; Newmann & Litchfield, 2005). However, the complexity of the regimen makes adherence difficult for patients to achieve (Macdonald, Garg & Haynes, 2002). As such, non-adherence rates worldwide have been found to range between 8.5% and 22.1% and have even been reported to be as high as 86% (Matteson & Russel, 2010). These numbers are worrying indeed, especially when one considers the myriad of medical complications that can arise from non-adherence to dialysis regimen such as cardiovascular disease and hyperphosphatemia (Stamatakis, Pecora and Gunel, 2007).
Mortality rates for RRT patients are similarly disappointing, particularly for new or incident patients. In Singapore, the survival rate of patients after the first year is 89.3%, while in the United Kingdom, 8% of dialysis patients die within the first year of treatment (MCYS Singapore, 2010; UK Renal Registry, 2010). Elsewhere, it has been found that mortality rates are highest during the first year of RRT (Wingard, Chan, Lazarus & Hakim, 2009; Bradbury et al, 2007). Considering the importance of adherence in successful haemodialysis treatment, along with the increased mortality rates for new haemodialysis patients, it is puzzling why little research has been conducted on adherence in new patients.
As treatment period lengthens and patients become more accustomed with the regimen, adherence to professionally prescribed regimens may decrease. This pattern has been found in other patient populations such as diabetics and COPD patients. Therefore, we expect this to be replicated in the current study’s sample (Donnelly, Donney, Morrist, Palmer & Donnan, 2008; Vinker et al, 2008; Turner, Wright, Mendella & Anthonisen, 1996).
Self-efficacy theory purports that behavioural change and maintenance are the products of both efficacy expectations and outcome expectations of the patient (Brady, Tucker, Alfino, Tarrant & Finlayson,...