The Study Of The Self-perceived Burden Among Patients With Peritoneal Dialysis

BACKGROUDSelf-perceived burden (SPB) is a new conception concerned about the self-sensation of patients which was first proposed by Cousineau et al. in2003. Based on the interviews on the100outpatient hemodialysis patients and professionals and reported literature, Cousineau et al. designed self-perceived burden scale and they proposed that SPB is a kind of empathy concern produced by the individual diseases and care needs which maybe bring some troubles for caregivers and affect the life of caregivers. The patients always have feelings of guilt, depression, pain, burden and reduce of individual self feeling.Peritoneal dialysis (PD) is one of the major important blood purification therapy for end stage renal disease (ESRD) patients awaiting kidney transplantation. Because of its safety and simple and relatively cheap cost advantage, PD has become as the important substitutive therapy for hospital or home ESRD patients. The PD patients are bearing enormous economic, psychological and physical pressure during long-term complex treatment. Li qinjiong et al. have reported that the incidence of depression in PD patients is37.33%, which is much higher than that in healthy people (9.8%). The analysis for the influencing factors of the depression in PD patients indicated that the source of patients have psychological problems mainly come from physical, spiritual and economic burden in long-term peritoneal dialysis process. The SPB in PD patients may be the important reason for the above psychological problems.Since the conception of SPB was proposed ten years ago, the studies on SPB are relatively limited. The foreign reports for SPB is mainly involved in neurodegenerative disease patients, advanced cancer patients, chronic pulmonary disease patients, hemodialysis patients and stroke patients. Domestic studies on SPB are at the beginning and some reports are focus on patients with cancer, COPD and hemodialysis since2010. There is no reported research on the SPB for PD patients and the relationship of SPB and depression up to now.OBJECTIVE1. To investigate the condition of of self-perceived burden (SPB) in patients with peritoneal dialysis and the scores of different dimensions for SPB;2. To analyze the possible influencing factors and the influencing degree of factors on SPB;3. To investigate the incidence of depression and analyze the correlations of SPB and depression in PD patients.SIGNIFICANT1. Provide a reference for peritoneal dialysis patients self-perceived burden related factors;2. To improve the the patients effective quality of life and clinical care intervention to provide a theoretical basis.METHORDS1.123PD patients with ESRD and their caregivers were rescruited by convenience sampling method in the medical department of two regional hospital (class A category3level) in Guangzhou. 2. A self-designed demographic questionnaire for patients and their caregivers were used to collect19demographic variables and clinical characters, which included gender, age, occupation, education of patients and the caregivers, duration of dialysis, frequence of dialysis, complication, method of payment and understanding of the disease of patients, living status, healthy status, times of care of the caregivers and the relationship between the patients and the caregivers.3. The conditions of self-perceived burden (SPB) of PD patients were investigated by generally accepted Self-perceived Burden Scale (SPBS). The scores of each dimensions of SPBS and the levels of SPB were analysized. SPBS has10items and is judged by5points which represents frequence of self-sensation."1" means "never","2" means "occasionaly","3"means "sometimes","4" means "frequently" and "5" means "always". Item8is marked reversely and the scores of all items were sumed up as the SPB total score. Higher scores indicate a heavier self-perceived burden. The score less than20means no obvious SPB,20≤the score <30means mild SPB,30≤the score<40means moderate SPB and the score more than40means severe SPB.4. An adapted version of the Center for Epidemiologic Studies Depression Scale (CESDS) were used to evalute the depression of PD patients. CESDS have20items and were evaluated by the frequence of symptoms occurred within the last1week. The frequence for less than1day means no symtom,1-3d means not often,3-4d means often and5-7d means always. The scores were marked as0,1,2and sequencely and item4,8,12and16were marked reversely. The score equal or less than15means no depressive syptoms, scores between16and19means possible depressive syptoms and the scores more than20means positive depressive symptoms.5. All data were collected, checked and analyzed by SPSS17.0soft ware. T tests and one way analysis of variance (one way ANOVA) were used to compare the differences of SPB and analyze the related factors among patients with different demographic variables and clinical characters. Multiple stepwise regression analyze the influcing factors of SPB. The relation of SPB and depression for PD patients were studied by ANOVA and Pearson correlation analysis.RESULTS1.86.18%of123studied patients have self-perceived burden, which was in a middle level generally. The mean SPB score of123PD patients was (30.77±8.12).18PD patients (14.63%) went to high score group with mean SPB score42.78±2.16,54PD patients (43.90%) went to median score group with mean SPB score34.15±2.55,34PD patients (27.64%) went to low score group with mean SPB score25.35±3.17and17PD patients (13.82%) show no obvious SPB with mean SPB score17.59±1.23. The second item in all investigated ten items of SPBS showed the highest score with mean score3.36±1.24, which express the degree of the fear for the overwork of caregivers. The mean score of the first item of SPBS is3.24±1.34.2. One way ANOVA analysis demonstrated that the SPB were statistically significant between different patients with different baseline characters such as age, occupation, education, insurance, the duration and times of dialysis, complications and caregiver’s health status of19factors (P<0.05). Stepwise regression analysis revealed times of dialysis per day, income, complications and caregiver’s health status were contributing factors, which can explain the viarances of SPB for PD patients by19.5%,9%,7.8%,4.4%respectively.3. CESD study showed that the mean depression score of123PD patients was25.89±10.77, which is higher than that of the national norm (11.5) and normal range value (<16point).24PD patients (19.51%) showed no depressive symptoms,21PD patients (17.07%) showed possible depressive symptoms and78PD patients (63.41%) showed obvious depressive symptoms. One way ANOVA showed that there were significant differences with the depressive scores for different patients with different degree of SPB (P<0.05). The mean CES-D score of17PD patients without SPB were15.65±5.86. The CES-D score become higher along with the increase of the score of SPB. The mean CES-D score of18PD patients with high level SPB was33.83±10.87and the post hoc tests showed the CES-D scores of PD patients with high level SPB were higher than those of patients without SPB (p<0.05). Pearson correlation analysis indicated that coefficient of correlation is0.522(P=0.000) and the degree of SPB is positively related to the depressive syptoms for PD patients.CONCLUSIONS1. Patients with perineal dialysis have middian level or above self-perceived burden, with14.63%in severe SPB,43.90%in moderate SPB and27.64%in no obvious SPB, which indicated that PD patients may have severe psychological burden and the decrease of self sensation.2. SPB of PD patients is influenced by multiple individual factors such as times of dialysis per day, income, complications and caregiver’s health status.3. SPB of PD patients is positively related to the depressive symptoms. Caregivers and nurses should take proper measures to alleviate the patients’s self-perceived burden and depressive symptoms in order to increase the quality of life for PD patients.