Effect Of Self-management On Health-related Quality Of Life In Hemodialysis Patients With End-stage Renal Disease

[Objective] This study aims to inquire into the present situation of self-management,health-related quality of life,symptom burden and social support in hemodialysis patients with end-stage renal disease,to initially construct a conceptual model of the impact of self-management on health-related quality of life based on the Wilson-Cleary theoretical model of health-related quality of life,to analyze the mechanism of ESRD hemodialysis patients’ self-management on health-related quality of life,enriching the application of the Wilson-Cleary health-related quality of life theoretical model in ESRD hemodialysis patients,so as to provide theoretical basis and data reference for strengthening self-management of hemodialysis patients with end-stage renal disease,reducing the burden of symptoms and improving their health-related quality of life.[Methods] Using the method of stratified cluster sampling to randomly select three provincial and three municipal top public tertiary hospitals in Wuhan.The self-made social-demographic characteristics,the SF-12 scale,the self-management scale for hemodialysis patients,the Dialysis Frequency Severity and Symptom Burden Index scale and the Social Support Rating Scale were used for questionnaire survey.The descriptive statistical analysis,non-parametric test,multiple linear regression analysis,Pearson correlation analysis and structural equation model were used for data statistical analysis.[Results](1)This study established a theoretical framework for the impact of self-management on health-related quality of life in patients with end-stage renal disease on hemodialysis.A total of 310 hemodialysis patients with end-stage renal disease were included in this study.The score of health-related quality of life was 77.28(s=7.46),and the total physiological score and total psychological score were 35.65(s=5.79)and 41.63(s=6.42)points respectively.The self-management score was 43.26(s=9.53),the symptom burden score was 82.29(s=24.21),and the social support score was 29.29(s=7.15).(2)There were significant differences in the physical component summary of hemodialysis patients with end-stage renal disease in ages,family average monthly income and dialysis years(P(27)0.05).There were significant differences in the mental component summary among educational levels and the number of combined diseases(P(27)0.05).There were significant differences in self-management of hemodialysis patients with end-stage renal disease in ages,dialysis years and health education frequencies(P(27)0.05).(3)Health-related quality of life and social support were significant positively correlated with self-management.Self-management and health-related quality of life were significant negatively correlated with Symptom burden.After controlling for other variables,self-management and emotional processing can predict the total physiological score and symptom burden(P(27)0.05),self-management,partnership and implementation of self-care can positively predict the total psychological score(P(27)0.05),symptom burden and occurrence frequency can negatively predict the total physiological score(P(27)0.05),and symptom burden and distress can negatively predict the total psychological score(P(27)0.05).(4)The symptom burden of hemodialysis patients with end-stage renal disease has a partial mediating effect in the impact of self-management on health-related quality of life.Social support regulated the direct path of the impact of self-management on health-related quality of life in hemodialysis patients with end-stage renal disease.Social support also moderated the first half of the mediating effect of the impact of self-management on health-related quality of life.[Conclusion](1)End-stage renal disease patients with hemodialysis have lower health-related quality of life,self-management,and social support levels,and higher symptom burden.(2)End-stage renal disease hemodialysis patients with advanced age,low education,low income,short dialysis years,and no health education have poor self-management and health-related quality of life.(3)The symptom burden of hemodialysis patients with end-stage renal disease has a partial mediating effect in the impact of self-management on health-related quality of life.The impact of self-management on health-related quality of life was positively moderated by social support and the first half of the mediating effect path of the impact of self-management on health-related quality of life was also positively regulated by social support.