Study On The Influencing Factors And Mechanism Of Symptom Burden,Benefit Finding And Quality Of Life In Patients With Maintenance Hemodialysis

Objective:In order to understand the current situation of symptom burden,benefit finding and quality of life of maintenance hemodialysis patients（MHD）,and to analyzes the correlation between symptom burden,benefit finding and quality of life of MHD patients,and to discusses the main influencing factors of symptom burden and benefit finding of MHD patients,and verifies the mediating effect of benefit finding between symptom burden and quality of life,so as to provide valuable theoretical basis for improving the level of benefit finding of MHD patients,reducing the burden of symptoms,and improving the quality of life.Methods:A convenient sample of MHD patients was recruited from six first-class hospitals in china from December 2021 to June 2022 according to pre-specified.Inclusion and exclusion criteria.The general information questionnaire,symptom burden questionnaire（DFSSBI）,benefit finding assessment scale（BFS）and short form of quality of life of kidney disease(KDQOL—SF^TM1.3)were used as survey measurement.Descriptive statistical analysis,t-test,one-way Anova,Pearson corrrelation analysis and multiple linear regression and intermediary effect test were carried out on the data by using SPSS25.0 and SPSS PROCESSV3.2.Result:1.The status quo and influencing factors of symptom burden in MHD patients.MHD patients experienced an average of（7.84±2.20）symptoms,including（4.12±1.23）psychological symptoms and（3.72±0.98）physiological symptoms.The total score of symptom burden is（114.94±29.82）,and the total score of frequency is（39.55±10.09）.The total score of severity is（36.36±11.82）;The total score of distress is（37.82±8.36）.The survey results show that the highest incidence of physical symptoms in MHD patients is itching,fatigue and dry mouth,accounting for 98.1%;Secondly,sexual excitement difficulty and headache,accounting for 93%and 92.8%;The highest incidence of psychological symptoms in MHD patients is worry,anxiety and irritability,accounting for 94.7%,94.5%and 94.4%.The top three symptoms are itching（2.94±0.41）,dry mouth（2.94±0.38）and fatigue（2.93±0.40）.The top three symptoms were itching（2.66±0.82）,fatigue（2.65±0.81）and dry mouth（2.64±0.81）.The top three symptoms were fatigue（2.75±0.65）,itching（2.75±0.64）and dry mouth（2.74±0.45）.The results show that age,occupation,education level,residence,living conditions,medical insurance,serum creatinine,basic diseases,acute complications and chronic complications are all influencing factors for the average score of symptom burden of MHD patients（P<0.05）2.The status quo and influencing factors of benefit finding in MHD patients.The average score of benefit finding of MHD patients was（34.94±4.79）,with the highest score of 57 and the lowest score of 19.The items with the highest scores are Item 13"Let me face everything calmly",Item 16"Let me be more patient",Item 1"Let me understand that everyone has the need to love and be loved",Item 3"Let me accept things more easily"and Item 7"Teach me how to adapt to the things I can’t change",and the topics are all（2.04±0.30）.The items with the lowest scores are（1.38±0.54）,（1.28±0.46）and（1.17±0.40）respectively.There were differences of the benefit finding in different medical insurance,age,education level and occupation,Which has statistical significance（P<0.05）.3.Quality of life of MHD patients and its influencing factors.The results showed that the total score of quality of life of MHD patients was（49.36±10.22）,indicating that the quality of life of MHD patients was poor.Among them,the score of SF-36 is（50.00±11.49）,which belongs to a low level.The dimensions of emotional function（（36.95±11.57））,social function（42.01±15.34）and general health status（46.5±7.62）are not ideal.The KDTA score of（48.79±17.1）is also at a low level.The dimensions of patient satisfaction（29.36±23.76）,the burden of kidney disease on life（31.78±17.06）and the influence of kidney disease on daily life（37.77±19.99）are not ideal.The results showed that chronic complications were the influencing factors of SF-36 scale in MHD patients（P<0.05）.Occupational and acute complications were the influencing factors of KDTA scale in MHD patients（P<0.05）.4.Correlation analysis of symptom burden,benefit finding and quality of life in MHD patients.Correlation analysis showed that benefit finding of MHD patients was negatively correlated with symptom burden（r=-0.382,P<0.05）,positively correlated with quality of life（r=0.402,P<0.001）,and symptom burden was negatively correlated with quality of life（r=-0.365,P<0.001）.5.Analysis of the mediating role of benefit finding between symptom burden and quality of life in MHD patients.Mediating effect analysis shows that benefit finding has a partial mediating effect on the relationship between symptom burden and quality of life of MHD patients,and indirect effect accounts for 86.50%of the total effect.The intermediary effect accounts for 13.50%of the total effect.Conclusion:1.MHD patients have a heavy burden of symptoms,and many symptoms appear at the same time,but their frequency,severity and degree of distress are not completely consistent.Among the physiological symptoms,we should pay more attention to itching,fatigue,dry mouth,difficulty in sexual excitement and headache.Among psychological symptoms,more attention should be paid to anxiety,irritability and worry.The main influencing factors of symptom burden of MHD patients include age,occupation,education level,residence,living conditions,medical insurance,serum creatinine,basic diseases,acute complications and chronic complications.2.The level of benefit discovery and quality of life of MHD patients are not ideal.The main influencing factors of benefit finding include medical insurance,age,education level and occupation.The quality of life is mainly affected by acute and chronic complications and occupation.3.There is a correlation among symptom burden,benefit finding and quality of life of MHD patients,and benefit finding is found to play a partial intermediary role between symptom burden and quality of life.It is suggested that medical staff should not only pay attention to the physical symptoms of patients,but also pay attention to the mental health of MHD patients,so as to take effective measures to reduce the burden of symptoms and promote the quality of life.