Original Investigations: Dialysis Therapies
Patient satisfaction with care and behavioral compliance in end-stage renal disease patients treated with hemodialysis

https://doi.org/10.1053/ajkd.2002.33397Get rights and content

Abstract

Compliance with the hemodialysis (HD) prescription is an important predictor of patient outcome. Although there is interest in the concept of patient satisfaction with medical care and caregivers, relatively few such data exist regarding HD patients. We examined whether associations exist between patient satisfaction with medical personnel and depressive affect and social support levels and behavioral compliance with prescribed HD treatment. Seventy-nine HD patients were interviewed, assessing depression, social support, and perception of satisfaction with dialysis staff. Medical and treatment data, Karnofsky functioning and severity of illness scores, and behavioral and laboratory compliance measures were determined. There was no association between patient satisfaction with care and level of depressive affect. A relationship was found between patient satisfaction with care with their nephrologist and attendance at dialysis sessions. Patients who had a poor perception of satisfaction with their nephrologist had poorer attendance at dialysis sessions. There was no relationship between behavioral compliance and patient perception of ancillary HD staff. In addition, patient perception of satisfaction with staff was related to perception of social support, protein catabolic rate, and serum albumin concentration, all of which have been linked to survival. We conclude that a nephrologist has a crucial role in patient compliance. These results suggest interventions that improve patient perception of physician support may improve patient adjustment and possibly survival. © 2002 by the National Kidney Foundation, Inc.

Section snippets

Methods

We previously conducted a cross-sectional multicenter study of the psychosocial status of urban HD patients.18 All patients enrolled in chronic ESRD HD programs for more than 3 months at the George Washington University Medical Center, Howard University Medical Center, and Washington Veteran's Administration Medical Center dialysis units in Washington, DC, with the exception of human immunodeficiency virus-infected patients, those with a psychiatric diagnosis of psychosis, and those who failed

Results

The sample was composed of 32 women (40.5%) and 47 men (59.5%); 93.7% of patients were African-American. Patient demographics are listed in Table 1.Mean age of the population was 52.8 ± 16.0 years (range, 20 to 85 years). Patients had been treated for ESRD for a mean of 57.7 ± 56.7 months (range, 4 to 244 months), and 30.8% of patients had diabetes mellitus. Mean Karnofsky score was 69.8 ± 17.1 (range, 40 to 100).

We assessed whether patients who consented to participate in this study were

Discussion

Psychosocial factors in patients with ESRD have received little, but increasing interest.1, 2 For psychosocial factors to have importance for the nephrologist, they must be related to important clinical outcomes and patient well-being. There has been little evaluation of renal patients' perception of satisfaction with care and caregivers4 and the relationships between these and outcomes. Harris et al4 showed that decreased satisfaction with care in a group of patients with chronic renal

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    Address reprint requests to Paul L. Kimmel, MD, Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University Medical Center, 2150 Pennsylvania Ave NW, Washington DC 20037. E-mail: [email protected]

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