Patients who have to undergo dialysis see their lives inevitably affected by the treatment. Despite medical advances, the quality of life perceived by these kidney patients has improved very little, although it varies from person to person. Basing this as her starting point, Dr Begoña Ruiz de Alegría studied the emotional progress of patients treated with dialysis (hospitalised haemodialysis treatment and domiciliary peritoneal dialysis) in the Basque Country Autonomous Community. She was able to identify the factors influencing this emotional progress and conclude that not all patients assimilate their illness in the same way – results which will help to establish future treatment and enhance the quality of life of these patients. Her thesis, defended at the University of Basque Country (UPV/EHU), was entitled, Living with dialysis. Confronting it and quality of life.
The results of the research reveal a process of the patient facing up to the illness in a dynamic manner. According to Dr Ruiz de Alegría, the start of dialysis involves an impact that is initially dealt with through an emotional catharsis, then the emotions begin to be regulated, after six months the situation can be processed cognitively and, finally, after a year, a more active and instrumental dealing with the situation is adopted.
Introspection or adaptation
The way in which each patient responds during this process and perceives their illness and quality of life varies notably. Two ways of confronting the illness are described: deliberate introspection and deliberate adaptation. Introspection involves the amplification of negative emotional states in the medium term: patients think about how things might be without dialysis, setting themselves unrealistic targets (and being self-critical on not reaching them), and avoid being with other people. These are persons who have weaker emotional networks and live with greater stress.
The exact opposite occurs with those who respond with deliberate adaptation: they live with less stress under dialysis and the good social support network which they have is key to their better emotional progress. In fact, they have more trust in others and are able to face up to the experience they are going through with greater positivism.
The role of the family is important
The personal resources (the cognitive, emotional and psychological elements) which each patient has condition the way in which the illness is confronted and quality of life is perceived. But so do contextual factors or external resources, such as the previously mentioned social support. Ms Ruiz de Alegría particularly highlighted good family support, as this helps to lessen the negative perception of the patient with respect to the repercussions of the chronic illness and to facilitate management of emotional unwellness.
Professional support and the concomitant doctor-patient relationship is also important, especially as regards willingness to accept treatment.
Better with peritoneal dialysis
The method of dialysis to which the patient is subjected also has repercussions on him or her. This is one of the most novel conclusions of the PhD thesis, having enabled the demonstration of hitherto undescribed differences between haemodialysis and peritoneal dialysis, from a health psychology perspective.
Haemodialysis is an in-hospital treatment which treats the blood directly, while peritoneal dialysis can be carried out by the patient in his or her own home, involving infiltrating the dialysis liquid into the peritoneal cavity by means of a catheter. The research concludes that, a year after initiation of treatment, patients on haemodialysis indicate less satisfaction, freedom and control over their lives than those on peritoneal dialysis. Thus, it was concluded that peritoneal dialysis has a less negative impact on the lives of persons than haemodialysis.
About the author
Begoña Ruiz de Alegría Fernández de Retana (Vitoria-Gasteiz, 1957) is a qualified nurse and a graduate in Anthropology. She drew up her thesis under the direction of Ms Nekane Basabe Barañano, lecturer in the Department of Social Psychology and Methodology of Behavioural Sciences, part of the Psychology Faculty at the UPV/EHU. She undertook her thesis in collaboration both with the public health system (Osakidetza) as well as the private sector in the Basque Autonomous Community, as well as with the Consolidated Social Psychology Research Team (Health, Culture and Education). Ms Ruiz de Alegría is a lecturer at the School of Nursing in the Basque capital of Vitoria-Gasteiz (UPV/EHU).