Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Nephrology
Published in: BMC Nephrology 1/2022

01-12-2022 | Care | Research article

Effectiveness of a brief hope intervention for chronic kidney disease patients on the decisional conflict and quality of life: a pilot randomized controlled trial

Authors: Kitty Chan, Frances Kam Yuet Wong, Suet Lai Tam, Ching Ping Kwok, Yuen Ping Fung, Ping Nam Wong

Published in: BMC Nephrology | Issue 1/2022

Login to get access

Abstract

Background

Stage 5 chronic kidney disease (CKD) patients often experience decisional conflict when faced with the selection between the initiation of dialysis and conservative care. The study examined the effects of a brief hope intervention (BHI) on the levels of hope, decisional conflict and the quality of life for stage 5 CKD patients.

Methods

This is a single-blinded, randomized controlled trial (ClinicalTrials.gov identifier: NCT03378700). Eligible patients were recruited from the outpatient department renal clinic of a regional hospital. They were randomly assigned to either the intervention or the control group (intervention: n = 35; control: n = 37). All participants underwent a customized pre-dialysis education class, while the intervention group received also BHI. Data were collected prior to the intervention, immediately afterwards, and one month following the intervention. The Generalized Estimating Equation was used to measure the effects in the level of hope, decisional conflict scores (DCS) and Kidney Disease Quality of life (KDQOL-36) scores. Estimated marginal means and standard errors with 95% confidence intervals of these scores were also reported to examine the within group and between group changes.

Results

An increase of the hope score was found from time 1 (29.7, 1.64) to time 3 (34.4, 1.27) in the intervention group. The intervention had a significant effect on the KDQOL-36 sub-scores Mental Component Summary (MCS) (Wald χ2 = 6.763, P = 0.009) and effects of kidney disease (Wald χ2 = 3.617, P = 0.004). There was a reduction in decisional conflict in both arms on the DCS total score (Wald χ2 = 7.885, P = 0.005), but the reduction was significantly greater in the control group (effect size 0.64).

Conclusions

The BHI appeared to increase the level of hope within the intervention arm. Nonetheless, differences across the intervention and control arms were not significant. The KDQOL-36 sub-scores on MCS and Effects of kidney disease were found to have increased and be higher in the intervention group. The DCS total score also showed that hope was associated with reducing decisional conflict.

Trial Registration

ClinicalTrials.gov Protocol Registration, NCT03378700. Registered July 12 2017.
Appendix
Available only for authorised users
Literature
1.
Li PK-T, et al. Changes in the worldwide epidemiology of peritoneal dialysis. Nat Rev Nephrol. 2017;13:90–103.PubMedCrossRef
2.
Porter E, Watson D, Bargman JM. Education for patients with progressive CKD and acute-start dialysis. Adv Chronic Kidney Dis. 2013;20(4):302–10.PubMedCrossRef
3.
Saeed F, et al. Patients’ perspectives on dialysis decision-making and end-of-life care. Clin Nephrol. 2019;91(5):294.
4.
5.
Murtagh FE, et al. Symptoms in the month before death for stage 5 chronic kidney disease patients managed without dialysis. J Pain Symptom Manage. 2010;40(3):342–52.PubMedCrossRef
6.
Yong DSP, et al. Symptom burden and quality of life in end-stage renal disease: a study of 179 patients on dialysis and palliative care. Palliat Med. 2009;23:111–9.PubMedCrossRef
7.
Unit R. In-house institutional documentation on the number of chronic kidney disease patients receiving renal replacement therapy and palliative care. Hong Kong: Kwong Wah Hospital; 2019.
8.
Cooper BA, et al. A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med. 2010;363(7):609–19.PubMedCrossRef
9.
Ashby M, et al. Renal dialysis abatement: lessons from a social study. Palliat Med. 2005;19(5):389–96.PubMedCrossRef
10.
Noble H, et al. Clinician views of patient decisional conflict when deciding between dialysis and conservative management: Qualitative findings from the PAlliative Care in chronic Kidney diSease (PACKS) study. Palliat Med. 2017;31(10):921–31.PubMedCrossRef
11.
Liu CY, Chen SC, Yang LC. Clinical experience of providing nursing care for a chronic renal failure patient receiving his first hemodialysis. J Taiwan Nephrol Nurs Assoc. 2012;11(3):62–74.
12.
Yang PC, et al. Experience of nursing a hemodialysis patient with end stage renal disease. J Taiwan Nephrol Nurs Assoc. 2011;10(2):1–13.
13.
14.
Keskin G, Engin E. The evaluation of depression, suicidal ideation and coping strategies in haemodialysis patients with renal failure. J Clin Nurs. 2011;20(19–20):2721–32.PubMedCrossRef
15.
Munro S, et al. Choosing treatment and screening options congruent with values: Do decision aids help? Sub-analysis of a systematic review. Patient Educ Couns. 2016;99:491–500.PubMedCrossRef
16.
Chan R, et al. Psychosocial risk and protective factors for depression in the dialysis population: A systematic review and meta-regression analysis. J Psychosom Res. 2011;71(5):300–10.PubMedCrossRef
17.
Cheavens JS, et al. Hope in cognitive psychotherapies: on working with client strengths. J Cogn Psychother. 2006;20(2):135–45.CrossRef
18.
Hutson H, Putting hope to work : five principles to activate your organization’s most powerful resource. Westport. Conn: Praeger; 2006.
19.
Tong A, et al. Thematic synthesis of qualitative studies on patient and caregiver perspectives on end-of-life care in CKD. Am J Kidney Dis. 2014;63(6):913–27.PubMedCrossRef
20.
Snyder CR. The psychology of hope. New York: The Free Press; 1994.
21.
Snyder CR. Hope and depression: a light in the darkness. J Soc Clin Psychol. 2004;23(3):347–51.CrossRef
22.
Snyder, C.R. and J.D. Taylor, Hope as a common factor across psychotherapy approaches: A lesson from the Dodo's verdict, in Handbook of hope : Theory, measures, and applicatiohs, C.R. Snyder, Editor. 2000, Academic: San Diego, Calif. ; London.
23.
Larsen DJ, et al. Hope in a strengths-based group activity for individuals with chronic pain. Couns Psychol Q. 2015;28(2):175–99.CrossRef
24.
Larsen DJ, Stege R. Client accounts of hope in early counseling sessions: a qualitative study. J Couns Dev. 2012;90(1):45–54.CrossRef
25.
Cheavens JS, et al. Hope therapy in a community sample: a pilot investigation. Soc Indic Res. 2006;77(1):61–78.CrossRef
26.
Snyder CR, Lopez SJ, Pedrotti JT. Positive psychology: The scientific and practical explorations of human strengths. 2nd ed. Thousand Oaks: SAGE Publications; 2011.
27.
Chan K, Wong FKY, Lee PH. A brief hope intervention to increase hope level and improve well-being in rehabilitating cancer patients: a feasibility test. Sage Open Nursing. 2019;5:1–13.CrossRef
28.
Lambert MJ. Implications of outcome research for psychotherapy integration. In: Norcross JC, Goldfried MR, editors. Handbook of psychotherapy integration. New York: Basic Book; 1992. p. 94–129.
29.
Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomized trials. Ann Intern Med. 2010;152(11):726–32.PubMedCrossRef
30.
Chan K, et al. The effects of a brief hope intervention on decision-making in chronic kidney disease patients: A study protocol for a randomized controlled trial. J Adv Nurs. 2020;76(12):3631–40.PubMedCrossRef
31.
Schrank B, et al. WELLFOCUS PPT – modified positive psychotherapy to improve well-being in psychosis: study protocol for a pilot randomised controlled trial. Trials. 2014;15(1):203.PubMedPubMedCentralCrossRef
32.
Hulley, S.B., et al., eds. Designing clinical research. 3rd ed. 2007, Lippincott, Williams & Wilkins: Philadelphia.
33.
Little, R.J., et al., The prevention and treatment of missing data in clinical trials. N Engl J Med. 2012;367(14):1355–60.
34.
Casellas-grau A, Font A, Vives J. Positive psychology interventions in breast cancer: a systematic review. Psychooncology. 2014;23(1):9–19.PubMedCrossRef
35.
Chan K, et al. The effects of a brief hope intervention on decision-making in chronic kidney disease patients: a study protocol for a randomised controlled trial. J Adv Nurs. 2020;76(12):3631–40.PubMedCrossRef
36.
Mak WWS, Ng ISW, Wong CCY. Resilience: enhancing well-being through the positive cognitive triad. J Couns Psychol. 2011;58(4):610–7.PubMedCrossRef
37.
Snyder CR, et al. Development and validation of the State Hope Scale. J Pers Soc Psychol. 1996;70(2):321–35.PubMedCrossRef
38.
O’Connor AM. Validation of a Decisional Conflict Scale. Med Decis Making. 1995;15(1):25–30.
39.
Lam WWT, et al. Psychometric assessment of the Chinese version of the decisional conflict scale in Chinese women making decision for breast cancer surgery. Health Expect. 2015;18(2):210–20.PubMedCrossRef
40.
O’Connor A.M. User manual - Decisional Conflict Scale. 2010.
41.
Chow SKY, Tam BML. Is the kidney disease quality of life-36 (KDQOL-36) a valid instrument for Chinese dialysis patients? BMC Nephrol. 2014;15:199–206.PubMedPubMedCentralCrossRef
42.
43.
Pekár, S. and M. Brabec, Generalized estimating equations: A pragmatic and flexible approach to the marginal GLM modelling of correlated data in the behavioural sciences. Ethology. 2018;124(2):86–93.
44.
Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Med Care. 2003;41(5):582–92.PubMed
45.
Mouelhi Y, et al. How is the minimal clinically important difference established in health-related quality of life instruments? Review of anchors and methods. Health Qual Life Outcomes. 2020;18(1):136–136.PubMedPubMedCentralCrossRef
46.
Chong K, Unruh M. Why does quality of life remain an under-investigated issue in chronic kidney disease and why is it rarely set as an outcome measure in trials in this population? Nephrol Dialysis Transplant. 2017;32(suppl_2):ii47–52.CrossRef
47.
Tong EMW, et al. Re-examining hope: the roles of agency thinking and pathways thinking. Cogn Emot. 2010;24(7):1207–15.CrossRef
48.
Van Cappellen P, et al. Positive affective processes underlie positive health behaviour change. Psychol Health. 2018;33(1):77–97.PubMedCrossRef
49.
50.
Snyder, C.R., ed. Handbook of hope : theory, measures, and applications. 2000, Academic: San Diego, Calif. ; London.
51.
Rai GS, Abdulla A. Treatment of older people. Clinical Risk. 2012;18(5):197–201.CrossRef
52.
Ku E, McCulloch CE, Johansen KL. Starting renal replacement therapy: Is it about time? Am J Nephrol. 2019;50(2):144–51.PubMedCrossRef
53.
Levinson W, et al. Not all patients want to participate in decision making: A national study of public preferences. J Gen Intern Med. 2005;20(6):531–5.PubMedPubMedCentralCrossRef
54.
Chung GS, et al. Predictors of hospitalised patients’ preferences for physician-directed medical decision-making. J Med Ethics. 2012;38(2):77–82.
55.
Orsino A, et al. Medical decision-making and information needs in end-stage renal disease patients. Gen Hosp Psychiatry. 2003;25(5):324–31.PubMedCrossRef
56.
Tonkin-Crine S, et al. Understanding by older patients of dialysis and conservative management for chronic kidney failure. Am J Kidney Dis. 2015;65(3):443–50.PubMedPubMedCentralCrossRef
57.
de Haes H, Koedoot N. Patient centered decision making in palliative cancer treatment: a world of paradoxes. Patient Educ Couns. 2003;50(1):43–9.PubMedCrossRef
58.
Harwood L, Clark AM. Understanding pre-dialysis modality decision-making: A meta-synthesis of qualitative studies. Int J Nurs Stud. 2013;50(1):109–20.PubMedCrossRef
59.
Harwood L, Clark A. Dialysis modality decision-making for older adults with chronic kidney disease. J Clin Nurs. 2014;23(23–24):3378–90.PubMedCrossRef
60.
Thompson-Leduc P, et al. Prevalence of clinically significant decisional conflict: an analysis of five studies on decision-making in primary care. BMJ Open. 2016;6(6):e011490–e011490.PubMedPubMedCentralCrossRef
61.
Shah KK, et al. Health-related quality of life and well-being in people over 75 years of age with end-stage kidney disease managed with dialysis or comprehensive conservative care: a cross-sectional study in the UK and Australia. BMJ Open. 2019;9(5):e027776.PubMedPubMedCentralCrossRef
62.
63.
Ahmed FA, Catic AG. Decision-Making in Geriatric Patients with End-Stage Renal Disease: Thinking Beyond Nephrology. J Clin Med. 2018;8(1):5.PubMedCentralCrossRef
64.
Snyder CR, et al. The will and the ways: development and validation of an individual-differences measure of hope. J Pers Soc Psychol. 1991;60(4):570–85.PubMedCrossRef
Metadata
Title
Effectiveness of a brief hope intervention for chronic kidney disease patients on the decisional conflict and quality of life: a pilot randomized controlled trial
Authors
Kitty Chan
Frances Kam Yuet Wong
Suet Lai Tam
Ching Ping Kwok
Yuen Ping Fung
Ping Nam Wong
Publication date
01-12-2022
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2022
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-022-02830-7

Other articles of this Issue 1/2022

BMC Nephrology 1/2022 Go to the issue

Research

“Role of kidney function and concentrations of BAFF, sPD-L1 and sCD25 on mortality in hospitalized patients with COVID-19”

Research

Relationships between social capital, patient empowerment, and self-management of patients undergoing hemodialysis: a cross-sectional study

Research

Hyperphosphatemia and its relationship with blood pressure, vasoconstriction, and endothelial cell dysfunction in hypertensive hemodialysis patients

Research

Comparing the effect of peritoneal dialysis cycler type on patient-reported satisfaction, support needs and treatments

Research

The effects of synbiotics on indoxyl sulphate level, constipation, and quality of life associated with constipation in chronic haemodialysis patients: a randomized controlled trial

Research

Chronic kidney disease and its health-related factors: a case-control study

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits