Illness Representations and Coping Processes of Taiwanese Patients with Early-Stage Chronic Kidney Disease

早期慢性腎臟疾病病患之疾病詮釋與因應過程

10.1097/JNR.0b013e3182921fb8

林秋菊(Chiu-Chu Lin)；陳玫君(Mei-Chun Chen)；謝秀芳(Hsiu-Fang Hsieh)；張淑真(Shu-Chen Chang)

慢性腎臟疾病 ； 因應過程 ； 疾病詮釋 ； 質性研究 ； chronic kidney disease ； coping ； illness representation ； qualitative study

The Journal of Nursing Research

21卷2期（2013 / 06 / 01）

120 - 128

英文

背景：慢性腎臟疾病（chronic kidney disease, CKD）之盛行率及發生率不斷增加，醫療花費亦高，已是普遍存有的公共衛生議題。個人對於疾病的詮釋會影響其健康相關的行為，然早期慢性腎臟疾病病患對其疾病的感受表現卻鮮少受到關注。目的：本質性研究旨在描述台灣的早期CKD病患疾病詮釋與因應過程之經驗。方法：本研究以立意取樣，從台灣兩家醫學中心腎臟科門診中，招募15位確診為早期CKD之病患為研究對象。採半結構、開放式之一對一、面對面訪談，訪談結果以質性內容分析方法進行分析，並以Lincoln與Guba所提的嚴謹度之四個準則進行評核。結果：從質性分析中得出以下六大主題：經歷到早期症狀、自我解釋其罹患CKD之原因、體認CKD是一種長期性疾病、相信遵從醫囑就可以控制CKD、預料罹患CKD的後果、以及採取因應策略來延緩CKD之病程。結論／臨床應用：本研究發現，健康照護專業人員對於患有腎臟疾病此族群病患，對其疾病的解讀與因應有更進一步的瞭解。相較於過去所發表之研究結果顯示，個人的疾病詮釋可以透過教育改變，繼而改善個人的因應行為。此發現使健康專業人員更體認到，進行衛生教育前，必須先評估個案對其疾病的解讀為何，如此方能提供具文化敏感性的介入措施。

Background: Chronic kidney disease (CKD) is a public health problem worldwide with an increasing incidence and prevalence and high cost. The role of illness perceptions in understanding health-related behavior has received little attention in patients with early-stage CKD. Purpose: This qualitative study aimed to describe the illness representation and coping process experience of patients with early-stage CKD in Taiwan. Methods: A qualitative content analysis approach was used to analyze semistructured, open-ended, one-on-one interviews with 15 patients with early-stage CKD. Purposive sampling was used to recruit patients diagnosed with early-stage CKD from the nephrology departments of two medical centers in Taiwan. Trustworthiness of the study was evaluated using four criteria suggested by Lincoln and Guba. Results: Six themes emerged from the analysis: experiencing early symptoms, self-interpreting the causes of having CKD, realizing CKD as a long-term disease, believing CKD could be controlled by following doctors' orders, anticipating the consequences of having CKD, and adopting coping strategies to delay the progress of CKD. Conclusions/Implications for Practice: Findings from this study compared with previous studies reveal that education can effectively change patient illness representations as an approach to improve coping behavior. This finding offers healthcare professionals insight into the health education necessary to assess patient illness representation to provide culturally sensitive interventions.

1. Lin, C. C.、Chin, C. C.、Liang, C. C.、Lai, Y. H.(2000)。Developing and testing of informational needs scale in uremic patients。Nursing Research (Taiwan)，8(6)，641-651。
   連結：
2. Bureau of National Health Insurance, Taiwan, ROC. (2008). National Health Insurance Report. Retrieved from http://www.doh.gov.tw/EN2006/DM/DM2_p01.aspx?class_no=390&now_ fod_list_no=10496&level_no=2&doc_no=7071 9 (Original workpublished in Chinese)
3. U.S. Renal Data System. (2009). Annual data report. Retrieved from http://www.usrds.org/2009/pdf/v1_09_09.pdf
4. Baum, A.(Ed.),Taylor, S. E.(Ed.),Singer, J. E.(Ed.)(1984).Handbook of psychology and health.Hillsdale, NJ:Lawrence Erlbaum Associates.
5. Brown, S. A.,Garcia, A. A.,Kouzekanani, K.,Hanis, C. L.(2002).Culturally competent diabetes self-management education for Mexican Americans.Diabetes Care,25(2),259-268.
6. Cameron, L. D.(Ed.),Leventhal, H.(Ed.)(2003).The self-regulation of health and illness behaviour.New York, NY:Routledge.
7. Chen, S. H.,Tsai, Y. F.,Sun, C. Y.,Wu, I. W.,Lee, C. C.,Wu, M. S.(2011).The impact of self-management support on the progression of chronic kidney disease- A prospective randomized controlled trial.Nephrology Dialysis Transplantation,26(11),3560-3566.
8. Costantini, L.,Beanlands, H.,McCay, E.,Cattran, D.,Hladunewich, M.,Francis, D.(2008).The self-management experience of people withmild tomoderate chronic kidney disease.Nephrology Nursing Journal,35(2),147-155.
9. Covic, A.,Seica, A.,Gusbeth-Tatomir, P.,Gavrilovici, O.,Goldsmith, D. J. A.(2004).Illness representations and quality of life scores in haemodialysis patients.Nephrology Dialysis Transplantation,19(8),2078-2083.
10. Diefenbach, M. A.,Leventhal, H.(1996).The common-sense model of illness representation: Theoretical and practical considerations.Journal of Social Distress and the Homeless,5(1),11-38.
11. Fowler, C.,Baas, L. S.(2006).Illness representations in patients with chronic kidney disease on maintenance hemodialysis.Nephrology Nursing Journal,33(2),173-186.
12. Gaston A.M.,Cottrell, D. J.,Fullen T.(2012).An examination of how adolescentYcaregiver dyad illness representations relate to adolescents' reported diabetes self-management.Child Care Health and Development,38(4),513-519.
13. Hagger, M. S.,Orbell, S.(2003).A meta-analytic review of the common-sense model of illness representations.Psychology & Health,18(2),141-184.
14. Haroun,M. K.,Jaar, B. G.,Hoffman, S. C.,Comstock, G. W.,Klag, M. J.,Coresh, J.(2003).Risk factors for chronic kidney disease: A prospective study of 23,534 men and women in Washington County, Maryland.Journal of the American Society of Nephrology,14(11),2934-2941.
15. Hart, P. L.,Grindel, C. G.(2010).Illness representations, emotional distress, coping strategies, and coping efficacy as predictors of patient outcomes in type 2 diabetes.Journal of Nursing and Healthcare of Chronic Illness,2(3),225-240.
16. Harwood, L.,Locking-Cusolito, H.,Spittal, J.,White, S.,Wilson,B.(2005).Preparing for hemodialysis: Patient stressors and response.Nephrology Nursing Journal,32(3),295-303.
17. Heijamans, M. J. W. M.(1998).Coping and adaptive outcome in chronic fatigue syndrome: Importance of illness cognitions.Journal of Psychosomatic Research,45(1),39-51.
18. Hsieh, H. F.,Shannon, S. E.(2005).Three approaches to qualitative content analysis.Qualitative Health Research,15(9),1277-1288.
19. Kaptein, A. A.,Klok, T.,Moss-Morris, R.,Brand, P. L. P.(2010).Illness perceptions: Impact on self-management and control in asthma.Current Opinion in Allergy and Clinical Immunology,10(3),194-199.
20. Karamanidou, C.,Clatworthy, J.,Weinman, J.,Horne, R.(2008).A systematic review of the prevalence and determinants of nonadherence to phosphate binding medication in patients with end-stage renal disease.BMC Nephrology,9
21. Kim, Y.,Evangelista, L. S.(2010).Relationship between illness perceptions, treatment adherence, and clinical outcomes in patients on maintenance hemodialysis.Nephrology Nursing Journal,37(3),271-281.
22. Kimmel, P. L.(2000).Psychosocial factors in adult end-stage renal disease patients treated with hemodialysis: Correlates and outcomes.American Journal of Kidney Diseases,35(4),S132-S140.
23. Lee, B. O.、Lin, C. C.、Wu, S. L.、Hsu, H. C.(2004)。Living with a hemodialysis machine: Living experience of an end-stage renal disease。Chang Gung Nursing，15(2)，121-130。
24. Levey, A. S.,Schoolwerth, A. C.,Burrows, N. R.,Williams, D. E.,Stith, K. R.,McClellan, W.(2009).Comprehensive public health strategies for preventing the development, progression, and complications of CKD: Report of an expert panel convened by the Centers for Disease Control and Prevention.American Journal of Kidney Diseases,53(3),522-535.
25. Lin, C. C.,Chang, S. H.(1985).Stress identification and coping patterns in patients on hemodialysis.Formosa Journal of Public Health,12(3),398-414.
26. Lin, C. C.,Lee, B. O.,Hicks, F. D.(2005).The phenomenology of deciding about hemodialysis among Taiwanese.Western Journal of Nursing Research,27(7),915-929.
27. Lin, Y. C.,Yen, M. F.(2003).The coping process of end-stage renal disease patient with dialysis treatment.Journal of Taiwan Nephrology Association,2(2),186-192.
28. Lincoln, Y. S.,Guba, E. G.(1985).Naturalistic inquiry.Thousand Oaks, CA:Sage.
29. Meyer, D.,Leventhal, H.,Gutmann, M.(1985).Common-sense models of illness: The example of hypertension.Health Psychology,4(2),115-135.
30. Moss-Morris, R.,Petrie, K.,Weinman, J.(1996).Functioning in chronic fatigue syndrome: Do illness perception play a regulatory role?.British Journal of Health Psychology,1(1),15-25.
31. O''Connor, S. M.,Jardine, A. G.,Millar, K.(2008).The prediction of self-care behaviors in end-stage renal disease patients using Leventhal's self-regulatory model.Journal of Psychosomatic Research,65(2),191-200.
32. Schaeffner, E. S.,Kurth, T.,Curhan, G. C.,Glynn, R. J.,Rexrode, K. M.,Baigent, C.,Gaziano, J. M.(2003).Cholesterol and the risk of renal dysfunction in apparently healthy men.Journal of the American Society of Nephrology,14(8),2084-2091.
33. Scharloo, M.,Kaptein, A. A.,Weinman, J.,Bergman, W.,Vermeer, B. J.,Rooijmans, H. G. M.(2000).Patients' illness perceptions and coping as predictors of functional status in psoriasis: A 1-year follow up.British Journal of Dermatology,142(5),899-907.
34. Shankar, A.,Klein, R.,Klein, B. E. K.(2006).The association among smoking, heavy drinking, and chronic kidney disease.American Journal of Epidemiology,164(3),263-271.
35. Shiloh, S.(2006).Illness representations, self-regulation, and genetic counseling: A theoretical review.The Journal of Genetic Counseling,15(5),325-337.
36. Stengel, B.,Tarver-Carr, M. E.,Powe, N. R.,Eberhardt, M. S.,Brancati, F. L.(2003).Lifestyle factors, obesity and the risk of chronic kidney disease.Epidemiology,14(4),479-487.
37. Vélez, E.,Ramasco, M.(2006).Meaning of illness and illness representations, crucial factors to integral care.Journal of Renal Care,32(2),81-85.
38. Wen, C. P.,Cheng, T. Y. D.,Tsai, M. K.,Chang, Y. C.,Chan, H. T.,Tsai, S. P.,Wen, S. F.(2008).All-cause mortality attributable to chronic kidney disease: A prospective cohort study based on 462 293 adults in Taiwan.The Lancet,371(9631),2173-2182.
39. White, Y.,Grenyer, B. F. S.(1999).The biopsychosocial impact of end-stage renal disease: The experience of dialysis patients and their partners.Journal of Advanced Nursing,30(6),1312-1320.
40. Zhang, Q. L.,Rothenbacher, D.(2008).Prevalence of chronic kidney disease in population-based studies: Systematic review.BMC Public Health,8,117.

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