School of Nursing, Midwifery and Health
Influences of spirituality on Quality of life and general wellbeing in patients with end-stage renal disease
Ali Alshraifeen
13th Annual Interdisciplinary Research Conference
7- 8th November 2012
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Outline:
1. Background
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General
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ESRD in Scotland
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Difficulties facing ESRD patients
2. Justification
3. Study aims
4. Method
•
Quantitative
•
Qualitative
5. Results
6. Summary
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Background
 Chronic illness: physical or mental conditions that affect the daily
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functioning of individuals for intervals >3 months/year, or for a
duration of hospitalisation >1 month (Theofanidis 2007)
Chronic illness has significant physical, psychological, social,
economical, and spiritual effects on the individual (Delaney 2005)
ESRD: a long term condition to both kidneys, it is debilitating and
progressive
Kidneys are unable to remove metabolic waste products from the
body (Tanyi & Werner 2003)
ESRD: patients need to start renal replacement therapy (HD, PD,
RX) (http://www.kidney.org)
HD is the most commonly used method of treatment (National
Kidney Foundation)
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ESRD in Scotland
 First patient dialysed in Scotland in 1960
 December 2010: 13506 accepted for renal replacement
therapy (RRT): HD, PD, and kidney transplantation (SRR, 2010)
 The number of prevalent patients is still rising; increasing cost
of treatment, pressure on patient, staff, and the NHS
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Difficulties facing patients with ESRD
 Physical (reduced mobility, fatigue, joint pain, site infection,
cardiovascular)
 Psychological ( depression, anxiety, low self esteem)
 Social (loss of role and identity)
 Logistic (fluid and diet restrictions, no choice of treatment)
 Spiritual (inability to practice beliefs, fulfil spiritual needs,
feeling tested)
 Together = poorer quality of life/ well-being
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Justification of the study
 Interest in studying spirituality increasingly emerging in the literature
 Spirituality: important aspect of health and well-being in people with
chronic health conditions (Parsian & Dunning 2009)
 Higher levels of spiritual health may lead to an improved quality of
life and coping (Morrison 2005)
 Providing spiritual care may lead to an improved coping with the
various challenges facing patients with chronic illnesses (Yao 2009)
 Is spirituality linked with health outcomes in patients with chronic
illness (ESRD)?
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Why ESRD…
 Minimal information in the literature linking spirituality and the
needs of patients with ESRD
 There is a lack of research addressing spirituality and its
contribution to adjustment in patients with ESRD (Tanyi &Werner
2003)
Study aims
 To investigate the influences of ESRD on patients’ quality of
life (QoL) and general well-being
 To examine the factors that can affect these influences (age,
gender, hope, social support)
 To examine the relationship between spirituality and the
QoL and general well-being of patients with ESRD
Spirituality framework
 Spiritual health: a fundamental dimension of people’s overall health
and well-being (physical, mental, emotional, social, and vocational)
 Fisher’s (1998) spiritual well-being model :
• Personal domain
• Communal domain
• Environmental domain
• Transcendental domain
Cross-sectional survey
(May 2009- May 2010)
Quantitative
Questionnaires
72 participants
Study Design
Grounded theory
Qualitative
December 2011ongoing
30 participants
In-depth interviews
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Quantitative
Cross-sectional survey (questionnaires)
 Quality of life Measure (SF-36v2): validated by analysing the scores
from patients with 25 different health conditions
 General health questionnaire (GHQ-28): to measure depression,
anxiety and insomnia, social dysfunction, and coping
 The multidimensional scale of perceived social support (MSPSS)
 Herth hope index (HHI)
 The spiritual well-being questionnaire (SWBQ)
 The brief COPE scale to assess patients’ coping with stressful events
Participants
 All ESRD patients in 5 Health
Boards in Scotland (800
participants) eligible
 Estimated number of
distributed study packs (364,
45.5% of the total sample)
 Number of completed
questionnaires (n=72)
 Inclusion criteria:
• ESRD patients/on HD
• On dialysis ≥6 months
• English speaking
• >18 years old
 Exclusion criteria:
• Distressed patients
• Psychological, neurological,
or communication
problems
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Data analysis and results
 Data analysis (PASW 18)
 Results
• Overall response rate (19.8%) out of estimated 364
• 50% of the sample were 56 years and older (n=36)
• Majority were retired (n=49)
• Majority were on HD for 6months- 5 years (n=44)
• Majority lived with families (n=46)
• More males (56.9%)
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Quality of life
Quality of life domains
Mean score
Standard Deviation
Physical Functioning
25.75
12.61
Role Physical
26.24
11.48
Bodily Pain
33.19
11.52
General Health
43.22
6.04
Vitality
47.62
6.78
Social Functioning
36.27
5.28
Role Emotion
35.66
15.59
Mental Health
43.66
6.07
MCS
47.84
7.52
PCS
26.53
7.26
Patients quality of life
 Patients scored considerably less than the UK population average
norms
 Most affected domains of QoL were the physical domains (PF, RP,
BP, PCS) and SF, and RE
 Scores on the Vitality, Mental Health and overall MCS were close to
general population average
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Demographics and quality of life
PF
RP
BP
GH
VT
SF
MH
MCS
PCS
R=-.237* R=-.094
R=-.052
R= -.111
R=.024
R=.067
R= .169
R= .234*
R=-.343**
p=.045
p=.430
p=.665
p=.351
p=.842
p=.579
p=.157
p=.048
p=.003
R= -.183
R=.-070
R= .113
R=-.089
R= .108
R=.082
R=-.007
R=-.083
R= -.135
p=.123
p=.557
p=.346
p=.458
p=.368
p=.495
p=.950
p=.480
p=.258
Living
R=-.025
R= .174
R=.037
R=.041
R= -.120
R= 113
R=-.090
R= -.112
R= .133
alone
p=.837
p=.144
p=.758
p=.735
p=.314
p=.346
p=.451
p=.348
p=.267
Working
R= -.192
R= -.119 R= .150
R=-.035
R= -.112
R= 133
R= .112
R= .107
R= -.162
status
p=.107
p=.319
P=.209
p=.771
p=.350
p=.264
p=.350
p=.369
p=.173
R=.058
R= .134
R= .139
R=-.067
R=.086
R= .159
R=.091
R=.055
p=.628
p=.263
p=.246
p=.577
p=.473
p=.181
p=.445
p=.644
Age
Gender
Period on R=-.036
dialysis
p=.765
**P< 0.01 (1-tailed), * P< 0.05 (2-tailed), PF (physical functioning), RP (role physical), BP (bodily pain), GH (general
health), VT (vitality), RE (role emotion), SF (social functioning), MH (mental health), MCS (mental component summary
scores), PCS ((physical component summary scores)
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Demographics and well-being
Socio-demographic
characteristics
General well-being
Age
R= -.292* (p=.013)
Gender
R= .297* (p=.011)
Living status
R= .192
Working status
R= -.043 (p=.721)
Period on dialysis
R= -.179 (p=.133)
(p= .107)
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Demographics and quality of life and well-being
 Pearson product moment correlation was conducted between sociodemographic characteristics and the SF-36 domains and patients wellbeing
 Age associated negatively with the overall PCS (r= -.343**, p=.003) and
Physical Functioning domain (r= -.237*, p=.045)
 Age positively associated with the overall MCS (r= .234*, p=.048)
 Age associated negatively with general well-being (r= -.292*, p=.013)
 Gender associated positively with general well-being(r=.297, p=.011)
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Spirituality and quality of life
Scale
MCS
PCS
Spiritual well-being total score
R= .013 (p= .911)
R= .119 (p= .321)
Importance of religion in your life
R= .229 (p= .053)
R= -.094 (p= .432)
Importance of spirituality in your
life
Frequency of church/religious
group attendance (apart from
weddings or funerals)
R= .131 (p= .272)
R= .013 (p= .911)
R= .157 (p= .189)
R= -.049 (p= .681)
Frequency of prayer
R= .101 (p= .398)
R= .057 (p= .635)
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Spirituality and quality of life
 Borderline significant associations between the importance of religion
in patients lives and SF (R= .226, p= .057)and MCS (R= .229, p= .053)
 Total Religion subscale (Brief COPE) associated positively with the
overall MCS score (r=.231, p=.051), indicating that more use of religion
associated with better mental health
 No significant correlations between spirituality and patient’s general
well-being
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Summary
 Patients with ESRD reported a marked decrease in all domains of QoL,
mainly (PF, RF, BP, GH and PCS) compared to the UK general population
 MCS & Vitality scores were very close to the general population norms
 Increasing age associated with reduced physical functioning; however
better mental health and general well-being
 Females reported worse general well-being
 Importance of religion associated with better mental health and social
functioning
 No significant associations between spirituality and general well-being
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References
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Delaney, C. (2005) the spirituality scale: development and psychometric testing of a holistic
instrument to assess the human spiritual dimension. Journal of Holistic Nursing. vol. 23, pp.
145-167
Fisher, J (1998) spiritual health: its nature and place in the school curriculum. PhD thesis. The
University of Melbourne
Morrison, D. (2005) nephrology nursing: spirituality and tough nursing. Canadian Association
of Nephrology Nurses and Technicians (CANNT). Conference presentation
National Kidney Foundation. Available online: http://www.kidney.org.
Parsian, N., Dunning, T., (2009) developing and validating a questionnaire to measure
spirituality: a psychometric process. Global Journal of Health Science. vol.1(1), pp.2-11
Scottish Renal Registry, (November 2003). [Online] available from http://www.srr.scot.nhs.uk
Tanyi, R., Werner, J., (2003) adjustment, spirituality, and health in women on haemodialysis.
Clinical Nursing Research. vol. 12(3), pp.229-245
Theofanidis, D. (2007) chronic illness in childhood: psychosocial adaptation and nursing
support for the child and family. ICUS and Nursing Web Journal. Vol. 29-30
Yao, C. (2009) spiritual care in palliative care team. Conference presentation at the 24th
General Conference of the World Fellowship of Buddhists Symposium on Buddhist Wisdom in
Caring for the Dying and Bereaved
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The influences of spirituality on well-being and health