Percepção sobre a doença renal crônica, estratégias de enfrentamento e adesão ao tratamento em pacientes em hemodiálise

Abstract

This dissertation comprises two articles. First one is a systematic literature review, whereas the second is an empyrical article. The investigation focuses on chronic kidney disease perception, coping strategies and adherence in hemodialysis patients. In Study I, a systematic review of international literature on illness perception and chronic kidney disease in hemodialysis patients in the period 2001-2012 was carried out. It was done on the databases Academic Search Premier and Medline with Full Text. 17 articles were found on quantitative delineation, which were published in different health magazines by various professionals. Results indicate that the concept of illness perception is useful to understand the impact of CKD and HD treatment on these patients' quality of life. Negative perception of the disease was associated with non-adherence with the recommended treatment and was related to self care behaviour, depression symptoms, quality of life, mortality and extended survival. Negative perception was also associated with adherence with treatment by Complimentary and Alternative Medicine - CAM, and with the negative perceptions in these patients' non-adherence with the treatment. The IPQ-R is the most used and useful tool to evaluate illness perception. In study 2, the objective was to investigate the relation between chronic kidney disease perception, coping strategies and adherence with treatment in HD patients, and the possible predictive power of illness perception and coping to adherence with hemodialysis treatment. 70 adult patients in hemodialytic treatment on the North Coast of the Brazilian state of Rio Grande do Sul took part in study 2. The instruments used were the sociodemographic data questionnaire, medical chart and adherence evaluation, the Illness Perception Questionnaire (IPQ-R) and the coping strategies questionnaire - Coping with Health Injuries and Problems (CHIP). Some illness perception dimensions were positively correlated to some coping dimensions: cyclic illness duration and palliative coping dimensions, distraction and emotional worry; illness consequences and emotional worry coping; treatment control and instrumental and paliative coping; emotional perception and emotional worry coping; and last, the dimension illness coherence was negatively correlated to instrumental coping. The dimensions identity, cyclic duration and illness consequences were negatively correlated to perceived compliance by nurses, whereas potassium levels also were negatively correlated to the illness consequences dimension. Predictive analysis showed that only the dimension related to the consequences was predictive of the adherence perceived by nurses (8,6% of its variance) and the potassium levels (6,7% of the variance). In conclusion, the perception of the illness consequences is an important dimension to be evaluated in hemodialysis patients in order to predict possible problems on treatment adherence. The results can also contribute for a better approach to these patients.