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GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE
A Journal on Internal Medicine and Pharmacology
Indexed/Abstracted in: BIOSIS Previews, EMBASE, Scopus, Emerging Sources Citation Index
Gazzetta Medica Italiana Archivio per le Scienze Mediche 2005 October;164(5):379-84
Psychological aspects of patients in dialysis and in non complaint patients
Rapisarda F., De Vecchi A., Fogazzi G. B., Guerra L., Baggio G., Ghezzi F., Nicodemo D., Reseca R., Zito M. T., Faraone R., Lanzarone C., Picone F., Di Lorenzo G., Li Vecchi M.
USL n. 3, Ospedale Civile - Fiorenzuola D’Adda (Piacenza), Divisione Ortopedica e Traumatologica
Aim. Haemodialysis and peritoneal dialysis are often not well accepted by patients, for the strictness of the therapeutic recipes and for the alteration imposed by these therapies to the uraemics’ every-day life. These therapies can push to a non complaint behaviour, in other words the lack of the therapeutic recipes respect. This study aims to check the existence or not in patients that have faced dialysis, either haemodialysis or peritoneal dialysis, of some particular characteristics and strategies of coping (kind of strategies used by a patient under pressure). It draws particular attention to the existence or not of these aspects in non-complaint patients.
Methods. We tested 120 patients that have faced haemodialysis and 50 that have been subject to peritoneal dialysis with different age, sex, social and cultural status, the beginning of the equivalent treatment and its typology (either haemodialysis or peritoneal dialysis). The screening succeeded in 11 cases among the first group and in 9 as far as what concerns the second, while the tests considered not valuable for contrasting answers are respectively 5 and 3. For the data-gathering we used a test for the analysis of the personality (MMPI2) and the COPE, that tests the strategies of coping used by the patient in certain situations, like dialysis, that can be perceived us stressful. Depending on the feedbacks we divided the patients in two groups: First group: patients that considered the kind of treatment as personal; Second group: patients that answered about the kind of treatment as a result of clinical conditions (see Table II).
Results. Our data show that patients (especially the ones subject to peritoneal dialysis) believing in a personal choice as far as what concerns their treatment seem to be positively inclined towards the equivalent treatment. The tendency of patients that have faced dialysis to worse their physical and psychological health let us consider them basically inclined towards a non complaint behaviour. This conclusion is also based on their foreboding, their nervousness and their depression, as well as their malaise in work, in social and especially family or couple life context.
Conclusion. This is the reason why we consider useful a psychological screening for the patients in order to help the clinician to gather data more effective regarding the patient and to establish if a psychological intervention is necessary to avoid or at least reduce the risk of non complaint behaviour or the choice to undergo the therapy irrespective of medical recipes.