Development of a measure for patients preparing to start dialysis and their partners: The Starting Dialysis Questionnaire (SDQ)

Abstract

Background The transition onto dialysis is a stressful time that affects both patients and their partners. Research suggests that psychological and interpersonal characteristics within the couple are related to how well they adapt to dialysis. The aim of this multi-phase, mixed methods study was to develop a measure, the Starting Dialysis Questionnaire (SDQ), that is applicable to both patients and their partners and assesses their own thoughts and feelings about these constructs. Methods Data from semi-structured interviews with patients and their partners (n = 22 couples) were analysed using theoretical thematic analysis to identify and define constructs related to quality of life (QOL). Next, items addressing these constructs were derived from the interviews. Then, cognitive interviews were conducted with patients with chronic kidney disease and their partners (n = 5 couples) to assess the face validity and comprehensibility of the items. Lastly, preliminary psychometric properties were evaluated in a sample of patients preparing to start dialysis and their partners (n = 83 couples). Results Three themes related to QOL were identified, namely dialysis expectations, accepting dialysis and dyadic relationship characteristics. The cognitive interviews refined the SDQ and established its face validity. Psychometric assessments indicated that overall the items performed well and did not show significant floor or ceiling effects. Good internal consistency was found within the three domains, and items correlated within the domains. Conclusions The SDQ is a measure (34 items) that assesses key psychological and interpersonal factors in patients and their partners as they start dialysis. It shows good preliminary psychometric properties; however, a large-scale field trial is needed to establish its validity. Once validated, it could offer a clinically useful tool to assist clinicians in preparing patients and partners for dialysis.

Patient, Caregiver, and Provider Perspectives on Improving Information Delivery in Hemodialysis: A Qualitative Study

“…Recent tools to assess key psychological and interpersonal factors in patients transitioning to dialysis may help to further individualize educational needs. 19 , 20 …”

“…Recent tools to assess key psychological and interpersonal factors in patients transitioning to dialysis may help to further individualize educational needs. 19,20 In addition, self-management strategies encourage patients to take an active role in their care. A self-management program that focused on self-efficacy through improving problem-solving skills, building partnerships between patients and providers, mental health and lifestyle support, and coping with challenges related to hemodialysis has been shown to improve quality of life.…”

Changes in patient activation in people starting dialysis: A prospective longitudinal, observational study

“…Follow-up surveys were administered during the fourth month of dialysis, specifically between 90 and 120 days following commencement of dialysis, see Figure 1b. We avoided collection of data in the first week after dialysis initiation because of the stress related to the dialysis initiation 18,19 and because of recommendation to PAM-13 surveys following a new diagnosis. 20 Social workers at participating centers invited patients to the study and introduced the survey with the use of a standard patient information script.…”