Spirituality, Social Support, and Survival in Hemodialysis Patients

Abstract

Background and objectives:No studies have evaluated the relationship among spirituality, social support, and survival in patients with ESRD. This study assessed whether spirituality was an independent predictor of survival in dialysis patients with ESRD after controlling for age, diabetes, albumin, and social support.Design, setting, participants, & measurements: A total of 166 patients who had ESRD and were treated with hemodialysis completed questionnaires on psychosocial variables, quality of life, and religious and spiritual beliefs. The religious variables were categorized into three scores on a 0 to 20 scale (low to high levels): Spirituality, religious involvement, and religion as coping. Social support was assessed using the Multidimensional Scale for Perceived Social Support. Analyses were also performed including and excluding patients with HIV infection. Religious variables were categorized on the basis of means, medians, and tertiles.Results: In analyses that used religious variables, only the responses on the spirituality scale split at the mean were associated with survival. The association of other religious variables with survival did not reach significance. Social support correlated with spirituality, religion as coping, and religious involvement measures. Only social support and age were associated with survival when controlling for diabetes, albumin concentration, HIV infection, and spirituality.Conclusions: These data suggest that the effects of spirituality may be mediated by social support. Larger, multicenter, prospective studies that use well-validated tools to measure religiosity and spirituality are needed to determine whether there is an independent association of spirituality variables with survival in patients with ESRD.

Quality of life and well‐being of people receiving haemodialysis treatment in Scotland: A cross‐sectional survey

“…Patel et al, 2002;Song and Hanson, 2009); recruiting participants from one dialysis unit (e.g. Ko et al, 2007;Martinez and Custodio, 2014) and studying a non-representative sample of the dialysis population such as African Americans (Spinale et al, 2008;Thomas and Washington, 2011) or women only (Tanyi and Werner, 2008b). One qualitative study in this review (Yodchai et al, 2011) recruited a sample of only five participants and so, based on its findings, it might not be possible to conclude that all patients employ spirituality/religion as a way of coping with their disease.…”

“…Only three studies were identified in the review that explore the relationship between spirituality and survival (Spinale et al, 2008), spirituality and satisfaction with care (Berman et al, 2004) and spirituality and treatment preferences (Song and Hansen, 2009) in patients with ESRD. All were conducted in the USA and used cross-sectional design and valid measures to assess spirituality and religion (as shown in Table 3.5).…”

“…Sample sizes ranged from as low as 51 participants (Song and Hanson, 2009) to as high as 166 (Spinale et al, 2008). Perhaps the difficulty assessing spirituality led to these studies only having small sample sizes on which to draw conclusions, which can affect their ability to identify significant findings.…”

“…Spinale et al (2008) demonstrated in a cross-sectional study with 166 dialysis patients in the USA that spirituality and religion were important coping mechanisms (p=.0002). Evaluated by mean split in their entire sample, higher spirituality scores were associated with longer survival (hazard ratio [HR] 0.49; 95% confidence interval [CI] 0.27 to 0.88; p= .02).…”

The influence of seeking god in the association between religiosity and prolonged survival in liver transplant recipients

“…This hypothesis seems more likely given that the authors refer to a study showing that the effects of spirituality can already be mediated by better social support alone. 9 Although their study design implies they had the chance, the authors did not acknowledge this and did not collect information on general attitude and social environment to be able to assess whether any additional influence of religiosity did exist.…”