One-Year Linear Trajectories of Symptoms, Physical Functioning, Cognitive Functioning, Emotional Well-being, and Spiritual Well-being Among Patients?Receiving Dialysis

摘要

BackgroundThis study evaluated 1-year linear trajectories of patient-reported dimensions of quality of life among patients receiving dialysis. Study DesignLongitudinal observational study. Setting & Participants227 patients recruited from 12 dialysis centers. FactorsSociodemographic and clinical characteristics. Measurements/OutcomesParticipants completed an hour-long interview monthly for 12 months. Each interview included patient-reported outcome measures of overall symptoms (Edmonton Symptom Assessment System), physical functioning (Activities of Daily Living/Instrumental Activities of Daily Living), cognitive functioning (Patient’s Assessment of Own Functioning Inventory), emotional well-being (Center for Epidemiologic Studies Depression Scale, State Anxiety Inventory, and Positive and Negative Affect Schedule), and spiritual well-being (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale). For each dimension, linear and generalized linear mixed-effects models were used. Linear trajectories of the 5 dimensions were jointly modeled as a multivariate outcome over time. ResultsAlthough dimension scores fluctuated greatly from month to month, overall symptoms, cognitive functioning, emotional well-being, and?spiritual well-being improved over time. Older compared with younger participants reported higher scores across all dimensions (allP<0.05). Higher comorbidity scores were associated with worse scores in most dimensions (allP<0.01). Nonwhite participants reported better spiritual well-being compared with their white counterparts (P<0.01). Clustering analysis of dimension scores revealed 2 distinctive clusters. Cluster 1 was characterized by better scores than those of cluster 2 in nearly all dimensions at baseline and by gradual improvement over time. LimitationsStudy was conducted in a single region of the United States and included mostly patients with high levels of function across the dimensions of quality of life studied. ConclusionsMultidimensional patient-reported quality of life varies widely from month to month regardless of whether overall trajectories improve or worsen over time. Additional research is needed to identify the best approaches to incorporate patient-reported outcome measures into dialysis care.