Award Date
May 2025
Degree Type
Dissertation
Degree Name
Doctor of Philosophy (PhD)
Department
Nursing
First Committee Member
Rebecca Benfield
Second Committee Member
Jinyoung Kim
Third Committee Member
Catherine Dingley
Fourth Committee Member
Ronald Brown
Number of Pages
99
Abstract
Introduction: Chronic hemodialysis patients have a significant treatment-related burden due to the physical and emotional challenges associated with disease management. The physical side effects of hemodialysis treatment, such as pain, muscle cramps, hypotension, nausea, vomiting, fatigue, and pruritus, often contribute to significant emotional challenges, such as depression and anxiety, experienced by 15-45% of patients. These challenges affect their ability to manage the chronic nature of hemodialysis, including lifestyle modifications such as frequently scheduled appointments and changes in functional status, which affect adherence to treatment and treatment outcomes. The present study aimed to examine the association between patient engagement and adherence to HD guidelines and whether the patient engagement level correlates with patient adherence. Engagement was defined as the developmental process of psychological and emotional adaptation to chronic disease, influencing a person’s ability to play an active role in chronic disease management. Adherence was defined as how a person’s behavior compares to the recommendations of the National Kidney Disease Quality Initiative (NKDQI) guidelines of treatment time and fluid restriction. Methods This was a cross-sectional, descriptive study. The final analyses included two hundred and four hemodialysis patients from five Fresenius Medical Care community in-center units. While undergoing hemodialysis treatment, each participant answered a demographic survey and two engagement surveys. Treatment data was obtained from the electronic medical record. Patient engagement was measured using the Patient Health Engagement Scale® (PHE-S®) and Patient Activation Measure® (PAM-13® survey). Adherence was defined as 1) they had interdialytic weight gain (IDWG) < 2.5 kg and 2) their time on the dialysis treatment was within 15 minutes of the recommended prescribed treatment time (taking into consideration specific reasons for changes in treatment time). To answer the study questions, Pearson’s correlation and Spearman’s correlation, t-test, Mann-Whitney U test, chi-square, and multivariate binomial logistic regression analyses were used to answer the research questions. Results: Univariate analyses identified four factors associated with adherence: age, race, employment status, and length of time on HD. In both multivariate models, Model 1(PHE-S®) and Model 2 (PAM-13®), there was no independent association between adherence and engagement after adjusting for demographic, disease-related, and substance use factors. However, in model 2, using the PAM-13®, increasing age was associated with increased odds of being adherent. Discussion: Adherence is multifaceted, especially in chronic hemodialysis care, requiring continuous patient and family engagement. Adherent patients to fluid restriction and treatment time had higher engagement scores; though not statistically significant, the findings had clinical relevance. The innovative aim of this study was to see if there was a relationship between the psychological and emotional adaptation to chronic disease, influencing a person’s ability to play an active role in chronic disease management (engagement) and adherence after adjusting for demographic, disease-related, and substance use factors. The first model that included the PHE-S® did not identify any significant findings. However, white patients had increased odds of being adherent. The second model that included the PAM-13® identified age as the only significant variable associated with adherence. Participants with a level three or four on the PAM-13® had increased odds of being adherent; However, the result was not statistically significant in the current study. A broader Nursing perspective of nonadherent patients should consider the importance of age and race in developing research to improve engagement interventions and adherence.
Keywords
Adherence; ESRD; Hemodialysis; PAM-13; Patient Engagement; PHE-S
Disciplines
Nursing
Degree Grantor
University of Nevada, Las Vegas
Language
English
Repository Citation
Johnson, Shannon L., "Patient Engagement and Treatment Adherence in End-Stage Renal Disease Hemodialysis Patients" (2025). UNLV Theses, Dissertations, Professional Papers, and Capstones. 5294.
https://oasis.library.unlv.edu/thesesdissertations/5294
Rights
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