Att leva med njursjukdom Patient-och anhörigperspektiv

The dissertation concerns biopsychosocial factors renal disease patients and their spouses
experienced as particularly stressful, the stress and coping appraisals they made within a situational
framework they themselves defined being examined. Paper I is a questionnaire-based interview
study of patients given home-hemodialysis and their spouses, together with bio-physiological and
laboratory data on the patients, and a 10-year follow-up study of them, indicating Important
predictors of survival to be patient age, severity of the disease, and dialysis-linked complaints,
notably itching, and burdens on the partner concerning sexual matters in particular. Paper II is a
questionnaire study of biopsychosocial problems of patients in pre-dialysis and dialysis. Bodily
problems, Work and leisure time, Sleep, cramps, itching, Financial problems and Dependence were
found to explain 71.1 % of the total variance. The usefulness of a contextual framework for
understanding the patients’ problems was illustrated. Paper III concerns repeated semi-structured
interviews of patient-partner dyads and of patients without a partner. Five themes were identified –
Importance of individualized treatment, Dependence on the apparatus employed, Consequences of
the disease and treatment, Hopes for the future, and Thoughts concerning life and death. Paper IV
compares patients and spouses concerning the stress they experience, the spouses being found to
generally experience greater stress than the patients do. Paper V identifies three types of thematic
configurations in the couple relationships – Supportiveness, Discontentment and Incongruence –
the first two being the most prevalent, both when the patient was in pre-dialysis and in dialysis. The
results highlight the importance in chronic kidney disease of individualized personal care and of
both early and continuous attention to psychosocial adjustment, both in patient-partner dyads and in
patients without a partner.