Substituting methods for renal function such as blood or peritoneal dialysis (PD) and kidney transplantation are required for patients with progressive chronic kidney diseases (CKD) whose remaining kidney function less than 10% of the normal capacity....
Substituting methods for renal function such as blood or peritoneal dialysis (PD) and kidney transplantation are required for patients with progressive chronic kidney diseases (CKD) whose remaining kidney function less than 10% of the normal capacity. Non-compliant patients with PD are difficult to monitor because of its nature as self-treatment managed at home by themselves. Furthermore, successful treatment outcome might be difficult to achieve without patients’ willingness to maintain self-care. Therefore, it is important to encourage their active participation in self-care by utilizing appropriate intervention methods that provide follow-up for continued monitoring. Additionally, patients with CKD may develop or experience exacerbated symptoms of depression due to stress arising from strict dietary restrictions; a limited time free from dialysis; decline in physical functioning, and home and work activities; a loss of employment or role changes in family and social life; changes in body images and sexual functioning; side effects of medications or treatments; and fear of death. Therefore, it is also important for patients with PD to improve their own self-care by managing psychological problems such as depression that hinder self-care activities. The current study was conducted in order to determine the effects of phone counseling program, which can provide emotional support as well as continued follow-up and monitoring, on self-care activities as well as to investigate the effects of the intervention program on the symptoms of depression experienced by patients with PD.
This study is a nonequivalent control group pre-post test design that sought to determine the effects of phone counseling program on self-care and symptoms of depression. A total of 54 patients with PD were recruited at the outpatient clinic at K University Medical center, located in Ansan. 27 patients received intervention program and the other 27 patients were participated for comparison as a control group.
Data collection was done over three months, from May to August 2013. All participants answered pre-test questionnaires and received a daily chart to record their daily self-care activities. Only intervention group received weekly phone call from a PD nurse for 3 weeks; During the fourth week, participants in the both intervention and control groups answered post-test questionnaires and submitted their daily charts. The phone counseling program provided them with information regarding PD weekly for three weeks; Phone counseling each offered for 15–20 minutes to each participant in the intervention group, was based on Kim Eun Min ’s phone consultation guidelines for patients with PD (2005) and Park Mee Hwa ’s self-care charts (2004).
Questionnaire used to measure self-care activities for patients with PD, which was originally developed by Kim Young Hee (1987) and revised by Park Mee Hwa (2004), was further revised by the investigator of this study. Symptoms of depression were measured by using Korean version of the revised Beck Depression Inventory (BDI-II) (Kim Myoung Shik et al., 2007), which was originally developed and later revised by Beck and his colleagues (1996).
The SPSS 12.0 was used for data analysis. Sociodemographic background and disease-related characteristics were analyzed by descriptive statistics and group differences were tested for homogeneity by using chi-square test and independent sample t-test. Analyses of the self-care and depression according to different sociodemographic background, such as age and spouse, were conducted using an analysis of variance (ANOVA). Differences in depression and self-care of the intervention and control groups were analyzed after controlling the effects of age and spouse. Effects of the phone counseling program on the self-care and depression were analyzed using an analysis of covariance (ANCOVA).
The results of the current study were as follows:
1) In terms of homogeneity, there was no statistically significant differences between intervention and control groups except for spouse (p=.018) and age (p=.015) variables.
2) There were no statistically significant differences in the years of PD treatment, cause of disease, form of dialysis, history of peritonitis, and history of other types of dialysis between the intervention and control groups
3) Regarding the first hypothesis, which stated that “intervention group who have received phone counseling program will have higher self-care scores than control group”, when the participants’ age and spouse were taken into consideration as covariates, differences in the self-care scores between the intervention group and control group (F=0.007, p=.933) were not statistically significant. Therefore, the first hypothesis was not supported.
4) Regarding the second hypothesis, which stated that “intervention group who have received phone counseling program will have lower depression scores than that of control group”, when the participants’ age and spouse were taken into consideration as covariates, differences in the depression scores were not statistically significant between the groups (F=.170, p=.682). Therefore, the second hypothesis was not supported.
As demonstrated above, no significant differences were found in the scores of self-care and depression between the groups even after three times of phone counseling program for the intervention group only. These findings can be interpreted as level of self-care ed by participants at K hospital were already high enough. Also participants’ age and their marital status might have impact on their self-care and depression. Accordingly, for phone counseling programs to be more effective intervention, it will be necessary to complement its content to improve depression and to consider individual attributes such as age or marital status in tailoring the intervention for individual needs. If the intervention methods can encourage the patients’ willingness to self-care and actually help to alleviate depression, phone counseling programs can be useful and effective follow-up tool for patients with PD.
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