MEDIATING EFFECT OF COPING STRATEGIES IN RELATIONSHIP BETWEEN ILLNESS PERCEPTION AND QUALITY OF LIFE AMONG PATIENTS WITH END STAGE RENAL DISEASE RECEIVING HEMODIALYSIS

Patients receiving Hemodialysis (HD) suffer from several signs and symptoms during the therapy. When receiving hemodialysis as long-life treatment, the patients’ perceptions and coping may play a role in adjustment to their condition as indicated by health-related quality of life (HrQoL). Some studies have showed different findings regarding the relationship between illness perceptions and health-related quality of life (HrQoL), and coping needs to be tested as a predictor or mediator in patients with ESRD. The Common Sense Model (CSMIR) has been applied in end stage renal disease (ESRD) in western countries and Asia, and its applicability has been recognized in patients with hemodialysis. However, no study has used the whole theory of the (CSMIR) in ESRD in Indonesia. The purposes of study was to examine coping as a mediator between illness perceptions and HrQoL in HD-receiving patients with ESRD

A correlational testing model was employed in this study. Convenience sampling method was used and 204 participants were involved in this study. This study was conducted in hemodialysis units at six hospitals, in East Nusa Tenggara Province and Maluku Province. Three instruments were used: the Revised Illness Perception Questionnaire (IPQ-R) Indonesian version, The Brief Coping Orientation to Problem Experienced (Brief COPE) Indonesian version, and World Health Organization Quality of Life (WHOQOL-BREF) Indonesian version. Hierarchial multiple linear analysis was used to examine the relationship between illness representations and HrQoL, and multiple mediation analysis was used to examine coping as a mediator. 

From the participants, 204 were male (n = 129; 63.2%) with average age of around 51 years old (SD = 12.54); mostly, they have completed more than 9-year education (69.1), married (81.9), and employed (73%). From the clinical data, the mean of period of HD was 29.48 months (SD 29.69), Interdialytic Weigh Gain (IDWG) < 2 (27%), hypertension as etiology of ESRD (68.8), mean of hemoglobin (Hb) 9.01 gr/dl (SD 1.85), creatinine 7.67 ml/s (SD 1.85), urea 92.79 (SD 60.49). The overall score for illness perceptions from 7 domain is 116.17, which was quite positive of illness perception; the high scores of mean were personal control 22.98 (SD= 3.92), consequences 22.58 (SD 5.79) and emotional representation 21.35 (SD 3.77).  Participants mostly used adaptive coping with mean 53.08 (SD 7.57); the highest mean was religion domain 7.16 (SD=1.41). The overall HrQoL was quite good with mean 61.48 (SD 13.10). Emplyment status, consequences, illness coherence, emotional representative and adaptive coping were predictors of HrQoL.  Adaptive coping acted as a mediator in the relationship between emotional representative of illness perceptions and HrQol.

Patients believe their illness have an impact in their life, and perceive more emotional response were predict for poor HrQoL. When patients have better perceptions and better coping, they may have better HrQoL. Nurses need to provide an intervention program to increase the Hb by collaborating with a dietitian. Besides, to increase coherence, nurses may plan to have a regularly interdisciplinary health education program for patients and their caregivers, followed by a regular home visit to ensure they practice adequately about self-care at home.