School of Nursing, Midwifery and Health

1. School of Nursing, Midwifery and Health Influences of spirituality on Quality of life and general well-being in patients with end-stage renal disease Ali Alshraifeen 13th Annual Interdisciplinary Research Conference 7- 8th November 2012

2. Outline: • Background • General • ESRD in Scotland • Difficulties facing ESRD patients • Justification • Study aims • Method • Quantitative • Qualitative • Results • Summary

3. Background • Chronic illness: physical or mental conditions that affect the daily functioning of individuals for intervals >3 months/year, or for a duration of hospitalisation >1 month (Theofanidis 2007) • Chronic illness has significant physical, psychological, social, economical, and spiritual effects on the individual (Delaney 2005) • ESRD: a long term condition to both kidneys, it is debilitating and progressive • Kidneys are unable to remove metabolic waste products from the body (Tanyi & Werner 2003) • ESRD: patients need to start renal replacement therapy (HD, PD, RX) (http://www.kidney.org) • HD is the most commonly used method of treatment (National Kidney Foundation) 3

4. ESRD in Scotland • First patient dialysed in Scotland in 1960 • December 2010: 13506 accepted for renal replacement therapy (RRT): HD, PD, and kidney transplantation (SRR, 2010) • The number of prevalent patients is still rising; increasing cost of treatment, pressure on patient, staff, and the NHS

5. Difficulties facing patients with ESRD • Physical (reduced mobility, fatigue, joint pain, site infection, cardiovascular) • Psychological ( depression, anxiety, low self esteem) • Social (loss of role and identity) • Logistic (fluid and diet restrictions, no choice of treatment) • Spiritual (inability to practice beliefs, fulfil spiritual needs, feeling tested) • Together = poorer quality of life/ well-being

6. Justification of the study • Interest in studying spirituality increasingly emerging in the literature • Spirituality: important aspect of health and well-being in people with chronic health conditions (Parsian & Dunning 2009) • Higher levels of spiritual health may lead to an improved quality of life and coping (Morrison 2005) • Providing spiritual care may lead to an improved coping with the various challenges facing patients with chronic illnesses (Yao 2009) • Is spirituality linked with health outcomes in patients with chronic illness (ESRD)?

7. Why ESRD… • Minimal information in the literature linking spirituality and the needs of patients with ESRD • There is a lack of research addressing spirituality and its contribution to adjustment in patients with ESRD (Tanyi &Werner 2003)

8. Study aims • To investigate the influences of ESRD on patients’ quality of life (QoL) and general well-being • To examine the factors that can affect these influences (age, gender, hope, social support) • To examine the relationship between spirituality and the QoL and general well-being of patients with ESRD

9. Spirituality framework • Spiritual health: a fundamental dimension of people’s overall health and well-being (physical, mental, emotional, social, and vocational) • Fisher’s (1998) spiritual well-being model : • Personal domain • Communal domain • Environmental domain • Transcendental domain

11. Quantitative • Quality of life Measure (SF-36v2): validated by analysing the scores from patients with 25 different health conditions • General health questionnaire (GHQ-28): to measure depression, anxiety and insomnia, social dysfunction, and coping • The multidimensional scale of perceived social support (MSPSS) • Herth hope index (HHI) • The spiritual well-being questionnaire (SWBQ) • The brief COPE scale to assess patients’ coping with stressful events Cross-sectional survey (questionnaires)

12. Participants • Inclusion criteria: • ESRD patients/on HD • On dialysis ≥6 months • English speaking • >18 years old • Exclusion criteria: • Distressed patients • Psychological, neurological, or communication problems • All ESRD patients in 5 Health Boards in Scotland (800 participants) eligible • Estimated number of distributed study packs (364, 45.5% of the total sample) • Number of completed questionnaires (n=72)

13. Data analysis and results • Data analysis (PASW 18) • Results • Overall response rate (19.8%) out of estimated 364 • 50% of the sample were 56 years and older (n=36) • Majority were retired (n=49) • Majority were on HD for 6months- 5 years (n=44) • Majority lived with families (n=46) • More males (56.9%)

14. Quality of life

15. Patients quality of life • Patients scored considerably less than the UK population average norms • Most affected domains of QoL were the physical domains (PF, RP, BP, PCS) and SF, and RE • Scores on the Vitality, Mental Health and overall MCS were close to general population average

16. Demographics and quality of life **P< 0.01 (1-tailed), * P< 0.05 (2-tailed), PF (physical functioning), RP (role physical), BP (bodily pain), GH (general health), VT (vitality), RE (role emotion), SF (social functioning), MH (mental health), MCS (mental component summary scores), PCS ((physical component summary scores)

17. Demographics and well-being

18. Demographics and quality of life and well-being • Pearson product moment correlation was conducted between socio-demographic characteristics and the SF-36 domains and patients well-being • Age associated negatively with the overall PCS (r= -.343**, p=.003) and Physical Functioning domain (r= -.237*, p=.045) • Age positively associated with the overall MCS (r= .234*, p=.048) • Age associated negatively with general well-being (r= -.292*, p=.013) • Gender associated positively with general well-being(r=.297, p=.011)

19. Spirituality and quality of life

20. Spirituality and quality of life • Borderline significant associations between the importance of religion in patients lives and SF (R= .226, p= .057)and MCS (R= .229, p= .053) • Total Religion subscale (Brief COPE) associated positively with the overall MCS score (r=.231, p=.051), indicating that more use of religion associated with better mental health • No significant correlations between spirituality and patient’s general well-being

21. Summary • Patients with ESRD reported a marked decrease in all domains of QoL, mainly (PF, RF, BP, GH and PCS) compared to the UK general population • MCS & Vitality scores were very close to the general population norms • Increasing age associated with reduced physical functioning; however better mental health and general well-being • Females reported worse general well-being • Importance of religion associated with better mental health and social functioning • No significant associations between spirituality and general well-being

22. References • Delaney, C. (2005) the spirituality scale: development and psychometric testing of a holistic instrument to assess the human spiritual dimension. Journal of Holistic Nursing. vol. 23, pp. 145-167 • Fisher, J (1998) spiritual health: its nature and place in the school curriculum. PhD thesis. The University of Melbourne • Morrison, D. (2005) nephrology nursing: spirituality and tough nursing. Canadian Association of Nephrology Nurses and Technicians (CANNT). Conference presentation • National Kidney Foundation. Available online: http://www.kidney.org. • Parsian, N., Dunning, T., (2009) developing and validating a questionnaire to measure spirituality: a psychometric process. Global Journal of Health Science. vol.1(1), pp.2-11 • Scottish Renal Registry, (November 2003). [Online] available from http://www.srr.scot.nhs.uk • Tanyi, R., Werner, J., (2003) adjustment, spirituality, and health in women on haemodialysis. Clinical Nursing Research. vol. 12(3), pp.229-245 • Theofanidis, D. (2007) chronic illness in childhood: psychosocial adaptation and nursing support for the child and family. ICUS and Nursing Web Journal. Vol. 29-30 • Yao, C. (2009) spiritual care in palliative care team. Conference presentation at the 24th General Conference of the World Fellowship of Buddhists Symposium on Buddhist Wisdom in Caring for the Dying and Bereaved

23. Any questions ?