Paradigma değişimi: Diyaliz hastalarının uyumlarını anlama

Son dönem böbrek yetmezliği (SDBY) ve tedavisi uyum sorunlarına yol açabilir; ancak, bu sorunların kapsamı bilinmemektedir. Uyum kavramı karmaşık ve çok boyutlu bir kavramdır. Genel anlamda hastalık ve tedavi ile ilgili inanışlar uyumu etkilemesine rağmen, bulgular tutarsızlık göstermektedir. Bu tutarsız bulgularn nedeni, olasılıkla bu inanışların profesyonel veya kuramsal görüşlere dayalı olarak tanımlanmış olmasıdır. Uyum ve inanış kavramlarını tanımlama konusunda standart bir yaklaşıma ulaşabilmek için hastalarının kendi görüşlerinden yararlanmak olası bir yol olabilir. Nitel araştırmalar yaşam değerlendirme yolları, hastalık ve tedavi ile ilgili inanışlar konularında nicel araştırmaların ulaşamadığı bulgulara ulaşmaktadır. Bu bulgular psikolojik eğitim veya klinik görüşmelerin hedefleri olarak düşünülebilir. Bununla birlikte, nitel araştırmalar hastaların inanışları ve yaşam değerlendirme yollarının sıklığı hakkında kanıt sağlayamaz. Böylelikle nitel bulgulara dayalı anketler geliştirilmiştir. Bu anketler bulguların klinik uygulamalar için yararlarını ve yaşam kalitesi ile inanışlar arasındaki ilişkiyi incelemeye yardım etmektedir. Bu anketlerin halen var olan genel ve/veya SDBY'ye özgü yaşam kalitesi ve inanış anketleri ile ne şekilde örtüştüğü ve farklılaştığı açısından incelenmesine yönelik daha fazla araştırmaya gerek duyulmaktadır.

Shift in paradigm: understanding adjustment of dialysis patients

End stage renal failure (ESRF) and its treatment can lead to adjustment difficulties. However, the extent of these difficulties is not known. Adjustment is a complex and multidimensional construct. In general beliefs about illness and its treatment influence adjustment but the findings are inconsistent. This is probably because adjustment and beliefs have been defined in a variety of ways based on professional or theoretical views. One possible way of establishing a standard approach to defining adjustment and beliefs is to be guided by patients' own views. Qualitative studies identify ways of evaluation of life and beliefs about ESRF and its treatment that have not been identified by quantitative studies. These findings can be considered as patient-derived targets for psychoeducational programs or clinical practice for ESRF patients. However, qualitative research cannot provide evidence about the frequency of patients' beliefs and ways of evaluation of life. Therefore, questionnaires have been developed on the basis of qualitative findings. These helped to examine the utility of the findings for clinical practice, and understand the relationship of quality of life with beliefs. More research is needed to investigate how the findings on these questionnaires converge and diverge with those on existing generic and/or ESRF specific quality of life and beliefs measures.

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