DEVELOPMENT AND EVALUATION OF A SUPPORT PROGRAM IN THE PSYCHOSOCIAL MANAGEMENT OF END STAGE RENAL DISEASE

CATHERINE ANN HASTINGS, Purdue University

Abstract

A major objective of this research was to design, implement, and evaluate the effectiveness of a support program with renal patients and their partners. Specifically, the study examined if the support program resulted in any significant changes in mood states, health status, or quality of relationship of the participants. An initial exploration was undertaken to describe the psychosocial impact of this disease, as well as characteristics of patients and their partners who cope well. The support program was then developed out of the awareness of the impact of this serious illness on the patient and partner. Participants in the sample were randomly assigned to one of the two treatment groups (N = 26) and to the control group (N = 12). A "pretest-posttest control group" design was used to evaluate the effectiveness of the support program. Couples were tested immediately before and after their participation in these groups, which were of six weeks duration. After an additional six weeks, delayed posttests were administered. The Profile of Mood States was used to assess the impact of renal disease and its treatment on the patient's and partner's mood states. In order to assess the behavioral impact of renal disease and its treatment on patients, the Sickness Impact Profile was administered. Quality of relationship was measured by the couples' responses to the Barrett-Lennard Relationship Inventory. Data was analyzed using multivariate profile analyses, correlated t-tests and repeated measures analyses of variance. The results indicated that the program was effective in alleviating some of the negative psychosocial effects of renal disease on both patients and family members. The support program resulted in significant improvements in the two treatment groups on the following mood states: Tension, Depression, Vigor, Fatigue, and Confusion. Also, there were significant improvements on the Overall, the Emotional Behavior, the Alertness Behavior, the Recreation and Pasttimes, the Physical, and the Pshcyosocial scores of the Sickness Impact Profile. In contrast, there were no significant pre- to posttest differences on these same measures among members of the control group. The results indicated that the program was also effective in building support. A systematic improvement in the perceived quality of the relationship between patients and partners was observed in both treatment groups. On all four measures of the Relationship Inventory; namely, Empathy, Level of Regard, Unconditionality, and Congruence, there were significant improvements among subjects participating in the support program. This finding was particularly important since family members are often called upon to provide most of the support for these types of patients. This indicates that the stress a chronic illness has on relationships with significant others can be somewhat alleviated by the development of a relatively short-term program. The delayed posttest showed tht these changes persisted even six weeks after the program was completed. The demonstrated effectiveness of the support program led to recommendations concerning the implementation of and research on similar types of programs.

Degree

Ph.D.

Subject Area

Psychotherapy

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