武汉市终末期肾病患者透析方式决策冲突影响因素的结构方程模型分析。

IF 2.2 4区 医学 Q2 UROLOGY & NEPHROLOGY BMC Nephrology Pub Date : 2024-10-17 DOI:10.1186/s12882-024-03805-6
Shiyi Zhang, Jinrui Cui, Xiaoqin Liu, Xifei He, Yulin Xu
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引用次数: 0

摘要

目的探讨终末期肾病(ESKD)患者透析方式决策冲突的影响因素及相关关系:本研究以武汉市某三级甲等医院的 150 名终末期肾脏病(ESKD)患者为调查对象,进行横断面调查。调查采用一般信息问卷、决策冲突量表、蒙特利尔认知评估、体弱量表、感知社会支持量表和简明健康素养筛查。采用 SPSS 25.0 比较决策冲突组和非决策冲突组之间的差异,采用 AMOS 23.0 构建结构方程模型探讨影响因素:150名ESKD患者中决策冲突的发生率为33.3%(50/150)。二元逻辑回归分析显示,ESKD 患者透析方式决策冲突的独立危险因素包括家庭月收入(OR = 0.184)、认知功能(OR = 7.0)、社会支持(OR = 0.891)、健康知识(OR = 0.608)、eGFR 水平(OR = 1.488)和 cTnI 水平(OR = 9.558)。构建的路径分析模型拟合良好(x2/df = 1.499,GFI = 0.957,AGFI = 0.911,NFI = 0.906,CFI = 0.967,RMSEA = 0.055)。路径分析显示,健康素养(0.577)对决策冲突的影响最大,直接影响为 0.480,通过认知功能和家庭月收入的间接影响为 0.097。其次是社会支持,影响值为 0.434:在临床实践中,提高患者及其家属的健康知识水平并提供有关透析计划的高级教育非常重要。此外,在管理和规划慢性肾脏病进展和透析时,建议定期系统地评估认知功能,尤其是在患者认知功能障碍恶化或疾病严重程度进展之前。可以通过医护人员和患者之间的合作来制定晚期护理计划,以确保适当的决策和管理:本文发现,影响终末期肾病患者透析方法并与之相关的因素有助于护士更好地行使自主权,协助患者减少决策冲突,改善临床疗效。患者或公众的贡献:患者收到了相关的问卷调查,护理人员协助开展了这项研究。
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Structural equation modeling analysis of factors influencing decisional conflict between dialysis modality among end-stage kidney disease patients in Wuhan.

Objectives: To explore the influencing factors and relationships associated with decisional conflict of dialysis modality in End-stage kidney disease (ESKD) patients.

Methods: This study was a survey-based cross-sectional investigation conducted on 150 ESKD patients in a third-class hospital in Wuhan. The general information questionnaire, decisional conflict scale, Montreal cognitive assessment, frail scale, perceived social support scale, and brief health literacy screen were used for investigation. SPSS 25.0 was used to compare the differences between the decisional and non-decisional conflict groups, and AMOS 23.0 was used to construct a structural equation model to explore the influencing factors.

Results: The incidence of decisional conflict in 150 ESKD patients was 33.3% (50/150). Binary logistic regression analysis showed that the independent risk factors for decisional conflict of dialysis modality in ESKD patients included monthly household income (OR = 0.184), cognitive function (OR = 7.0), social support (OR = 0.891), health literacy (OR = 0.608), the level of eGFR (OR = 1.488), and the level of cTnI (OR = 9.558). The constructed path analysis model had a good fit (x2/df = 1.499, GFI = 0.957, AGFI = 0.911, NFI = 0.906, CFI = 0.967, RMSEA = 0.055). The path analysis showed that health literacy (0.577) had the greatest impact on the decisional conflict, with a direct effect of 0.480 and an indirect effect of 0.097 through cognitive function and monthly household income. Next was social support, with an effect value of 0.434.

Conclusions: In clinical practice, it is important to enhance the health literacy of patients and their families and to provide advanced education on dialysis plans. Additionally, in managing and planning chronic kidney disease progression and dialysis, it is recommended to regularly and systematically assess cognitive function, particularly before the patient's cognitive impairment worsens or the severity of the disease progresses. Advanced care planning can be established through collaboration between healthcare professionals and patients to ensure appropriate decision-making and management.

Implications for the profession and patient care: This paper finds that the factors that influence and relate to dialysis methods in end-stage renal disease patients help nurses exercise autonomy better, assist patients in reducing their decisional conflict, and improve clinical outcomes.

Patient or public contribution: Patients received a relevant questionnaire survey, and caregivers assisted in conducting the study.

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来源期刊
BMC Nephrology
BMC Nephrology UROLOGY & NEPHROLOGY-
CiteScore
4.30
自引率
0.00%
发文量
375
审稿时长
3-8 weeks
期刊介绍: BMC Nephrology is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of kidney and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.
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