Health Mindset and One Year Outcomes in Adult Peritoneal Dialysis (PD) Patients.

Background: Many patients who start peritoneal dialysis (PD) transition to hemodialysis (HD) after a PD-related complication. Patient psychological factors may influence clinical outcomes. One possible factor is health mindset, or patient belief that their health knowledge and ability can change. The goal of this study is to evaluate the longitudinal associations of baseline health mindset with patient outcomes after one year.

Methods: The Health Mindset Scale (HMS, score 3-18) was administered on paper during clinic to a convenience sample of 100 adult PD patients, to quantify patient mindset along a continuum from fixed mindset (lower scores) to growth mindset (higher scores). Participants were 31% African American, 4% Hispanic, and 64% White American. Demographic and comorbid information were abstracted from medical records. Outcomes assessed at 1 year were death, transition to HD, renal transplant, and maintaining PD.

Results: HMS scores were highest in patients who subsequently received a renal transplant (mean 15, SD 2.1), indicating a growth mindset. HMS scores in patients who died were lower (mean 10, SD 5.2) suggesting a more fixed mindset. Among those who maintained PD, HMS scores were between fixed and growth mindset (mean 12.8, SD 4.2) and similar to those who transitioned to HD (mean 13, SD 4.2). One-way ANOVA for difference in HMS scores by clinical outcome was p = 0.042.

Conclusions: This initial longitudinal study suggests associations between mindset and clinical outcomes. The HMS is a novel and easily administered instrument that quantifies one patient psychological component that could contribute to patient outcomes, and that could also be modified. The HMS may identify individuals who could benefit from specific interventions to favor a growth mindset, with the goal of supporting optimal clinical outcomes.