| ObjectiveThe purpose of this study was to investigate the current situation of quality of life of young and middle-aged hemodialysis patients in different periods,analyze the influencing factors of quality of life of young and middle-aged hemodialysis patients in different periods;and explore the longitudinal development trend and characteristics of quality of life of young and middle-aged hemodialysis patients by combining the latent variable growth model.On this basis,we conducted semi-structured interviews with young and middle-aged hemodialysis patients to deeply explore patients’ feelings and experiences of quality of life in different periods,further explore the factors affecting patients’ quality of life,supplement the results of the questionnaire survey,and provide theoretical support for the relevant departments to propose group-based intervention measures.MethodsThe study was a non-experimental study with a longitudinal research design,questionnaire method and semi-structured interview method to collect data.1.Questionnaire survey method: from April 2021 to October 2022,263 young and middle-aged hemodialysis patients were conveniently selected as the study subjects in 3tertiary A and 1 tertiary B general hospitals in Shandong Province to start the questionnaire survey;the patients themselves filled out the general information questionnaire,the simple health status questionnaire,the family support self-assessment scale,and the Herth personal hope trait scale in The first period collection was completed1 to 2 days before hemodialysis,and the data collection was completed at 1 month,3months and 6 months of hemodialysis follow-up,respectively;Excel 2016 was used to enter the valid questionnaire data;IBM SPSS Statistics 26.0 statistical software was used to conduct descriptive analysis,one-way ANOVA and multiple linear regression analysis on the collected data;Mplus 8.0 software was used to construct a latent variable growth model to analyze the trajectory of quality of life changes in young and middle-aged hemodialysis patients,and further fit family support variables and personal hope trait variables as covariates to establish a time-varying latent variable growth model to verify its role in improving patients’ quality of life.2.Semi-structured interview method: from June 2021 to April 2022,14 young and middle-aged hemodialysis patients in a tertiary general hospital in Shandong Province were selected using purposive sampling method,and one-to-one semi-structured interviews were conducted before hemodialysis,1 month,3 months and 6 months of hemodialysis,based on chronic disease trajectory theory,and Colaizzi’s seven-step analysis method was applied to the obtained interview data Themes were extracted to explore the feelings and experiences related to quality of life of young and middle-aged hemodialysis patients in different periods.Results1.Results of the questionnaire.(1)Pre-hemodialysis quality of life score(38.32±2.94),including physical health score(38.77±7.49),mental health score(37.88±7.92),family support self-assessment scale score(8.06±1.27),and hope quality scale score(30.38±0.65);hemodialysis 1-month quality of life score(40.49±2.45),of which physical health score(41.8±8.00),mental health score(39.17±8.03),family support self-rating scale score(8.00±1.26),and hope trait scale score(29.41±0.66);hemodialysis 3-month quality of life score(43.52±2.38),of which physical health score(44.80±8.22),mental health score(42.23±8.02),family support self-rating scale score(8.21±1.26),and hope special scale score(29.17±0.67);hemodialysis 6-month quality of life score(47.19±3.11),of which physical health score(47.09±8.06),mental health score(47.29±8.19),Family Support Self-Rating Scale score(7.84±1.27),and Hope Specil Scale score(30.21±0.66).(2)The results of univariate analysis showed that before hemodialysis,the differences in quality of life scores of patients with different gender and marital status were statistically significant(P < 0.05);at 1 month of hemodialysis,the differences in quality of life scores of patients with different gender,age,family income,and primary disease were statistically significant(P < 0.05);at 3 months of hemodialysis,the differences in quality of life scores of patients with different age,family income,nutritional status,and The differences in quality of life scores were statistically significant(P < 0.05)among patients with different family income,nutritional status,work status,and primary disease at 6 months of hemodialysis;and at 6 months of hemodialysis,the differences in quality of life scores were statistically significant(P < 0.05)among patients with different family income,nutritional status,work status,and primary disease.(3)The results of multiple linear regression analysis showed that among the factors of gender,age,family income,primary disease,nutritional status,marital status,education level,and work status,the factor of primary disease at 1 month of hemodialysis(β=0.69,P < 0.05)had a significant effect on quality of life;the factor of nutritional status at 6 months of hemodialysis(β=1.438,P < 0.05)had a significant effect on quality of life had a significant effect.(4)The results of fitting the latent variable growth model for quality of life in young and middle-aged hemodialysis patients in four periods showed that 2 was 1.5,CFI was0.984,TLI was 0.907,RMSEA was 0.36,SRMR was 0.018,and the fitting results were better,where the intercept coefficient was 4.511,slope coefficient was 0.302,slope of the curve was-0.062,intercept variance was 0.191,slope variance was 0.147,and curve slope variance was 0.038(P< 0.05).The results showed that the variable quality of life showed a quadratic curve growth trend change.(5)The results of fitting a time-varying latent variable growth model with family support and personal hope traits as covariates showed that 2 was 22.936,CFI=0.91,RMSEA=0.975,and SRMR=0.042.before hemodialysis(β1=0.103,P>0.05;β2=0.1,P>0.05);1 month of hemodialysis(β1= 0.12,P>0.05;β2=0.202,P<0.05);hemodialysis for 3 months(β1=0.22,P<0.05;β2=0.04,P>0.05);and hemodialysis for 6 months(β1=0.25,P<0.05;β2=0.138,P>0.05).Family support and personal hopeful traits contribute to the quality of life of young and middle-aged hemodialysis patients.2.Results of semi-structured interviews:Based on the chronic disease trajectory theory and combined with clinical interview data,three major themes were extracted from the quality of life of young and middle-aged hemodialysis patients before hemodialysis,1 month,3 months,and 6 months of hemodialysis,and four periods,Theme 1: heavy symptom burden(symptom discomfort,limitation of daily activities,primary disease distress,dialysis line discomfort,somatic pain,and complications);Theme 2: co-existence of positive and negative emotions(unknown fear,irritability,sense of loss,anxiety,loneliness,optimism and hope);Theme3: desire for external support(information support,peer education,family support,social support).Conclusions1.The quality of life of young and middle-aged hemodialysis patients is at a moderately low level and needs to be strengthened;the factors influencing the quality of life of young and middle-aged hemodialysis patients in different periods are different;the change of quality of life in the four periods is not a simple linear increase,but a curvilinear increasing trend,and the increasing speed is gradually slowing down;family support and personal hope traits,as both internal and external factors of individuals,contribute to the quality of life of young and middle-aged hemodialysis patients.There is a facilitating effect.2.Young and middle-aged hemodialysis patients’ perceptions of quality of life have stage-specific characteristics in four periods,and patients’ disease knowledge and psychosocial support needs are different in different periods.During hemodialysis patients’ negative emotions coexist with positive emotions and desire to return to society.Medical personnel should pay attention to their feelings and existing problems,develop dynamic care measures in a targeted manner,and provide personalized services to promote social transition in order to improve their quality of life. |
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