PATIENT'S SELF ASSESSMENT OF STRESSORS AND ADJUSTMENT TO HOME HEMODIALYSIS AND CAPD

We studied adaptability to tbe stresses of bome bemodialysis and CAPD programs by asking patients (143 on bemodialysis; 53 on CAPD) to assess particular treatment-associated stressors. A 14-item questionnaire was constructed to measure areas in wbicb tbe patients felt stress and tbe intensity of tbe stress. Also we used a self-rating scale to obtain information about botb tbe patient's overall and bis or ber pbysical wellbeing. Tbe majority of patients complained ofpbysical weakness and an inability to sleep. Tbis paper outlines stressors for eacb treatment modality, and based on patient selfassessment concludes tbat tbe two modes of treatment are comparable. The development and application of continuous ambulatory peritoneal dialysis (CAPD) has altered dramatically the treatment of chronic renal failure in North America. The progressive shift in the ratio of patients treated with CAPD to those treated with home From the Division of Rehabilitation Psychiatry, Department of Psychiatry, Toronto Western Hospital and Department of Psychiatry, Hadassah Medical Center, Jerusalem, Israel. Key Wards: Home hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), stress, patient self assessment. hemodialysis has allowed a closer examination of treatment-related factors likely to enhance the patient's capacity to adapt to a home program. Although CAPD has the advantages of simplicity, low cost, and does not need a dialysis assistant, it remains to be established whether it reduces the stresses of home therapy more than does hemodialysis. Research suggests that the patient's concern about the effect of their illness on the family causes a great deal of stress, perhaps more than any objective change in lifestyle. Role changes within the family also are said to be a major source of stress for the spouses (1, 2, 3), and others say that home dialysis is particularly stressful for the spouse assistant (4, 5). McCubbin and Patterson (6) and Molumphy and Sporakowski (7) identified a series of stressful events related to dialysis, which produce complex changes in family roles which, cumulatively, may explain the patient's lack of recuperative power in a crisis. Because of its constricting effect on outside social activities and established friendships hemodialysis is tremendously stressful. The advent of CAPD brought a feeling of optimism to many patients on home hemodialysis. It seemed logical that freedom from the machine would bring greater independence and mobility, lessen the need to alternate family roles, and would reduce personal stresses and concerns. Constantly patients had been reminded that personal management of dialysis would minimize dependency and ease the stress on other family members (8). Unfortunately much of the information concerning the stresses of CAPD, is based on clinical insights or anecdotal data derived from unstructured interviews. Except for the Ontario study, workers have paid little attention to a comparison between the patients' adaptation to CAPD and to home hemodialysis, as this relates to type and severity of stressors (9-11). The purpose of this study was to evaluate the incidence of stresses and degree of stressfulness associated with CAPD and with home hemodialysis. Further, the study explored the relationship of these stressors with selfreported sense of well being.