Patient Attitudes Toward Transplantation as Preferred Treatment Modality in Different Stages of Renal Disease.

OBJECTIVE: Kidney transplantation is generally considered to be the best treatment for end-stage renal disease. Not every patient can be operated, but many of suitable patients refuse this possibility. We aimed to explore the attitudes of patients with chronic kidney disease towards renal replacement therapies to recognize motives, thoughts, and feelings concerning accepting or refusing the treatment. We studied the attitudes towards the illness and the treatment, the appearance of depression, and the disease burden during different stages of the disease. METHODS: For this study we implemented a questionnaire that we developed (which has been described in an earlier publication of this journal) with 99 pre-dialysis patients, 99 dialysis patients, and 87 transplantation patients. We completed the attitude questionnaire designed by our team to include disease burden and depression questionnaires. RESULTS: We used discriminant analysis to describe different stages of the disease. There was a significant difference in the following factors between the three patient groups: accepting the new kidney, lack of confidence in transplantation therapy, fear of surgery, accepting self-responsibility in recovery, dependency on the transplanted kidney, confidence in recovery, subjective burden of dialysis, and denial of personal responsibility in maintaining the transplanted kidney. Significant differences were also detected in these three groups regarding the level of depression and disease burden: we measured the highest value among the dialysis patients, and the lowest value among the pre-dialysis patients. Comparing patients accepting and refusing transplantation, we found a correlation between the refusal of transplantation and the attitudes towards the illness and treatment. CONCLUSIONS: Most patients remain unmotivated to change treatment modality and refuse transplantation. Misbelief about transplantation shows a correlation with the motive of refusal. Dissemination of information may facilitate a change in the situation.

Questionnaire Development for the Measurement of Patients' Attitudes Toward Renal Transplantation.

OBJECTIVE: The aim of this work was the exploration of chronic renal insufficiency patients' attitudes toward treatment, various motifs underlying their acceptance or refusal of kidney therapy, and understanding of their psychologic content. Examinations were carried out of chronic renal insufficiency patients' attitudes toward renal treatments, and a questionnaire suitable for its assessment was developed. METHODS: Suppositions of patients before and after renal transplantation were explored by means of semistructured interviews. The content-based analysis of the interview narratives revealed the system of content-categories, which we fitted with attitude questions. Transplant patients took part in the trial of the questionnaire, and the statistical analysis of their replies revealed specific variations in patients' attitudes toward transplantations. RESULTS: The results of the principal component analysis classified the replies of transplanted patients into 8 categories for interpretation: hope of recovery, effects of dialysis in deterioration of quality of life, mistrust of transplantation, refusal, anxiety in the run-up phase to transplantation, difficulty in acceptance of the disease and transplantation as a treatment, fears of living-donor transplantations, acceptance of transplantation, and curiosity about dead donors. CONCLUSIONS: Our research explored attitude variances among patients for and against transplantations. A good understanding of patients' attitudes (the exploration of valid and invalid assumptions) might exert a positive influence on patient decisions, and might improve their attitude toward their treatment and their adherence from preparation for the operation to the postoperative phase of recovery.

Infertility Specific Quality of Life and Gender Role Attitudes in German and Hungarian Involuntary Childless Couples.

Introduction: As gender role attitudes and the evaluation of parenthood and childlessness have subtle variations in each society, cross-country studies focusing on infertility are needed to draw a complex picture in the psychosocial context of infertility. This study investigates similarities and differences between German and Hungarian infertile couples regarding infertility specific quality of life and personal gender role attitudes. Methods: A cross-sectional study was conducted with data of 540 participants (270 couples) attending the first fertility consultation in one fertility clinic in Germany and in five fertility clinics in Hungary. Data were collected between February 2012 and March 2013. Two psychological questionnaires were applied: The FertiQoL to measure infertility specific quality of life and the PAQ to measure gender role attitudes like "instrumental" acting (as a traditional "masculine" attitude) and "expressive" communicating (as a traditional "femine" attitude) and their combinations "combined" attitude (as both "instrumental" and "expressive") and "neutral" attitude (neither "instrumental" nor "expressive"). Results: German couples seeking assisted reproduction treatment are older aged and have longer lasting relationships than Hungarian couples. Hungarian couples scored higher on all quality of life scales than did German couples. In the Hungarian group, "combined" attitudes (use of both "expressive" and "instrumental" attitudes) is associated with higher levels of quality of life compared with other gender role attitudes. In the German group, individuals with "combined" attitudes seem to show better quality of life than those in "expressive" and "neutral" clusters. Conclusions: The strategy of using combined "expressive" and "instrumental" attitudes proved to act as a buffer against infertility-related stress for both members of the couple in two European countries and can therefore be recommended as helpful in counselling the infertile couple.