Illness perceptions and treatment perceptions of patients with chronic kidney disease: Different phases, different perceptions?

Objectives To examine the variability of illness and treatment perceptions that have been found to be associated with chronic kidney disease (CKD) patients' outcomes (e.g., quality of life) across the CKD trajectory, by investigating whether there are differences in perceptions in patients: (1) on varying treatments (pre-dialysis, haemodialysis, peritoneal dialysis), (2) with varying lengths of time on (dialysis) treatment, and (3) over time on dialysis, with an 8-month interval. Design and methods Mixed cross-sectional and longitudinal design, using self-report questionnaires on illness and treatment perceptions; the study sample consisted of 105 pre-dialysis and 161 dialysis patients; of the 161 dialysis patients, 87 patients filled in the questionnaires again after an 8-month interval. Data were examined using multilevel (multivariate) repeated measurements regressionanalyses, controlled for background characteristics and repeated measures. Results Patients on haemodialysis and peritoneal dialysis believed more strongly that their treatment controls their illness (p<.05, p<.01, respectively) and perceived more illness consequences (p<.001, p<.05, respectively) than pre-dialysis patients. Haemodialysis patients perceived more treatment consequences than pre-dialysis (p<.001) and peritoneal dialysis patients (p<.01). The perception of illness understanding fluctuated between patients with varying lengths of time on dialysis (p<.05). Perceived treatment consequences were more negative in patients who were on dialysis for longer lengths of time (p<.01). Lastly, perceptions of illness and treatment varied within dialysis patients over an 8-month interval, with treatment control and personal control showing the lowest correlations. Conclusions Findings suggest that illness and treatment perceptions vary across the CKD trajectory. This indicates that perceptions are amenable to influences and that interventions might potentially be helpful in influencing them in order to improve outcomes.