Repercussões psicossociais e espirituais da doença renal crônica e dos tratamentos de hemodiálise e diálise peritoneal sobre os familiares

Abstract

Chronic kidney disease causes physical, emotional and social changes in the person affected, with repercussions on the family, which is subject to the various adaptive demands imposed by the disease and dialysis therapy. From the literature, quality of life, spirituality, hope, resilience and social support were highlighted as elements that may be present and be influenced by illness, and even present themselves differently among family members of people on hemodialysis and on peritoneal dialysis. General objective: To analyze the psychosocial and spiritual repercussions that chronic kidney disease and hemodialysis and peritoneal dialysis treatments can have on the sick person's family members. Method: Mixed study with qualitative (n = 20) and quantitative (n = 160), descriptive, cross-sectional and comparative study, carried out with family members of people with chronic kidney disease undergoing dialysis therapy, in a dialysis unit in Salvador-Bahia, Brazil. Data collection was carried out from September to December 2019, after approval by the Ethics Committee, using the following instruments: sociodemographic questionnaire; semi-structured interview script; WHOQOL-bref; WHOQOL-SRPB; Resilience Scale for Adults; Herth's Hope Scale and Perceived Social Support Multidimensional Scale. The data obtained from the scales wereanalyzed with descriptive statistics and association tests adequate to the nature of the variables. Content analysis was used to treat narratives and discussions were carried out through the triangulation of methods. Results: illness and treatment repercussions on the investigated elements were identified and quality of life, spirituality, religiosity and social support obtained higher scores for the peritoneal dialysis group; while in hope and resilience the scores had similar values between treatment groups. Negative self-perception of life quality emerged after the disease and treatment, dealing with it through overcoming mechanisms, reorganization of family, personal and social everyday life, and through passive acceptance of the experienced situation. As sources of support, spirituality, religiosity, hope, and support from family, friends, and health professionals were mentioned. Correlations were identified showing that age, gender, belief, income and length of care influenced the quality of life. There were positive correlations between the averages of quality of life domains; general quality of life index; spirituality, religiosity and personal belief; resilience; hope; and perceived social support, indicating that the higher the score of one of these elements, the higher the score of the others. Main conclusions: this study confirm the thesis that the statistically significant differences in the quality of life of family members of peritoneal dialysis with a higher score in the environment domain, when compared to those of hemodialysis, do not occur due to the type of treatment, considering that this treatment causes greater care overload for the family, but due to the socioeconomic characteristics of the families of the people who are indicated for the referred treatment. Given the differences in scores between groups of family members, specific care actions and programs for family members are required by type of treatment.