PhD in Nursing Science Program

Coping and Health-related Quality of Life in Renal Transplant Patients

Dissertation under the direction of Professor Kathleen Dwyer

Purpose:  The purpose of this study was to investigate the relationships among transplant-related clinical factors, cognitive appraisal of health, perceived self-efficacy, perceived social support, coping, and health-related quality of life (HRQOL) in renal transplant patients using a theoretically derived model.

Method:  Using a descriptive cross-sectional design, a convenience sample of 160 participants following renal transplantation was recruited from an outpatient transplant clinic [N=55 < 1 yr post transplant; N=105 1 - 3 yrs post transplant]. Standardized instruments were used to measure the key constructs.

Results:  Path analysis demonstrated that perceived self-efficacy had a significant direct effect on negative primary appraisal of health and physical HRQOL, and had both direct and indirect effects through primary appraisal on disengagement coping. Perceived social support had significant direct effects on negative primary appraisal of health and engagement coping, and an indirect effect on disengagement coping through negative primary appraisal. History of transplant related hospitalizations and medication side effects had significant direct effects on primary cognitive appraisal of health. Medication side effects had a direct effect on mental HRQOL. Results also indicated that negative primary appraisal of health had a significant direct effect on disengagement coping, physical and mental HRQOL. The findings suggested that engagement coping had a significant direct effect on physical HRQOL, while disengagement coping had a significant direct effect on mental HRQOL.

Using multivariate analysis of variance to examine the effects of clinical factors on psychosocial variables, participants reporting more symptoms (>17) appraised their health more negatively, used more disengagement coping, had lower degrees of perceived self-efficacy, physical and mental HRQOL than those with fewer symptoms (=17). Participants less than one year post-transplant used more engagement coping, reported higher degrees of perceived self-efficacy and perceived social support than participants in the later period post-transplant.

Conclusions:  PHRQOL of renal transplant patients is the outcome of a complex interplay between clinical factors, personal and social resources, cognitive appraisal of health, and coping strategies. Holistic interventions including physical and psychosocial components are needed to help renal transplant patients cope with transplantation and improve their HRQOL.