The effect of coping strategies training on hemodialysis patients' quality of life

Document Type : Original Quantitative and Qualitative Research Paper


1 MS in Medical Education, Rafsanjan University of Medical sciences, Rafsanjan, Iran

2 Assistant professor in Nursing, School of Nursing & Midwifery, Occupational Enviroment Research Center, Rafsanjan University of Medical sciences, Rafsanjan, Iran

3 MS in Nursing, Faculty member, School of Nursing & Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran

4 PhD Nursing student, , Kerman University of Medical Sciences School of Nursing & Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran


Background: The hemodialysis patients, who are able to make better use of adaptive techniques, accept the treatment easier and will have a higher quality of life.
Aim: The aim of this study was to measure the effect of training of coping methods (problem-focused and emotion-focused) on quality of life in hemodialysis patients.
Methods: This was a one-group before- after quasi-experimental design, in which 38 hemodialysis patients admitted at the Ali ebn Abi Talib Hospital in Rafsanjan 2010, were included. Quality of life questionnaire (SF36) and Lazarus Jalowiece Coping Style Questionnaire were used to measure the patients' quality of life and coping styles before intervention. Coping strategies were then trained and quality of life and coping styles were measured again after intervention. Data analysis was performed with SPSS Software Version 18 using paired t-test, ANOVA and Fisher's exact test.
Results: Most of the subjects were female, married, with a mean (SD) age of 51.42 ± 20/50 years. The mean score of quality of life was 89.03±19.35 before versus 98.89±16 after intervention.  The mean score of quality of life was increased 9.85 after training compared to the baseline. Paired t-test showed significant difference between the scores of quality of life before and after intervention (p<0.0001).
Conclusion: The results indicated that coping methods training can promote the use of problem-based instead of emotion-focused coping strategies, which intern could enhance patients' quality of life.


  1. Hagren B, Pettersen IM, Severinsson E. Maintenance Haemodialysis: Patients' Experiences of their Life Situation. J Clin Nurs. 2005;14:294–300.
  2. Davison SN. End-of-Life Care Preferences and Needs: Perceptions of Patients with Chronic Kidney Disease. Clin J Am Soc Nephrol. 2010;5:195–204.
  3. Horigan AE. Fatigue in Hemodialysis Patients: A Review of Current Knowledge. J. Pain Symptom Manag. 2012;44(5):715-24.
  4. Chilcot J, Wellsted D, Farrington K. Illness Representations are Associated with Fluid Nonadherence among Hemodialysis Patients. J. Psychosom. Res. 2010;68(2):203-12.
  5. Idier L, Untas A, Koleck M, Chauveau P, Rascle N. Assessment and Effects of Therapeutic Patient Education for Patients in Hemodialysis: A Systematic Review. Int J Nurs Stud. 2011;48(12):1570-86.
  6. Christensen A, Ehlers S. Psychological Factors in End-Stage Renal Disease: An Emerging Context for Behavioural Medicine Research. J Consult Clin. Psychol. 2002;70(3):712-24.
  7. Courts N. Psychosocial Adjustment of Patients on Home Hemodialysis and their Dialysis Partners. Clin. Nurs. Res. 2000;9(2):177-90.
  8. Calvin A. Haemodialysis Patients and End-of-Life Decisions: A Theory of Personal Preservation. J Adv Nurs. 2004;46(5):558-69.
  9. Kimmel P. Psychosocial Factors in Dialysis Patients. Kidney Int. 2001;59:1599-613.
  10. Pakpour A, Zeidi IM, Chatzisarantis N, Molsted S, Harrison A, Plotnikoff R. Effects of Action Planning and Coping Planning within the Theory of Planned Behaviour: A Physical Activity Study of Patients Undergoing Haemodialysis. Int. J. Sports Psychol 2011;12(6):609-14.
  11. Folkman S, Tedlie J, Moskowitz J. Coping: Pitfalls and Promise. Annu Rev Psychol 2004;55:745-62.
  12. Lorig K, Holman H. Self-Management Education:History, Definition, Outcomes, and Mechanisms. Ann Behav Med. 2003;26(1):1-7.
  13. Gilbar O, Or-Han K, Plivazky N. Mental Adjustment, Coping Strategies, and Psychological Distress among End-Stage Renal Disease Patients. J Psychosom Res. 2005;58(6):471-6.
  14. Kusman I, Sunuttra T, Kittikorn N. Coping and Quality of Life among Indonesians Undergoing Hemodialysis. Thai J Nurs Res. 2009;13(2):109 - 17.
  15. Mok E, Tam B. Stressors and Coping Methods among Chronic Hemodialysis Patients in Hong Kong. J Clin Nurs. 2001;10:503-11.
  16. Pucheu S, Consoli SM, D'Auzac C, Fransais P, Issad B. Do Health Causal Attributions and Coping Strategies Act as Moderators of Quality of Life in Peritoneal Dialysis Patients? J Psychosom Res. 2004;56(3):317-22.
  17. Breiterman White R. Adherence to the Dialysis Prescription:Partnering with Patients for Improved Outcomes. J Nephrol Nurs, 2004;31(4):432-5.
  18. Christensen A. Patient-by-Treatment Context Interaction in Chronic Disease: A Conceptual Framework for the Study of Patients’ Adherence. Psychosom. Med 2000;62:435-43.
  19. Christensen A, Benotsch E, Wiebe J, Lawton W. Coping with Treatment-Related Stress: Effects on Patient Adherence in Hemodialysis. J Consult Clin Psychol. 1995;63(3):454-9.
  20. Yeh S-C, Chou H-C. Coping Strategies and Stressors in Patients with Hemodialysis. Psychosom Med. 2007;69:182-90.
  21. Finkelstein FO, Wuerth D, Finkelstein SH. Health Related Quality of Life and the CKD Patient: Challenges for the Nephrology Community. Kidney Int. 2009;76:946–52.
  22. Kimmel PL, Patel SS. Quality of Life in Patients with Chronic Kidney Disease: Focus on End-Stage Renal Disease Treated with Hemodialysis. Semin Nephrol. 2006;26:68–79.
  23. Coelho R, Amorim I, Prata J. Coping Styles and Quality of Life in Patients with Non-Insulin-Dependent Diabetes Mellitus. Psychosom J. 2003;44:312-18.
  24. Santos PR. Correlation between Coping Style and Quality of Life among Hemodialysis Patients from a Low –Income Area in Brazil. Hemodial Int. 2010;14:316 -21.
  25. Patel SS, Shah VS, Peterson RA, PL. K. Psychosocial Variables, Quality of Life, and Religious Beliefs in ESRD Patients Treated with Hemodialysis. Am J Kid Dis. 2002;40:1013-22.
  26. Motamed N, Ayatollahi AR, Zare N, Sadeghi-Hassanabadi A. Validity and Reliability of the Persian Translation of the SF-36 Version 2 Questionnaire. East Mediterr Health J. 2005;11(3):349-57.
  27. Mahmoudi G.R, Shariati A.R, Behnampour N. Relationship between Quality of Life and Coping Methods Used by Patients Undergoing Hemodialysis. J Gorgan Uni Med Sci. 2003;5(2):43-52
  28. Narimani K. Effect of Self-Care Education on Quality of Life in Hemodialysis Patients. Daneshvar Pezeshki J. 2008;79:63-70.
  29. Lazarus RS, S. F. Stress, Appraisal and Coping. New York: NY: Springer; 1984.
  30. Aziznezhad P, Kashanineya Z. Self-Care Education in the Use of Coping Strategy in Adolescents with Major Thalassemia Referred to Thalassemia Center in Amyrkla’s Children's Hospital. J Hormozgan Uni Med Sci. 2007;3:265-72.
  31. Bagherian Reza, Maroofi M, Fatolah Gol M, Zare F. Prevalence of Anxiety, Depression and Coping Styles in Myocardial Infarction Patients Hospitalized in Isfahan Hospitals. J Mazand Univ Med Sci. 2010;20(77): 37-45.
  32. Rahimian B. Quality of Life Stressors and Coping in Hemodialysis Patients. J Urmia Nur 2009;6(4):10-7.
  33. Takaki J, Nishi T, Shimoyama H, Inada T, Matsuyama N, Kumano H, et al. Possible Interactive Effects of Demographic Factors and Stress Coping Mechanisms on Depression and Anxiety in Maintenance Hemodialysis Patients. J Psychosom Res. 2005;58(3):217-23.