title: Choice of treatment improves quality of life. A study on patients undergoing dialysis.
abstract: BACKGROUND
  Quality of life (QOL) is an important measure of the success of medicine. Choice of treatment is an important variable influencing QOL. We studied QOL in patients undergoing treatment for end-stage renal failure. Until June 1993 our patients needing dialysis could freely choose continuous ambulatory peritoneal dialysis (CAPD); however, since that time most patients have been forced to undergo CAPD because the hemodialysis program is full.
  
  
  METHODS
  We compared QOL in patients accepted before or after June 1993. Forty-five patients undergoing CAPD were studied during the period of choice compared with 44 who had no choice. Quality of life was studied by Bradburn Affect Scale, Mental Health Scale, Campbell Life Satisfaction, Perceived Health, Karnofsky Scale, Activity Scale, Physical Symptoms Scale, and desire for treatment change.
  
  
  RESULTS
  The patients undergoing CAPD in the no-choice group had a lower score than the choice population in 4 of the 7 QOL scales. The Mental Health Scale mean score was 18.4 compared with 15.5, and the patients ranking highest on the Mental Health Scale decreased from 33% to 18%, while those ranking lowest increased 7-fold from 2% to 14% comparing choice with no-choice group. The Bradburn Affect Scale score was +0.7 in the choice group compared with -0.3 in the no-choice group. There were no differences in age, sex, race, or treatment that explained the difference. Influence of other time-related factors is unlikely as there were no similar lower scores with time in the QOL reported by patients in the in-center or assisted self-care hemodialysis or transplant groups.
  
  
  CONCLUSIONS
  Once the freedom of choice of treatment is gone from the patients undergoing CAPD their psychological QOL deteriorates.
authors.affiliation: Department of Medicine, University of Alberta, Edmonton.
authors.forename: E
authors.initials: E
authors.lastname: Szabo
authors.forename: H
authors.initials: H
authors.lastname: Moody
authors.forename: T
authors.initials: T
authors.lastname: Hamilton
authors.forename: C
authors.initials: C
authors.lastname: Ang
authors.forename: C
authors.initials: C
authors.lastname: Kovithavongs
authors.forename: C
authors.initials: C
authors.lastname: Kjellstrand
mesh_terms: D000328:Adult; D000368:Aged; D002755:Choice Behavior; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000523:psychology*; D011581:Psychological Tests; D011788:Quality of Life; D006435:Renal Dialysis / Q000523:psychology*