title: Influence of Staff Encouragement on Perceived Burden of Dietary Restriction Among Patients Living Alone.
abstract: To help relieve the burden of dietary restrictions experienced by many hemodialysis (HD) patients, dialysis staff may encourage patients, with no consideration to the degree of family support. Here, we clarified the effect of staff encouragement and living conditions on the burden of dietary restrictions in HD patients. This retrospective cohort study was conducted using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) I and III. We enrolled patients aged 18-75 years on HD therapy for at least 3 months. We categorized patients into four groups based on combinations of level of staff encouragement (high or low) and living condition (alone or with family) at baseline survey. Patients who felt they received high staff encouragement and lived with their family were set as the control. The main outcome was increase in patients' perceived burden of dietary restriction after 1 year. 1377 (69.1%) felt they received high staff encouragement, and 176 (9.1%) were living alone. After 1 year, 537 (26.9%) patients reported feeling an increased burden of dietary restriction. A low level of staff encouragement did not increase the burden in any patients, regardless of living situation. However, a high level of staff encouragement did increase the burden in patients living alone (adjusted odds ratio: 1.57, 95% confidence interval: 1.05-2.36). We observed an unexpected association between high staff encouragement and increased burden of dietary restriction among patients living alone. Staff encouragement may not relieve patients' burden with respect to dietary restriction and may in fact exacerbate it.
authors.affiliation: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Tatsuyoshi
authors.initials: T
authors.lastname: Ikenoue
authors.affiliation: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shingo
authors.identifier: http://orcid.org/0000-0002-8379-8761
authors.initials: S
authors.lastname: Fukuma
authors.affiliation: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Yamamoto
authors.affiliation: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shin
authors.initials: S
authors.lastname: Yamazaki
authors.affiliation: Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Tadao
authors.initials: T
authors.lastname: Akizawa
authors.affiliation: Department of Blood Purification, Tokyo Women's Medical University Hospital, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Akiba
authors.affiliation: Division of Nephrology and Metabolism, Department of Medicine, Tokai University School of Medicine, Sagamihara, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Saito
authors.affiliation: National Graduate Institute for Policy Studies, Tokyo, Japan.
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kurokawa
authors.affiliation: Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.
authors.forename: Shunichi
authors.initials: S
authors.lastname: Fukuhara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D015331:Cohort Studies; D017281:Cost of Illness; D004032:Diet / Q000523:psychology*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods / Q000523:psychology*; D012189:Retrospective Studies; D012944:Social Support; D055815:Young Adult
keywords: Diet therapy; Hemodialysis patients; Psychological stress