Shift in paradigm: understanding adjustment of dialysis patients
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End stage renal failure (ESRF) and its treatment can lead to adjustment difficulties. However the extent of these difficulties is not known. Adjustment is a complex and multidimensional construct. In general beliefs about illness and its treatment influence adjustment but the findings are inconsistent. This is probably because adjustment and beliefs have been defined in a variety of ways based on professional or theoretical views. One possible way of establishing a standard approach to defining adjustment and beliefs is to be guided by patients' own views. Qualitative studies identify ways of evaluation of life and beliefs about ESRF and its treatment that have not been identified by quantitative studies. These findings can be considered as patient-derived targets for psychoeducational programs or clinical practice for ESRF patients. However qualitative research cannot provide evidence about the frequency of patients' beliefs and ways of evaluation of life. Therefore questionnaires have been developed on the basis of qualitative findings. These helped to examine the utility of the findings for clinical practice and understand the relationship of quality of life with beliefs. More research is needed to investigate how the findings on these questionnaires converge and diverge with those on existing generic and/or ESRF specific quality of life and beliefs measures.