Quality of life in patients starting dialysis and their partners

  • Currie Moore

Student thesis: Phd


Patients with established renal failure (ERF) and their partners prioritise quality of life (QOL), especially as the patient prepares to start dialysis. However, limited research exists which examines QOL in patient-partner couples around the start of dialysis. Patients and their partners form a unique social unit, or dyad, who influence each other and may be mutually or individually affected by illness or its treatment. Examining QOL in patient-partner dyads may provide new insight into the psychological or relationship factors related to QOL. The thesis comprises a literature review and three empirical studies which are described across four chapters: 1) a narrative literature review exploring QOL in ERF patients and their partners (Chapter 3), 2) a qualitative study using dyadic thematic analysis to examine the impact of dialysis on the dyadic relationship between male patients and their female partners (Chapter 4), 3) a multi-phase study to develop a measure to assess psychological and interpersonal factors related to QOL (Chapter 5), and 4) a longitudinal, quantitative questionnaire-based study to describe changes in QOL in patient-partner dyads over the transition onto dialysis (Chapter 6). The literature review is the first to focus on QOL in ERF patients and their partners. It identified 14 studies (8 qualitative, 4 quantitative and 2 mixed methods). A narrative review of quantitative results and a narrative synthesis of qualitative findings suggested that ERF and dialysis significantly affect QOL. Both patients and their partners described impairments in their QOL, most notably in their psychological QOL. Semi-structured interviews were conducted with 20 dyads (male patients and their female partners) who were in the early phases of dialysis (pre-dialysis to first 16 months on dialysis). Dyadic thematic analysis highlighted the substantial ways dialysis impacted their lives and were captured by the themes 'Prioritising the patient', 'Carrying the burden' and 'Changing identities'. Despite these changes, dyads who worked together and found ways to be positive, accepting of or normalised dialysis minimised negative effects on their relationship. Further analysis of the findings suggested that dialysis expectations, accepting dialysis and features of the dyadic relationship relate to QOL. A measure, the Starting Dialysis Questionnaire (SDQ), was developed to assess these constructs. Cognitive interviews and preliminary psychometric evaluations indicate that the SDQ has good face validity and overall performance. A longitudinal, quantitative study measured changes in QOL from pre-dialysis (83 dyads), at 6 weeks (42 dyads) and 12 weeks (39 dyads) after starting dialysis. Patients' general and physical QOL improved from poor to good QOL. For partners, QOL was good overall despite it worsening at 6 weeks after the patient started dialysis. The thesis makes a novel contribution to the ERF literature by focusing on patient-partner dyads over a critical time period in the illness trajectory and using methods which better our understanding of the wider interpersonal context in which dialysis occurs.
Date of Award1 Aug 2020
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorAlison Wearden (Supervisor), Sandip Mitra (Supervisor), Lesley-Anne Carter (Supervisor) & Suzie Skevington (Supervisor)


  • dialysis
  • chronic kidney disease
  • partner
  • dyad
  • mixed methods

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