Cooperation and successful outcomes in home dialysis

Cooperation among those involved in the triad of patient-partner-health professional is associated with desirable patient outcomes and has been demonstrated in 2 studies with consistent results. In the dyad analysis, cooperation between the patient and partner was associated with work and leisure activity. Spouses often encourage and facilitate the patients ability to engage in work and leisure activities and probably can impede activity equally well. The correlations of cooperation in the patient-doctor dyad with physical status and adherence is also of note. Many of the patients who have been on dialysis for several years and are doing well see their doctor for checkups only a few times a year, which might suggest patients' independence of their physicians or at least some distancing due primarily to the infrequency of contacts with each other. On the contrary, the data suggest some that the patient-doctor relationship remains important. Cooperation in the partner-doctor dyad did not relate to any of the patient outcomes; many of the partners and doctors hardly knew each other personally. Whether this is reflected by the data cannot be determined. How accurately triad members perceived each other (mutual perception) was related to adherence and total activity while trust was related to physical status and adherence. Empirical evidence has been presented to support the long held assumption that cooperation among those caring for a patient is associated with selected patient outcomes. The study also provides an alternative to the traditional model for interactions between health care providers and patients, which includes a family member. While the traditional model fits the needs of emergency and acute care situations effectively, the cooperation model is one alternative that may fit the different needs in the long term, self-care, chronic illness situation, which is the greatest health care delivery challenge of today and tommorrow. Patient and family responsibility for treatment and symptom management in home dialysis illustrates an extremely expensive, demanding and highly technological treatment pattern. The success of many of these families to assume this responsibility effectively and to maintain a productive and acceptable life style is a profound example, which designers of services for other chronically ill populations would do well to consider. Inclusion of the patient in establishing his treatment plan within the parameters of his own value system and life style may at times compromise the health professional's own idealistic needs for maximal wellness. The model proposed here would attempt to bring greater congruence between the patient, family and health professional's goals, legitimize the patients' rights to participate in planning and decison making which affect them to the degree which meets their own needs. Health professionals can educate and train patients, provide treatment means to better health, provide support for patient and family responsibility and facilitate informed decision making...