Control and coping for individuals with end stage renal disease on hemodialysis: a position paper

The hemodialysis regimen required to treat end stage renal disease (ESRD) can be extremely rigid, requiring individuals to adapt to and cope with multiple acute and chronic stressors. Stressors for individuals on hemodialysis can be treatment-related such as dietary and fluid restrictions and ingesting handfuls of medications, or psychosocial in nature such as alterations in sexual function, changes in self-perception, and fear of death. Coping for individuals with ESRD can be adaptive or maladaptive. Adaptive coping can produce desirable outcomes, such as employment and successfulf functioning within the family. If coping is maladaptive, however, marital and family dysfunction can occur, as well as depression, anxiety and loss of one's role and identity. ESRD is marked by extreme loss of personal control and the challenge of lifelong behavioural change. This paper explores and examines the concept of control and its relevance to coping for individuals with ESRD receiving hemodialysis. It also critically analyzes the research literature, and makes recommendations for clinical practice and future research.