The impact of treatment transitions between dialysis and transplantation on illness cognitions and quality of life - A prospective study

Objectives. Treatment transitions are frequent in end-stage renal disease (ESRD) but little is known about cognitive responses pre- to post-transplantation or after transplant failure. The purpose of this study was to examine changes in illness cognitions across treatment transitions between dialysis and transplantation and their impact on quality of life (QOL). Methods. In this longitudinal study, ESRD patients (N= 262) patients were followed up across treatment transitions over a 7-year observation window using the Illness Perceptions Questionnaire, the Illness Effects Questionnaire, and measures of QOL. Study sample comprised the patients from this cohort who switched treatment modality (N= 60 post-transplantation; N= 28 transplant failure). Data were collected while on dialysis or transplantation and at 6 months post-treatment change. Results. Significant changes in QOL and illness perceptions were found in treatment transitions with opposite patterns of either improvement or deterioration following transplantation or transplantation failure. Pre- to post-transplantation, QOL improves and patients report less symptoms, lower consequences, and illness intrusiveness, more acute timeline and stronger control beliefs (ps < .01). QOL is diminished following transplant failure and patients report more symptoms, consequences, illness disruptiveness, more chronic timeline, and lower control. Changes in cognitions are associated with changes in QOL (R2= .469.789). Conclusions. Treatment transitions marked significant changes in illness perceptions that were associated with changes in QOL. Interventions to prepare patients for treatment transitions and prevent increasingly negative patterns of illness perceptions with transplant failure may serve towards maintaining or improving adjustment outcomes. Statement of contribution What is already known on this subject? Illness cognitions have been shown to predict health outcomes and to change in response to changes in health status. Treatment transitions between dialysis and transplantation are frequent in end stage renal disease but their effect on illness representations has not been explored. What does this study add? The paper described results of the first study to prospectively explore changes in illness cognitions across treatment transitions between dialysis and transplantation and their impact on QOL outcomes. The paper documents dynamic changes in illness cognitions when treatment modality is changed in line with the predictions of a dynamic reassessment of illness perceptions and coping behaviour as described in Leventhal's Common Sense Model of Illness Behaviour.