@article{17141,
  author = {Snelling P. and Chan R. and Brooks R. and Erlich J. and Chow J. and Suranyi M. and Gallagher M.},
  title = {Studying psychosocial adaptation to end-stage renal disease: The proximal-distal model of health-related outcomes as a base model},
  abstract = {<p>
OBJECTIVE: Studying psychosocial adaptation in end-stage renal disease (ESRD) is increasingly important, as it may explain the variability in health outcomes unaccounted for by clinical factors. The Brenner et al. proximal-distal model of health-related outcomes provides a theoretical foundation for understanding psychosocial adaptation and integrating health outcomes, clinical, and psychosocial factors (Brenner MH, Curbow B, Legro MW. The proximal-distal continuum of multiple health outcome measures: the case of cataract surgery. Med Care. 1995;33(4 Suppl):AS236-44). This study aims to empirically validate the proximal-distal model in the dialysis population and examine the impact of psychosocial factors on the model. METHODS: A cross-sectional observational study was conducted with a sample of long-term dialysis patients (n=201). Eleven factors: quality of life (QoL), depression, positive affect, comorbidity, symptoms, physical functioning, disease accommodation, loss, self-efficacy, illness acceptance, and social support were measured by standardized psychometric scales. A three-month average of hemoglobin was used. Latent composite structural equation modeling was used to examine the models. RESULTS: The proximal-distal model with slight modification was supported by fit statistics [chi(2)=16.04, df=13, P=.25, root mean square error of approximation (RMSEA)=0.024], indicating that the impact of clinical factors on QoL is mediated through a range of functional and psychological factors, except for hemoglobin which impacts directly on QoL. The model with additional psychosocial factors was also supported by fit statistics (chi(2)=43.59, df=41, P=.36, RMSEA=0.018). These additional factors mainly impact on symptom status, psychological states, and QoL components of the model. CONCLUSION: The present study supported the proximal-distal model in the dialysis population and demonstrated the considerable impact of psychosocial factors on the model. The proximal-distal model plus psychosocial factors as a biopsychosocial model can be applied to studying psychosocial adaptation in ESRD.
</p>
},
  year = {2011},
  journal = {Journal of Psychosomatic Research},
  volume = {70},
  edition = {2011/04/23},
  number = {5},
  pages = {455-64},
  isbn = {1879-1360 (Electronic)0022-3999 (Linking)},
  note = {Chan, RamonyBrooks, RobertErlich, JonathanGallagher, MartinSnelling, PaulChow, JosephineSuranyi, MichaelEnglandJournal of psychosomatic researchJ Psychosom Res. 2011 May;70(5):455-64. Epub 2011 Feb 12.},
  language = {eng},
}