Psychological Adaptation to Serious Illness: A Qualitative Study of Culturally Diverse Patients with Advanced Chronic Kidney Disease.

Abstract Context Psychological distress is associated with adverse health outcomes in serious illness and magnified among patients of low socioeconomic status. Aspects of one’s culture, such as religion and spirituality, can influence these patients’ coping response to distress. Advanced chronic kidney disease (CKD) is a serious illness that disproportionately affects patients of low socioeconomic status, but a theory-based understanding of this group’s lived experience of CKD is lacking. Objectives We explored the cognitions, emotions, and coping behaviors of patients with CKD with emphasis on those of low socioeconomic status. We further inquired into any influences of religion or spirituality. Methods We interviewed 50 English or Spanish-speaking adults with advanced CKD from three medical centers in Nashville, Tennessee. Analyses occurred with 1) isolation of themes; 2) development of a coding system; and 3) creation of a conceptual framework using an inductive-deductive approach. Results Median age was 65 years old, median annual income was $17,500 per year, and 48% of participants had not progressed beyond high school. Key beliefs (awareness of mortality, lack of control) influenced patients’ emotions (existential distress in the form of death anxiety, prognostic uncertainty, hopelessness) and coping behaviors (acceptance, avoidance, emotion regulation via spirituality, seeking social support via a religious community). Conclusions Individuals with advanced CKD and low socioeconomic status lack control over disease progression, experience death anxiety and existential distress, and emphasize spirituality to cope. Our study identifies novel components for a psychotherapeutic intervention for patients with advanced CKD at high risk for adverse health outcomes.