Impact of symptom burden clusters on self-efficacy and quality of life in hemodialysis patients: a multicenter cross-sectional study

Hemodialysis is a therapeutic procedure used to manage and treat acute and chronic kidney failure, which cannot respond to traditional medical therapy. Patients undergoing hemodialysis frequently experience multiple burdensome symptoms that impact their psychological and physical well-being. Understanding how symptom burden influences self-efficacy and quality of life is essential to improve care for this population. This study aimed to evaluate the impact of physical and mental health symptoms on self-efficacy in managing the chronic disease and quality of life among patients undergoing haemodialysis. This was a multicentre cross-sectional study, including two large hemodialysis centers at An-Najah National University Hospital, Nablus, and Al-Hussein Government Hospital in Beit Jala. The symptom clusters experienced by patients undergoing hemodialysis were assessed via the Dialysis Symptom Index. Self-efficacy and quality of life were assessed using the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SEMCD-6) and the EuroQol-5 Dimension (EQ-5D-5L), respectively. Independent-samples t-test and one-way ANOVA assessed group differences in self-efficacy and quality of life, and multivariable linear regression identified independent predictors of these outcomes. This study involved 306 patients undergoing hemodialysis, with a mean age of 58.1 ± 13.3 years. More than half of the participants were female (54.9%), and most lived in cities (51.0%). More than two-thirds of the participants experienced fatigue (84.3%), anxiety (72.5%), and sadness (72.5%). More than half reported stress (68.6%), agitation (64.7%), difficulty sleeping (62.7%), dry mouth (58.8%), dry skin (56.9%), depression (56.9%), cough (54.9%), difficulty concentrating (54.9%), itching (52.9%), and vertigo/dizziness (51.0%). The patients were moderately self-efficient in managing their chronic disease though faced challenges with mobility (56.9%), self-care (37.3%), and performing their usual activities (52.9%). The mean health rating of the participants based on the EQ-5D visual analogue scale (EQ-VAS) was 60.3 ± 18.3. Higher QoL was significantly associated with lower symptom burden, higher self-efficacy, urban residence, and younger age (p < 0.05). Having a healthy weight, living in urban areas, living with family, and having higher education were significantly associated with higher self-efficacy (p < 0.001). Symptom burden was negatively associated with both self-efficacy and quality of life (p < 0.001). This research provides significant insight into the factors affecting self-efficacy and overall quality of life among patients undergoing hemodialysis in Palestine. The findings suggest that self-efficacy and quality of life are negatively affected by greater symptom burden. Interventions targeting symptom burden and enhancing self-efficacy may improve patient outcomes. This underscores the need to integrate the clinical and psychosocial aspects of patient treatment in Palestine to enhance patient self-efficacy and overall health.