Application of Guided Self- Determination (GSD) Method in Hemodialysis Patients
Condition: Hemodialysis Patients
Study type: Interventional

Summary: 
      The aim of this study is to assess how guided self-determination method affects adherence to
      treatment, fluid control, self-efficacy, anxiety level and quality of life in hemodialysis
      patients.

      The population of the study consisted of patients who received HD treatment at Private
      Eskişehir Anatolian Dialysis Center and Eskişehir Osmangazi University Health, Practice and
      Research Hospital Dialysis Unit between April 2022 and October 2022. The sample of the study
      was 65 patients who met the inclusion criteria in the specified population.

      Individual Identification Form, Biological/Biochemical Data Form, End Stage Renal Failure
      Compliance Scale, Hemodialysis Patients Fluid Control Scale, General Self-Efficacy Scale,
      Beck Anxiety Scale and SF-36 Quality of Life Scale Short Form were used to collect research
      data.
    

Detailed description: 
      Guided Self- Determination (GSD) is a self-management support intervention aimed at
      supporting decision making and problem solving and helping patients suffering from a chronic
      disease to improve their life skills. GSD aims to support and develop the self management
      ability of the patients' chronic illness according to their own needs and desires by sharing
      psychosocial aspects, enabling active involvement of the patient in goal setting and
      treatment decisions, and thus developing positive autonomy and responsibility in the patient.
      This method is based on the idea that there is a potential for change in the patient-nurse
      relationship to support mutual understanding and cooperation.

      This method consists of interviews using structured self-evaluation forms based on theories.
      It aims to guide the patient to gain skills for self-determination and self management by
      using these self-evaluation forms in thinking, goal setting, and problem solving .The
      self-assessment forms include four themes: the patient-healthcare professional relationship,
      illness and life, the relationship between ideal and reality, and working for change. The aim
      is to guide patients and healthcare professionals through mutual thinking using a six-step
      interaction process. These six stages are (i) establishing a clear mutual patient-nurse
      relationship (ii) self-discovery, (iii) self-understanding, (iv) shared decision making, (v)
      action, and (vi) feedback from action. In each interview, the patient fills out the
      self-evaluation forms in advance to encourage sharing before and during the interview with
      the nurses.

      In our study, there are 2 groups; intervention and control groups. In addition to routine
      treatment and care, the patients in the intervention group were interviewed by the researcher
      once a week for 6 weeks, with a total of 6 sessions of directed self-determination, each
      session being approximately 30 min-1 hour before HD treatment. The interview time was
      determined in consultation with the patients, and when the patient forgot/missed an
      interview, he was offered an appointment for another interview if he wanted to continue the
      study. Evaluations of the patients in both groups was performed with biological and/or
      biochemical data, ESRD-SQ, General Self-Efficacy Scale, HHSSK, SF-36 Quality of Life Scale
      Short Form and the Beck Anxiety Scale at the end of the interviews (week 6) and week 18,
      conducted within the scope of guided self-determination method.
    

Intervention name(s): interview
Intervention type(s): Other
Intervention description(s): In addition to routine treatment and care, the patients in the application group were interviewed by the researcher once a week for 6 weeks, within the first hour of HD treatment, for a total of 6 sessions, each session being approximately 30 minutes-1 hour, within the scope of the guided self-determination method.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Supportive Care
Keywords: guided self-determintion; hemodialysis; treatment adherence; quality of life; fluid control; anxiety