Mediation model tests with control variables.

PurposeThis study aimed to investigate the mediating role of fear of progression on illness perception and social alienation among maintenance hemodialysis (MHD) patients.BackgroundMHD is frequently accompanied by increased pain and complications such as itchy skin, chronic fatigue, and muscle spasms. Cardiovascular disease rates are also elevated among MHD patients, which can heighten their anxiety regarding prognosis and treatment discomfort. This chronic fear may severely impact social functioning, leading patients to withdraw from interpersonal interactions and experience heightened helplessness and loneliness. Further investigation is necessary to understand the factors behind the high level of social alienation in MHD patients and their underlying mechanisms.DesignA cross-sectional study guided by the STROBE.MethodsA convenience sample of 230 MHD patients were enrolled from January to May 2023. Data including demographic and clinical characteristics, illness perception, fear of progression, and social alienation were collected. Descriptive analysis and Pearson correlations were conducted using IBM SPSS version 25.0. The mediating effect was analyzed using Model 4 of the PROCESS macro for SPSS, with the Bootstrap method employed to assess its significance.ResultsThe score of social alienation in MHD patients was high, with illness perception and fear of progression both significantly correlated with social alienation. In the mediating effects model, illness perception can predict social alienation in MHD patients, and fear of progression use plays a part in mediating the process by which illness perception affects social alienation. The Kappa Squared (κ2) value of 21.9%, suggests a medium effect size.ConclusionsIllness perception directly predicts social alienation in MHD patients and exerts an indirect effect through the mediating role of fear of progression. Suggests that healthcare professionals should concentrate on MHD patients with high negative illness perceptions to alleviate their fear of progression, thereby decreasing the level of social alienation and enhancing their integration into society.研究目的：本研究旨在探讨进展恐惧在维持性血液透析（Maintenance Hemodialysis, MHD）患者的疾病感知与社交疏离之间的中介作用。 研究背景：维持性血液透析患者常伴随疼痛加剧及皮肤瘙痒、慢性疲劳、肌肉痉挛等并发症。此类患者的心血管疾病患病率亦显著升高，这会加重其对预后及治疗不适的焦虑情绪。这种长期存在的恐惧可能严重损害社会功能，导致患者回避人际互动，并体验到更强烈的无助感与孤独感。目前仍需进一步研究以阐明维持性血液透析患者社交疏离程度偏高的成因及潜在机制。 研究设计：本研究为遵循STROBE指南的横断面研究。 研究方法：本研究于2023年1月至5月间，通过便利抽样法纳入230名维持性血液透析患者。收集的资料包括人口学与临床特征、疾病感知、进展恐惧及社交疏离情况。采用IBM SPSS 25.0软件进行描述性分析及Pearson相关分析。使用SPSS宏程序PROCESS的Model 4分析中介效应，并采用Bootstrap法检验其显著性。 研究结果：维持性血液透析患者的社交疏离得分偏高，疾病感知与进展恐惧均与社交疏离呈显著相关。在中介效应模型中，疾病感知可预测维持性血液透析患者的社交疏离水平，且进展恐惧在疾病感知影响社交疏离的过程中发挥部分中介作用。Kappa平方（Kappa Squared, κ²）值为21.9%，提示效应量为中等水平。 研究结论：疾病感知可直接预测维持性血液透析患者的社交疏离水平，并通过进展恐惧的中介作用发挥间接效应。本研究提示，医护人员应重点关注存在高消极疾病感知的维持性血液透析患者，以缓解其进展恐惧情绪，进而降低社交疏离程度，提升其社会融入水平。