Understanding Healthcare Data Analysis

This assignment focuses on the critical aspect of ethical research in healthcare by requiring students to analyze a sample Institutional Review Board (IRB) proposal related to healthcare data analysis. The document provides background information about patients participating in the study, details about their medical conditions, and questions probing the support system available to them. Students need to understand the ethical considerations outlined in the IRB proposal and how it ensures the protection of patient rights and privacy while conducting research involving sensitive health information.

Running head: QUALITY OF LIFE ASSESSMENT
Research Proposal- Assessment of factors affecting quality of life in hemodialysis
patients in Saudi Arabia
Name of the Student
Name of the University
Author Note

1QUALITY OF LIFE ASSESSMENT
Executive summary
The concept of quality of life (QoL) or health-related quality of life (HRQoL) is used as a patient
specific outcome measure in different healthcare settings. It has been measured and
conceptualised by using several validated instruments in the scientific community. However, in
most literature, the true meaning of this concept is still not clear. The aim of this research
proposal is to formulate a study that will explore the gap in present literature and will define the
concept of HRQoL, identify the key domains and eventually conceptualise it as perceived by
patients with end stage renal failure and those undergoing haemodialysis in a healthcare centre at
Saudi Arabia.

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Table of Contents
Introduction..........................................................................................................................3
Literature review..................................................................................................................6
Methodology......................................................................................................................14
Plan for data analysis.........................................................................................................18
Probable findings...............................................................................................................19
Conclusions........................................................................................................................20
References..........................................................................................................................22
APPENDIX A....................................................................................................................28
APPENDIX B....................................................................................................................29
APPENDIX C....................................................................................................................30
APPENDIX D....................................................................................................................49

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Introduction
The term quality of life (QoL) is a multidimensional concept that encompasses an array
of negative and positive indicators related to psychological, physical, environmental and social
domains (Fayers & Machin, 2013). Health related quality of life (HRQoL) assessment is not just
limited to the verification of the health status of any individual, it analyses the physical, social
and mental wellness and life satisfaction of the person as well. According to the The World
Health Organization Quality of Life Group, Quality of life is the perception of an individual of
positions in their life with respect to value and culture systems where they live and in accordance
to their expectations, goals, concerns and standards (Frisch, 2014). HRQoL is defined as the
functional consequence of a disease and its related therapy administered on the patient, as the
patient perceives. Over the last decade, research on quality of life has emerged as a valuable tool
to assess therapeutic intervention outcomes of several chronic diseases (Michalos, 2017).
End-stage renal failure/disease (ESRD) is one type of a chronic disease form of
irreversible decline in the functions of the kidneys, which require kidney transplantation or
dialysis to sustain our life (Coresh et al., 2014). The impacts of ESRD in human are severe. The
aggregate costs of dialysis, co-morbid conditions and recurrent hospitalizations overwhelm the
patients and affect their health plans. In 2011, the total Medicare cost for ESRD in 2011 was
$34.3 billion. PPPY health costs (per person per year) for patients on hemodialysis were $87,945
in the same year (Collins et al., 2015). The fifth stage of chronic kidney disease progression
manifests itself in the form of end stage renal disease. It is measured by the rate of glomerular
filtration (GFR).

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Causes- Certain conditions or disease responsible for end stage renal disease are
hypertension, type 1 and type 2 diabetes, glomerulonephritis, polycystic kidneys, urinal tract
obstruction form kidney stones or enlarged prostate and interstitial nephritis.
Symptoms- The common symptoms observed as the disease progresses are vomiting,
nausea, loss of appetite, muscle twitch, swelling of ankles and feet, chest pain, hypoxia and
hypertension. Hemodialysis, peritoneal dialysis and kidney transplantation are the common
treatment methods.
ESRD patients are subjected to hemodialysis treatment that removes the salt, wastes and
extra water from their body to prevent waste accumulation in the blood (Robinson et al., 2014).
It also ensures a safe level of specific chemicals in the blood and regulates blood pressure. Renal
replacement therapy reduces symptom severity and increase survival rates of ESRD patients.
Hemodialysis is expensive, time intensive and restricts the amount of fluid and dietary intakes.
Prolonged therapy leads to dependence on healthcare givers, freedom loss and disruption of
social and family life. It also affects financial stability.
Objective- Frequent hospitalizations increase morbidity and mortality risks in patients
exacerbates social and emotional stress. This affects the patient HRQo (Kang et al., 2015)L.
Literature based evidence indicate association of low QoL scores with death in such patients.
HRQoL assessment will help in improving treatment and prognosis (Birren et al., 2014). The
main aim of this study is assessing QoL in hemodialysis patients with respect to their
psychological, physical, environmental and social health domains. Moreover, the study will
analyse effects of sex, age, education level, income, disease duration and treatment on the QoL
(Martinson et al., 2014).

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Research question- Quality of life is an essential issue for healthcare providers. The
research questions for this proposal are: 1) “What is the quality of life of hemodialysis patients at
healthcare facility in Saudi Arabia?”, 2) “Do symptoms (dialysis, fatigue, anxiety, depression),
general health perception, functional status, individual characteristics (gender, age, race),
biological function (serum albumin and hemoglobin) and socio-economic factors, marital status
and treatment time affect the quality of life?” (Lowney et al., 2015) and 3) “When individual
characteristics and environmental characteristics are controlled, do biological factors affect the
overall quality of life?” Little research has been conducted on the broad spectrum of QoL in
patients with ESRD. This research proposal thus aims to explain how factors of satisfaction,
dissatisfaction, physical quality, duration of hemodialysis treatment, standard of living and
psychological aspects that are important to a person affect his perception on the quality of life
(Bayoumi et al., 2013). Independent variables such as gain in weight, urea reduction ratio, years
of dialysis treatment and levels of phosphorus, calcium, albumin, parathyroid hormone and
serum hemoglobin were considered. The dependent variables were kidney disease burden,
symptoms, problems and their effects on daily life of the patients. These variables have been
selected because previous studies have reported lack of theoretical framework in selecting the
variables for the assessment. This failed to establish the relationship between HRQoL and its
physical and psychological determinants.
Scope- The study will help in improving financial and social and support of ESRD
patients. It will provide interventions for promoting physical activity and coping with
psychological distress in the patient population. This might prove effective in eventually
enhancing their HRQoL. The findings from the study will add to the literature, the underlying
complex psychological and biological processes of HRQoL. It will take knowledge acquired

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through statistical analysis in HRQoL of hemodialysis patients to a theoretical level and will
provide insight for the development of appropriate and effective strategies to optimize their
quality of life.
Limitations- Limitations of this research proposal include small caregiver sample size,
lack of random sampling and low reliability of independent variables. Recruiting samples from a
single institution is another limitation. This will prohibit any form of generalization beyond the
sample for this study.
Literature review
Quality of life is a matter of utmost concern in clinical research based on evaluation. All
healthcare policies expect improvement in the quality of life as a desired outcome. Though,
health related quality of life is extensively used for research studies, the term has not been
conceptualized yet and this creates confusion among researchers. Several studies developed
definitions for quality of life. However, these lacked consensus (Anees et al., 2014). Some
studies focused on the concept of patient reported toxicity to define quality of life. Some global
definitions incorporate and encompass the ideas of patient happiness, unhappiness, satisfaction
and dissatisfaction. Quality of life is also defined as a feeling of satisfaction and wellbeing that
indicates the way a patient perceives his life to be. Quality of life makes life worthwhile. Other
studies state that the value and meaning of life are expressed in terms of an individual’s view of
quality of life (Vasilopoulou et al., 2016). However, these definitions fail to provide information
on the components related to quality of life; therefore make it difficult for researchers to
operationalize. The ambiguous definitions can be made research specific if they focus on the
concept of QoL related to research area of interest. Multidimensional concepts that consist of

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four life domains such as social and economic, health and functioning, family and psychological
or spiritual, wellbeing can help in defining HRQoL in a comprehensive way (Rostami et al.,
2013). These definitions are generally found in research articles that focus on the term “health
related quality of life”. Several studies compared the HRQoL in end stage renal failure in nurses,
patients, and physicians. These studies utilized tools to determine the quality of life only related
to health items (Borzou et al., 2016). Some instruments used to assess HRQoL emphasize on the
use of a single domain like emotional functioning. On the other hand, other studies consider all
components to be equally important in affecting health outcomes and therefore include a
combination of different factors or components.
Moreover, many authors utilized a combination of all the definitions (Lopes et al., 2014).
Some research studies revealed health related quality of life as an essential cultural concept.
They evaluated the differences in association between clinical compliance of the patient, rates of
patient survival, health outcomes and the life quality (Cukor et al., 2014). For the purpose of this
proposed study, review of the literature will focus specifically on health realted quality of life in
hemodialysis patients who have been admitted to healthcare centres or hospital. Health related
quality of life evaluation and determination can be attempted by researchers and clinicians either
by designing objective assessments for the patients which are generally undertaken by an
interviewer or by designing subjective assessments which are done by the patients themselves.
Both these assessment methods report different findings. A particular study used more than 250
patients as sample and had collected data based on a reliable questionnaire. The questions in the
survey were framed based on the clinical history of the patients and several social and
demographic factors (Ayoub & Hijjazi, 2013). The health status of the patients was determined
by using the EQ-5D-5L dimensions. The obtained results suggested that low rates of HRQoL

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were associated with higher medication and more severity of the chronic disease. One particular
study designed a comparative to study dialysis patients. The participants were allowed to
complete the SF-36 (36-Item Short Form Health Survey) and the QoL index dialysis tool. A
thorough comparative analysis of the results was done for both the tools by using descriptive
statistical methods.
Results of multiple linear regression analysis determined the effect of different variables
on QoL scores (Sa’ed et al., 2016). In a study results of multiple regression analysis revealed that
prevalence of a chronic illness created the strongest impact on the scores obtained from both the
tools. A thorough comparison between the variables that were statistically significant for both the
samples revealed some contradictory results on using the two tools (D’Onofrio et al., 2017). This
meant that, the two tools had measured QoL differently. The participants who had been suffering
from ongoing chronic illness showed lower QoL scores. This finding was also supported by
evidence from other international studies. It was also found that ethnicity showed statistically
significant difference in the total score of QoL index in UAE nationals. The chronic illness
variables had a statistically significant implication on the total scores. In some studies age failed
to show statistically significant correlation with SF-36 scores.
Advanced age has also been linked with deterioration in physical activity. This resulted in
lower SF-36 scores in hemodialysis patients. In contrast, some study also reported that old
patients undergoing hemodialysis were more satisfied with their life. Older patients had accepted
their limitations better on comparison with younger patients. However, another study showed
absence of statistically significant age correlation with QoL index total scores. It had used the
same tool, but results depicted that with increase in age, some QoL index scores increased. This
suggested that chronically ill older patients had a tendency to show greater contentment level

9QUALITY OF LIFE ASSESSMENT
with respect to their health and social status (Brown et al., 2015). In some studies, iPTH was
found to be the only clinical parameter that correlated to a poor QoL (Villa-Bellosta et al., 2017).
Other parameters like phosphate levels or hemoglobin that are responsible for itching and fatigue
were not found to be associated with a poor QoL in some population.
To increase the statistical relevance, a larger population should always be assessed for
long term evaluation. Specific KDQoL-SF dimensions are associated with low mean scores of
PCS and MCS. MCS score were generally found to be higher than PCS. The difference between
the scores is generally small. In many studies, the average number of hemodialysis years is
small. It concludes reduction in MCS at the beginning of treatment. It gets subsequently
improved (Turkistani et al., 2014). According to multiple linear regression analysis results,
physical and mental health is improved when associated to normal iPTH values. The values are
linked with longer age of dialysis and living in a family. The fact that better QoL is linked with
longer dialysis age is surprising. Studies found that patients with ESRD in predialysis stage had a
poor QoL and suffered from impaired cognition than ESRD patients on regular dialysis. It has
been demonstrated that dialysis improves cognitive variables like attention, memory, information
processing and concentration. Furthermore, variables such as ethnicity and chronic health
problems were statistically significant determinants of QoL Index in people living in the UAE..
Conceptual framework- The framework used for this proposal will be loosely based on
Ferran’s model on quality of life. According to this model, several determinants are associated
with the quality of life of a particular person. The framework used for this study will deal with
the effects of health status, functioning status, social and economic status, family status and
psychological status to assess the health related quality of life in the respondents of the study. It
will evaluate concepts like, limitations in physical activities, limitations in social activities,

10QUALITY OF LIFE ASSESSMENT
limitations in usual role due to physical problems and emotional problems, boy pain, mental
wellbeing, energy and fatigue and general health perceptions.
Table 1- Conceptual framework for the proposed study
HEALTH RELATED QUALITY OF LIFE FACTORS
HEALTH AND FUNCTIONING
DOMAIN
 Physical independence
 Usefulness To others
 Ability to meet family
responsibilities
 Pain
 Stress or worries
 Energy or fatigue
 Leisure time activities
 Control over own life
 Ability to travel on vacations
 Potential for a happy old age or
retirement
 Sex life
 Potential for a long life
FAMILY DOMAIN
 Family health
 Family happiness
 Relationship with spouse
 Relationship with children

11QUALITY OF LIFE ASSESSMENT
SOCIAL AND ECONOMIC DOMAIN
 Education
 Financial independence
 Standard of living
 Home (house, apartment)
 Job/Unemployment
 Friends
 Neighborhood
 Emotional support from others
PSYCHOLOGICAL AND SPIRITUAL
DOMAIN
 Happiness in general
 Satisfaction with life
 Satisfaction with self
 Peace of mind
 Faith in God
 Achievement of personal goals
 Personal appearance
Nursing implication- Quality of care undergoes a routine assessment for all hemodialysis
patients by their clinicians, physicians and nurses. Changes are required to be routinely made in
order to maintain a standard of healthcare. The health related quality of life can also be addressed
and assessed with respect to each patient by utilizing different generic and disease specific
instruments. It is essential for nurses to understand what probable factors can create an impact on
the quality of life of a patient. By identifying these factors through statistical analysis, the areas
of interest can be determined which promote overall satisfaction and thereby play a role to
improve quality of life in patients. Nurses working in hemodialysis units should analyse whether
the patients would be more willing or ready to accept and comply to the dietary and fluid intake

12QUALITY OF LIFE ASSESSMENT
restrictions and the time they have to spend for hemodialysis treatment in hospitals if there is an
increased satisfaction in the quality of healthcare outcome subscale (Liyanage et al., 2015). The
area of consideration that needs to be evaluated by the caretaker is the issue of patient existence.
A person who is diagnosed with end stage renal failure is generally forced to make a
difficult life or death decision all by himself. Life means being supported with several costly
hemodialysis instruments and treatments thrice or four times a week. A choice of death is bound
to follow if the patient undergoes no treatment to reduce waste accumulation in his body. If the
patient shows compliance with the treatment procedures and chooses to start hemodialysis, it
certifies the fact that the concerned patient has chosen to live. Therefore, it is essential for life to
contain a certain amount and level of quality (Jha et al., 2013). That quality of life can only be
measured and assessed by the diseased patient. Health related quality of life can be defined for a
particular person only by that person. The hemodialysis patients who will complete the surveys
and the questionnaires used in this study will be able to distinctly conceptualize their health
related quality of life. They will be able to clearly state the specific areas of their life, which are
of utmost importance to them. They will also assess how satisfied they are in that domain. Thus,
nurses and physicians are expected to closely examine the quality of life and related healthcare
for hemodialysis patients.
Furthermore, extensive education and research is required so that physicians and
clinicians obtain better and relevant data that will facilitate proper assignment of ill patients to
novel therapeutic treatment approaches, which will enhance their quality of life. Some areas of
research that might prove beneficial in improving the quality of life often include the
implications of family involvement and atmosphere in patient care, the sudden changes in self
esteem, which is associated with selfcare hemodialysis and the association between

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improvements in quality of life and formal or extensive exercise programs. A thorough analysis
and study of the probable association between hemodialysis treatment procedure and the grief
processes or depression among patients might reveal new areas of research that the nurses can
anticipate. Therefore, this would help them in devising novel coping strategies. Administrators
and nurses should continue to explore avenues to promote the health related quality of life.
Fundings from health organization and governments allow anyone with end stage renal disease
to receive hemodialysis.
This has indeed become a large form of resource allocation that would benefit patients in
the upcoming years (Tao, Chow & Wong, 2015). This information obtained from the instruments
can be easily used to examine the current practices that are employed to treat such patients and
will also facilitate effective communication between health workers and help them to plan for
therapeutic interventions that would play a major role to improve the quality of life in a
hemodialysis patient.
Methodology
Research studies suggest that large samples are better than small samples (keeping other
components equal) owing to the fact that large samples minimize error probability, increase
accuracy and generalizability. The sample will be determined following the table provided by
Krejcie and Morgan.
s = X2NP (1-P)/d2 (N-1) + X2P (1-P)
Where s = sample size, X2 = the table value of chi-square for 1 degree of freedom at the
desired confidence level (1.96 × 1.96 = 3.84), N = Population size, P = Population proportion
(.50). The total population of patients is 230, who are admitted to the hospital due to kidney

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disorders. 144 participants will be selected (Male- 75 and Female- 69). With increase in
population size, the sample size will increase at a diminishing rate.
Inclusion criteria-
 ESRD (stage V, chronic renal failure) patients will be the target population.
 Patients should have undergone hemodialysis for more than 4 months to realize its
effects on their life.
 Aged between 22-70 years old.
 Able to read, write and speak to give consent and answer the survey questions.
 Should be without any cognitive impairment.
Exclusion criteria-
 ESRD patients on peritoneal dialysis treatment to avoid wrong results.
 Patients with aphasia, non-English speakers or with hearing impairment.
 Patients with cognitive impairment.
 With terminal illness like cancer and HIV.
Prior to the study, approvals will be taken from the Institutional Review Board (IRB) to
approve the study (Algarni, 2014). Participants will be allowed privacy while answering the
survey and confidentiality will be assured. A written informed consent will be obtained before
initiating the study. To assess the clinical status of a patient, the following data will be extracted
from the medical records of each patient:
Socio-demographic data- age, gender, marital status, educational level, living standards,
family members in the household and work activity.

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Clinical data- Years of hemodialysis treatment, nephropathy, type of dialysis treatment,
transplantation history, erythropoietin therapy, vascular access, Kt/V according to criteria
formulated by Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines, hemoglobin,
albumin, ferritin, triglycerdies, cholesterol, seum calcium, C-Reactive Protein (CRP), serum
phosphate and intact Parathyroid Hormone (iPTH) levels.
Generic instruments- There are some generic instruments that are use to assess the
condition of the patient. The generic questionnaires are often applied to healthy people. These
instruments are used to measure physical disabilities, impairments and handicaps. These are
commonly referred to as the QoL scale and are parameters used to measure the health status
depending on their focus on the physical symptoms of patients (Longworth et al., 2014). These
instruments rely on the assumption that a low score of QoL indicates poor health status. The
instruments have scales to examine emotional, physical and social aspects of a patient based on
the questions. The tool to be used for this study is Medical Outcome Study 36- item Short From
(SF-36).
It was developed to evaluate the general health status and intended to fill the gap between
other lengthy questionnaires. It was designed to evaluate generic health concepts that
emphasized upon social, physical and emotional functioning of a person. It is the most widely
used health status measurement tools. A trained interviewer will administer the tool to the
participants. A set of 36 questions will address the 8 essential health concepts related to physical
health, bodily pains, social functioning, mental health and general health.
Disease specific instruments- Though generic instruments cover a range of health related
conditions and can be used to compare patient results with the general population, they

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sometimes fail to focus on particular issues of concern and lack sensitivity. Disease specific
questionnaires have therefore been developed. The proposed study will utilize three such
instruments, the KDQoL-SF and the QLI-D questionnaires.
Kidney Disease Quality of Life Short Form (KDQoL-SF)- It is a self reported
questionnaire used to asses both the wellbeing and functioning of patients with chronic kidney
disease and those on hemodialysis. The questionnaire will be administered together with the
Manual for Use and Scoring of the Kidney Disease Quality of Life—Short Form (KDQOL—SF
1.3). The questionnaire will contain specific and generic measures for patients suffering from
end stage renal disease (Joshi et al., 2015). The general measures are based on the questions from
the 36-item Short-Form Health Survey (SF-36). Previous research provides support for the use of
KDQOL-SF in combination with SF-36 as research instruments to analyse HRQoL. It has 5
subscales:
 SF 12- PCS (Physical Component Summary, questions 1-12).
 SF 12- MCS (Mental Component Summary, questions 1-12)- contains questions on
Activity limits, general health, ability to complete desired task, anxiety, depression,
energy and social activity.
 Burden of kidney disease subscale (questions 13-16)- contains questions on
interference of the disease with daily life, time consumption and feelings of
frustration or burden.
 Symptoms and problems subscale (questions 17-28)- questions a patient on the effect
of sore muscles, cramps, chest pain, dry and itchy skin, hypoxia, dizziness, loss of
appetite and numbness of feet and hands.

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 Effects of kidney disorders in daily life subscale (questions 29-36) - evaluates the
effect of diet restrictions, fluid limits on travel or work, sex life, personal appearance
and a feeling of dependence on the patient.
The scores range from 0-100. A high score indicates better functioning and better health
related quality of life.
Quality of Life Index- It was developed during the 1980s, in the USA as a morbidity
measurement tool to be used in normal and diseased population. The original instrument had 6
dialysis specific questions that were meant to be tested on hemodialysis patients. The instrument
will have 2 sections that will assess the patient satisfaction and relative importance of each
domain. Each section will have 34 items (Byock & Merriman, 2014). The responses will range
from ‘very dissatisfied/unimportant’ or to ‘very satisfied/important’. The scores will range from
0 to 30. Moreover, a high score will indicate better quality of life.
Reliability of the instruments will be detected by Cronbach’s alpha index. It is a measure of
internal consistency. It measures the relatedness or closeness of a group of items. It is
considered to be a good measure of scale reliability. Cronbach’s alpha can be written as a
function of the number of test items and the average inter-correlation among the items. Using
the statistical software SPSS 21, the Cronbach’s alpha value is computed (Bonett & Wright,
2015). It will evaluate the internal consistency of the instrumewnts used to measure HRQoL
among patients. If the estimates of internal consistency reliability for the components and
subscales of KDQOL-SF, SF36 and QLID exceeded 0.7, it would recommend a score that
denotes good reliability. Previous studies have published the results of different subscales

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using Cronbach’s alpha. The values ranged from .70-.92 for the health and functioning
subscale, .77-.89 for social and economic subscale, and .83-.93 for psychological subscale.
Upon approval from the ethics committee, the questionnaires will be offered to the 144
patients on hemodialysis (Males- 75, Females-69).
Plan for data analysis
Upon approval from the review board and the ethical commitee, a packet which includes
an informed consent, Medical Outcome Study 36- item Short From, Kidney Disease Quality of
Life Short Forms and Quality of Life Index will be distributed to all the 144 chronic
hemodialysis patients (Male- 75, Female- 69) who are routinely dialyzed at the healthcare center
and are able to read and understand English. Patients who were unable to give responses to the
questions will be provided with an assistant to help them. The packets will be distributed by the
investigator on specific days designated for the study. A cover letter will also be prepared that
will describe the proposed study and its procedure. Informed consent will be assumed if the
participants complete the questionnaire and return it. When the questionnaires will be completed,
the participants will have to place them back in the packet and return it to the designated area in
the dialysis ward.
Data analysis will begin after completion of all the surveys. The linear regression and
Pearson correlations will be analysed using SPSS version 21.0. The software is used to obtain
accurate results and better productivity. It will integrate with other tools and technologies and
produce results in the form of percentages and frequencies, or mean +/- SD or median with an
upper and lower rang value. The Pearson correlation coefficient will be used to assess the
correlation between the reported scores and the index values. Multiple linear regressions will be

19QUALITY OF LIFE ASSESSMENT
carried out to identify the factors that have significant association with HRQoL. It will identify
association between dependent variables. 0 and 1 dummy coding will be used to enter the
independent variables into the regression model. The variables with a p < 0.05 will be entered in
the regression model. The significance level will be kept at p level < of 0.05 for all the tests.
Pearson correlation coefficients will then be examined to determine presence of
relationship between the variables of age, time and education on hemodialysis to the overall
health related quality of life in patients.
Probable findings
The SF-36 analysis results are likely to prove that gender is an important pain predictor.
Women will be more likely to report pain symptoms than the men who participate in the study.
Mean reported scores of body pain related subscale are more likely to less than females. The
respondents will probably display lower scores on an average on the physical ability and physical
function subscales. This can account for the fact that dialysis participants suffer from at least one
chronic illness, which reduces their physical activity. Living with such a chronic ailment is
bound to create negative impacts on employment, education and everyday life (Maduell et al.,
2013).
Significant correlation can be observed between age and the family subscale, education
and the family subscale, education and the psychological subscale and between age and the
social and economic subscale. Results from previous studies suggest that increased age is often
associated with low HRQoL. In the current study, older patients will probably show low HRQoL
and a poor health status. Another probable finding can be the association of physical inactivity
and poor social life with low HRQoL scores. The statistical analysis will also help in evaluating

20QUALITY OF LIFE ASSESSMENT
the relationship between anxiety or depression and low HRQoL levels. Analysis of the data will
also demonstrate whether obesity is associated with worsening of the quality of life.
A histogram will be used to depict the mean changes in the tools that will be used to
determine the quality of life. Histograms will illustrate the overall QoL as measured by the SF-
36, KDQoL-SF and Quality of Life index, with a range of scores. Higher scores will indicate
better HRQoL and lower scores will indicate poorer HRQoL.
Conclusions
Quality of life measurements (QOL) in everyday clinical practice and clinical trials is
gaining interest and is on the increase. In addition to morbidity and mortality that act as key
indicators for life performance, quality of life is an essential factor that evaluates the outcome
and quality of healthcare for patients suffering from chronic illness. ESRD is one such chronic
illness where the kidney fails to remove waste products from the body. This leads to waste
accumulation which manifests itself in the form of a variety of symptoms. Patients who undergo
hemodialysis to survive have to live with a great uncertainty about their future (Fischer Grönlund
et al., 2015). They deal not only with treatment related abnormalities and complications like
hyperparathyroidism, left ventricular hypertrophy and arthrosclerosis, but also have to live with
the changes in their self worth perception. The major physiological and psychological stresses
experienced by these patients on hemodialysis are restriction of fluid and dietary intake, pain,
itching, dry skin, discomfort, fatigue, limitations in physical activity, weaknesses, feelings of
inadequacy, high cost of care and negative moods (Ahrari, Moshki & Bahrami, 2014).
Therefore, a hemodialysis treatment significantly interferes with both their personal and
professional lifestyles. The factors contribute to diminished or low QoL rates that are generally

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reported by patients who are on regular hemodialysis. It can be concluded from the proposal that
a number of clinical and demographic factors are associated with health related quality of life in
patients who are undergoing hemodialysis (Hmwe et al., 2015). This research study will reveal
noteworthy results that can be taken into consideration while dealing with hemodialysis patients.
Elderly patients, female gender, obese patients, patients with no formal education, and living in
Palestinian refugee camps were all associated with poor HRQOL (Ho et al., 2013). In addition,
this study may also reveal that lower HRQOL is associated with higher numbers of chronic
diseases as well as higher numbers of medications.
These results are expected to be of interest to educators, pharmacists, and clinicians
working with ESRD patients. Healthcare providers should be aware of low HRQOL among
patients with no formal education, female gender, patient’s residents of refugee camps, multiple
co-morbid diseases, multiple chronic medications, and elderly patients to improve their QOL.

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References
Ahrari, S., Moshki, M., & Bahrami, M. (2014). The relationship between social support and
adherence of dietary and fluids restrictions among hemodialysis patients in Iran. Journal
of caring sciences, 3(1), 11.
Algarni, R. (2014). Exploring the Concept of Health-related Quality of Life for Patients with
End-stage Renal Disease on Haemodialysis in the Eastern Region of Saudi
Arabia (Doctoral dissertation, University of Manchester).
Anees, M., Malik, M. R., Abbasi, T., Nasir, Z., Hussain, Y., & Ibrahim, M. (2014). Demographic
factors affecting quality of life of hemodialysis patients–Lahore, Pakistan. Pakistan
journal of medical sciences, 30(5), 1123.
Ayoub, A. M., & Hijjazi, K. H. (2013). Quality of life in dialysis patients from the United Arab
Emirates. Journal of family & community medicine, 20(2), 106.
Bayoumi, M., Al Harbi, A., Al Suwaida, A., Al Ghonaim, M., Al Wakeel, J., & Mishkiry, A.
(2013). Predictors of quality of life in hemodialysis patients. Saudi Journal of Kidney
Diseases and Transplantation, 24(2), 254.
Birren, J. E., Lubben, J. E., Rowe, J. C., & Deutchman, D. E. (Eds.). (2014). The concept and
measurement of quality of life in the frail elderly. Academic Press.
Bonett, D. G., & Wright, T. A. (2015). Cronbach's alpha reliability: Interval estimation,
hypothesis testing, and sample size planning. Journal of Organizational Behavior, 36(1),
3-15.

23QUALITY OF LIFE ASSESSMENT
Borzou, S. R., Zonoori, S., Falahinia, G. H., & Soltanian, A. R. (2016). The effect of education
of health promotion behaviors on quality of life in hemodialysis patients. leukemia, 11,
12.
Brown, M. A., Collett, G. K., Josland, E. A., Foote, C., Li, Q., & Brennan, F. P. (2015). CKD in
elderly patients managed without dialysis: survival, symptoms, and quality of
life. Clinical Journal of the American Society of Nephrology, 10(2), 260-268.
Byock, I., & Merriman, M. (2014). Missoula-VITAS Quality of Life Index. In Encyclopedia of
Quality of Life and Well-Being Research (pp. 4082-4088). Springer Netherlands.
Collins, A. J., Foley, R. N., Gilbertson, D. T., & Chen, S. C. (2015). United States Renal Data
System public health surveillance of chronic kidney disease and end-stage renal
disease. Kidney international supplements, 5(1), 2.
Coresh, J., Turin, T. C., Matsushita, K., Sang, Y., Ballew, S. H., Appel, L. J., ... & Green, J. A.
(2014). Decline in estimated glomerular filtration rate and subsequent risk of end-stage
renal disease and mortality. Jama, 311(24), 2518-2531.
Cukor, D., Ver Halen, N., Asher, D. R., Coplan, J. D., Weedon, J., Wyka, K. E., ... & Kimmel, P.
L. (2014). Psychosocial intervention improves depression, quality of life, and fluid
adherence in hemodialysis. Journal of the American Society of Nephrology, 25(1), 196-
206.
D’Onofrio, G., Simeoni, M., Rizza, P., Caroleo, M., Capria, M., Mazzitello, G., ... & Segura-
Garcia, C. (2017). Quality of life, clinical outcome, personality and coping in chronic
hemodialysis patients. Renal failure, 39(1), 45-53.

24QUALITY OF LIFE ASSESSMENT
Fayers, P. M., & Machin, D. (2013). Quality of life: the assessment, analysis and interpretation
of patient-reported outcomes. John Wiley & Sons.
Fischer Grönlund, C. E., Söderberg, A. I., Zingmark, K. M., Sandlund, S. M., & Dahlqvist, V.
(2015). Ethically difficult situations in hemodialysis care–Nurses' narratives. Nursing
ethics, 22(6), 711-722.
Frisch, M. B. (2014). Quality-of-life-inventory. In Encyclopedia of quality of life and well-being
research (pp. 5374-5377). Springer Netherlands.
Hmwe, N. T. T., Subramanian, P., Tan, L. P., & Chong, W. K. (2015). The effects of acupressure
on depression, anxiety and stress in patients with hemodialysis: a randomized controlled
trial. International journal of nursing studies, 52(2), 509-518.
Ho, S. E., Ho, C. C., Norshazwani, N., Teoh, K. H., Ismail, M. S., Jaafar, M. Z., & Das, S.
(2013). Perception of quality of life amongst end stage renal failure patients undergoing
haemodialysis. Clinica Terapeutica, 164(6), 499-505.
Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., ... & Yang, C. W. (2013).
Chronic kidney disease: global dimension and perspectives. The Lancet, 382(9888), 260-
272.
Joshi, V., Mulay, A., Dighe, T., Jeloka, T., & Biwalkar, V. (2015). Validity of marathi translated
kidney disease quality of life short form (KDQOL-SF) TM. J Evid Based Med
Healthc, 2, 409-20.

25QUALITY OF LIFE ASSESSMENT
Kang, G. W., Lee, I. H., Ahn, K. S., Lee, J., Ji, Y., & Woo, J. (2015). Clinical and psychosocial
factors predicting health‐related quality of life in hemodialysis patients. Hemodialysis
International, 19(3), 439-446.
Liyanage, T., Ninomiya, T., Jha, V., Neal, B., Patrice, H. M., Okpechi, I., ... & Rodgers, A.
(2015). Worldwide access to treatment for end-stage kidney disease: a systematic
review. The Lancet, 385(9981), 1975-1982.
Longworth, L., Yang, Y., Young, T., Hernandez Alva, M., Mukuria, C., Rowen, D., ... &
Brazier, J. (2014). Use of generic and condition-specific measures of health-related
quality of life in NICE decision-making: systematic review, statistical modelling and
survey.
Lopes, A. A., Lantz, B., Morgenstern, H., Wang, M., Bieber, B. A., Gillespie, B. W., ... &
Mapes, D. L. (2014). Associations of self-reported physical activity types and levels with
quality of life, depression symptoms, and mortality in hemodialysis patients: the
DOPPS. Clinical journal of the American Society of Nephrology, CJN-12371213.
Lowney, A. C., Myles, H. T., Bristowe, K., Lowney, E. L., Shepherd, K., Murphy, M., ... &
Conlon, P. J. (2015). Understanding what influences the health-related quality of life of
hemodialysis patients: a collaborative study in England and Ireland. Journal of pain and
symptom management, 50(6), 778-785.
Maduell, F., Moreso, F., Pons, M., Ramos, R., Mora-Macià, J., Carreras, J., ... & ESHOL Study
Group. (2013). High-efficiency postdilution online hemodiafiltration reduces all-cause
mortality in hemodialysis patients. Journal of the American Society of Nephrology, 24(3),
487-497.

26QUALITY OF LIFE ASSESSMENT
Martinson, M., Ikizler, T. A., Morrell, G., Wei, G., Almeida, N., Marcus, R. L., ... & Beddhu, S.
(2014). Associations of body size and body composition with functional ability and
quality of life in hemodialysis patients. Clinical Journal of the American Society of
Nephrology, 9(6), 1082-1090.
Michalos, A. C. (2017). Social indicators research and health-related quality of life research.
In Connecting the Quality of Life Theory to Health, Well-being and Education (pp. 25-
58). Springer International Publishing.
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Akizawa, T. (2014). World-wide, mortality is a high risk soon after initiation of
hemodialysis. Kidney international, 85(1), 158.
Rostami, Z., Einollahi, B., Lessan-Pezeshki, M., Abadi, A. S. N., Kebar, S. M., Shahbazian,
H., ... & Jalalzadeh, M. (2013). Health-related quality of life in hemodialysis patients: an
Iranian multi-center study. Nephro-urology monthly, 5(4), 901.
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& Al-Jabi, S. W. (2016). Factors affecting quality of life in patients on haemodialysis: a
cross-sectional study from Palestine. BMC nephrology, 17(1), 44.
Tao, X., Chow, S. K. Y., & Wong, F. K. Y. (2015). A nurse-led case management program on
home exercise training for hemodialysis patients: A randomized controlled
trial. International journal of nursing studies, 52(6), 1029-1041.

27QUALITY OF LIFE ASSESSMENT
Turkistani, I., Nuqali, A., Badawi, M., Taibah, O., Alserihy, O., Morad, M., & Kalantan, E.
(2014). The prevalence of anxiety and depression among end-stage renal disease patients
on hemodialysis in Saudi Arabia. Renal failure, 36(10), 1510-1515.
Vasilopoulou, C., Bourtsi, E., Giaple, S., Koutelekos, I., Theofilou, P., & Polikandrioti, M.
(2016). The impact of anxiety and depression on the quality of life of hemodialysis
patients. Global journal of health science, 8(1), 45.
Villa-Bellosta, R., Rodriguez-Osorio, L., Mas, S., Abadi, Y., Rubert, M., de la Piedra, C., ... &
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associated with higher mortality in prevalent hemodialysis patients. PloS one, 12(3),
e0173831.

28QUALITY OF LIFE ASSESSMENT
APPENDIX A
GANTT CHART

29QUALITY OF LIFE ASSESSMENT
APPENDIX B
CONSENT TO PARTICIPATE IN THE STUDY
This consent form will be held for [X] years.
Researcher: [Add Name, School]
I have read the Information Sheet and the project has been well explained to me. My
questions have been answered to my satisfaction. I agree to take part in the study. I
understand that: I acknowledge that I am agreeing to keep the information shared during the
study confidential. I am aware that after the study, I must not communicate to anyone,
including family members and close friends, any details about its questions. I can withdraw
while it is in progress however it will not be possible to withdraw the information I have
provided up to that point as it will be part of a discussion with other participants. The
identifiable information I have provided will be destroyed on [....date.....]
Any information I provide will be kept confidential to the researcher, the supervisor and the
transcribers. I understand that the results will be used for a dissertation/report or academic
publications and/or presented to conferences. My name will not be used in reports, nor will
any information that would identify me. I consent to information which I have given to be
attributed to any reports in this study. I would like to receive a final copy of the results.
Name of participant: ________________________________
Signature of participant: ________________________________
Date: ______________

30QUALITY OF LIFE ASSESSMENT
Contact details: ________________________________
APPENDIX C
LIKERT SCALE QUESTIONNARES-QUALITY OF LIFE INDEX
PART 1- Please select the answer that best describes how satisfied you are with the area
of your life. Please mark by circling the number.
SATISFATION
QUOTIENT
VERY
DISSATIS
FIED
MODERA
TELY
DISSATIS
FIED
SLIGHTL
Y
DISSATIS
FIED
SLIGH
TLY
SATISF
IED
MODERA
TELY
SATISFIE
D
VERY
SATISF
IED
1. Health 1 2 3 4 5 6
2. Health
care
1 2 3 4 5 6
3. Energy
for daily
activities
1 2 3 4 5 6
4. Self care
abilities
without
help
1 2 3 4 5 6
5. Likelihoo
d of
kidney
transplant
1 2 3 4 5 6
6. Changes
in diet and
needs for
dialysis
1 2 3 4 5 6
7. Control
over life
1 2 3 4 5 6
8. Living as
long as
you wish
1 2 3 4 5 6
9. Family 1 2 3 4 5 6

31QUALITY OF LIFE ASSESSMENT
health
10. Children 1 2 3 4 5 6
11. Family
happiness
1 2 3 4 5 6
12. Sex life 1 2 3 4 5 6
13. Spouse or
partner
1 2 3 4 5 6
14. Friends 1 2 3 4 5 6
15. Emotional
support
from
family
1 2 3 4 5 6
16. Emotional
support
from
friends
1 2 3 4 5 6
17. Ability to
take
family
responsibi
lities
1 2 3 4 5 6
18. Usefulnes
s to others
1 2 3 4 5 6
19. Worries in
life
1 2 3 4 5 6
20. Neighborh
ood
1 2 3 4 5 6
21. Home,
apartment
or place of
residence
1 2 3 4 5 6
22. Employm
ent status
1 2 3 4 5 6
23. No job
status
(retired,
unemploy
ed or
disabled)
1 2 3 4 5 6
24. Education 1 2 3 4 5 6
25. Financial 1 2 3 4 5 6

32QUALITY OF LIFE ASSESSMENT
needs
26. Things to
do for fun
1 2 3 4 5 6
27. Chances
for happy
future
1 2 3 4 5 6
28. Peace of
mind
1 2 3 4 5 6
29. Faith in
God
1 2 3 4 5 6
30. Personal
goals
achieveme
nt
1 2 3 4 5 6
31. General
happiness
1 2 3 4 5 6
32. General
life
1 2 3 4 5 6
33. Personal
appearanc
e
1 2 3 4 5 6
34. Yourself
in general
1 2 3 4 5 6
PART 2- Please select the answer that best describes how important that area of life is to
you. Please mark by circling the number.
HOW
IMPORTANT
TO YOU
VE
RY
UNIMPOR
TANT
MO
DERATEL
Y
UNIMPOR
TANT
SLI
GHTLY
UNIMPOR
TANT
S
LIGHTL
Y
IMPORT
ANT
M
ODERAT
ELY
IMPORTA
NT
V
ERY
IMPORT
ANT
1) Health 1 2 3 4 5 6
2) Health
care
1 2 3 4 5 6

33QUALITY OF LIFE ASSESSMENT
3) Having
energy
for daily
activities
1 2 3 4 5 6
4) Self care
without
help
1 2 3 4 5 6
5) Getting a
kidney
transplan
t
1 2 3 4 5 6
6) Diet and
need
changes
for
dialysis
1 2 3 4 5 6
7) Control
over life
1 2 3 4 5 6
8) Living as
long as
you wish
1 2 3 4 5 6
9) Family
health
1 2 3 4 5 6
10) Children 1 2 3 4 5 6
11) Family
happines
s
1 2 3 4 5 6
12) Sex life 1 2 3 4 5 6
13) Spouse
or
partner
1 2 3 4 5 6
14) Friends 1 2 3 4 5 6
15) Emotion
al
support
from
family
1 2 3 4 5 6
16) Emotion
al
support
from
friends
1 2 3 4 5 6
17) Ability 1 2 3 4 5 6

34QUALITY OF LIFE ASSESSMENT
to take
family
responsi
bilities
18) Usefulne
ss to
others
1 2 3 4 5 6
19) Worries
in life
1 2 3 4 5 6
20) Neighbor
hood
1 2 3 4 5 6
21) Home,
apartmen
t or place
of
residence
1 2 3 4 5 6
22) Employ
ment
status
1 2 3 4 5 6
23) No job
status
(retired,
unemplo
yed or
disabled)
1 2 3 4 5 6
24) Educatio
n
1 2 3 4 5 6
25) Financial
needs
1 2 3 4 5 6
26) Things to
do for
fun
1 2 3 4 5 6
27) Have a
happy
future
1 2 3 4 5 6
28) Peace of
mind
1 2 3 4 5 6
29) Faith in
God
1 2 3 4 5 6
30) Personal
goals
achieve
ment
1 2 3 4 5 6
31) General
happines
s
1 2 3 4 5 6

35QUALITY OF LIFE ASSESSMENT
32) Satisfied
with life
1 2 3 4 5 6
33) Personal
appearan
ce
1 2 3 4 5 6
34) Are you
to
yourself
1 2 3 4 5 6

36QUALITY OF LIFE ASSESSMENT
LIKERT SCALE QUESTIONNARES- KDQoL SF
Same set of questions were used for SF-36 as well (for verification and validity of the
data)
YOUR HEALTH (Circle one number)
In general your health is
Excellent 1
Very Good 2
Fair 3
Poor 4
Compared to a year ago, rate your present health
Much better 1
Somewhat better 2
About the same 3
Somewhat worse 4
Much worse 5
Does your present health permit you to take part in these activities? If yes, state how
much?
Activities Yes, limited ( a lot) Yes, limited (a little) No, no limited (at all)
Vigorous activities
like running, lifting
heavy objects and
1 2 3

37QUALITY OF LIFE ASSESSMENT
doing strenuous
exercise
Moderate activities
like moving a table,
playing golf, using
vacuum cleaner
1 2 3
Carrying groceries 1 2 3
Climbing a flight of
stairs
1 2 3
Walking more than a
mile
1 2 3
Walking several
blocks
1 2 3
Walking one block 1 2 3
Bathing or dressing 1 2 3
During the past 4 weeks, do you have any problems with your work or regular activities
due to current physical status?
Yes No
Cut down time you spent on
work
1 2
Accomplished less tasks 1 2

38QUALITY OF LIFE ASSESSMENT
Were limited to specific work
types
1 2
Had difficulty performing
work or had to put extra effort
1 2
During past 4 weeks did you face any problems in regular activities due to emotional
disturbance?
Yes No
Cut down time you spent on
work
1 2
Accomplished less tasks 1 2
Did not work carefully as
usual
1 2
During past 4 weeks how has your emotional and physical problems interfered with
social life?
Not at all 1
Slightly 2
Moderately 3
Quite a bit 4
Extremely 5
How much bodily pain did you face during past 4 weeks?
None 1
Very mild 2

39QUALITY OF LIFE ASSESSMENT
Mild 3
Moderate 4
Severe 5
Very severe 6
How much pain interfered with your normal work?
Not at all 1
A little bit 2
Moderately 3
Quite a bit 4
Extremely 5
How you feel and how things have been during past 4 weeks?
All the
time
Most of the
time
A good bit
of time
Some of
the time
A little of
the time
None of the
time
Feel full of
pep
1 2 3 4 5 6
Been a
nervous
person
1 2 3 4 5 6
Felt so
down that
nothing
could cheer
1 2 3 4 5 6

40QUALITY OF LIFE ASSESSMENT
you up
Have a lot
of energy
1 2 3 4 5 6
Felt
downhearte
d and blue
1 2 3 4 5 6
Been a
happy
person
1 2 3 4 5 6
Feel tired 1 2 3 4 5 6
Feel
peaceful and
calm
1 2 3 4 5 6
Feel worn
out
1 2 3 4 5 6
During the past 4 weeks how many times did your physical and emotional state interfere
with social activities?
All of the time 1
Most of the time 2
Some of the time 3
A little of the time 4
None of the time 5
Choose the answer that best describes how TRUE or FALSE the statements are for you?

41QUALITY OF LIFE ASSESSMENT
Definitely
true
Mostly true Don’t know Mostly false Definitely
false
I seem to get
sick a little
easier than
others
1 2 3 4 5
I am as
healthy as
others
1 2 3 4 5
I expect my
health to get
worse
1 2 3 4 5
My health is
excellent
1 2 3 4 5
YOUR KIDNEY DISEASE
How TRUE or FALSE is each of the statements for you?
Definitely
true
Mostly true Don’t know Mostly false Definitely
false
My disease
interferes too
much with
my life
1 2 3 4 5
Too much is 1 2 3 4 5

42QUALITY OF LIFE ASSESSMENT
spent dealing
with the
disease
I feel
frustrated
dealing with
it
1 2 3 4 5
I feel like a
burden on my
family
1 2 3 4 5
Give one answer how you feel and how things have gone during the past 4 weeks?
None of the
time
A little of
the time
Some of
the time
A god bit
of the time
Most of the
time
All of the
time
Isolated
yourself
from
surrounding
people
1 2 3 4 5 6
React
slowly to
things said
or done
1 2 3 4 5 6
Act 1 2 3 4 5 6

43QUALITY OF LIFE ASSESSMENT
irritable
towards
people
Faced
difficulty to
concentrate
or think
1 2 3 4 5 6
Become
confused
1 2 3 4 5 6
To what extent were you bothered by these?
Not at all
bothered
Somewhat
bothered
Moderately
bothered
Very much
bothered
Extremely
bothered
Soreness in
muscles
1 2 3 4 5
Chest pain 1 2 3 4 5
Cramps 1 2 3 4 5
Itchy skin 1 2 3 4 5
Dry skin 1 2 3 4 5
Shortness of
breath
1 2 3 4 5
Faint or
dizziness
1 2 3 4 5
Loss of 1 2 3 4 5

44QUALITY OF LIFE ASSESSMENT
appetite
Washed out
or drained
1 2 3 4 5
Numbness 1 2 3 4 5
Nausea or
stomach upset
1 2 3 4 5
Problems
with access
site
1 2 3 4 5
EFFECTS OF KIDNEY DISEASE ON DAILY LIFE
Not at
all bothered
Some
what bothered
Moder
ately bothered
Very
much
bothered
Extre
mely bothered
Fluid
restriction
1 2 3 4 5
Dietary
restriction
1 2 3 4 5
Ability to
work around
house
1 2 3 4 5

45QUALITY OF LIFE ASSESSMENT
Ability to
travel
1 2 3 4 5
Dependent on
doctors for
medicine
1 2 3 4 5
Stress or
worries
1 2 3 4 5
Sex life 1 2 3 4 5
Personal
appearance
1 2 3 4 5
Have you had any sexual activity in past 4 weeks?
No 1 Please skip to next
question
Yes 2
How much problem did you face in the two following cases?
Not a
problem
Little
problem
Some
what problem
Very
much
problem
Severe
problem
Enjoying sex 1 2 3 4 5
Become
sexually
1 2 3 4 5

46QUALITY OF LIFE ASSESSMENT
aroused
On a scale of 1-10, how would you rate your sleep pattern?
1 (Very bad)
2
3
4
5
6
7
8
9
10 (very good)
How often did you?
None of the
time
A little
time
Some of
the time
A good bit
of time
Most of the
time
Al the time
Awaken
during
night and
trouble
falling
asleep
1 2 3 4 5 6
Get the 1 2 3 4 5 6

47QUALITY OF LIFE ASSESSMENT
amount of
sleep
needed
Had trouble
staying
awake
during the
day
1 2 3 4 5 6
Concerning your friends and family, how satisfied are you with?
Very satisfied Somewhat
satisfied
Somewhat
dissatisfied
Very satisfied
Amount of time
spend with them
1 2 3 4
Support received
from them
1 2 3 4
Did you work at a paying job during past 4 weeks?
Yes 1
No 2
Does your health keep you from working at a paying job?
Yes 1
No 2
How would you rate your health status?

48QUALITY OF LIFE ASSESSMENT
0 (worst possible as bad as being
dead)
1
2
3
4
5 (half way been worst and best)
6
7
8
9
10 (best possible health)
SATISFACTION WITH CARE
Think about the care you receive for dialysis. Rate the friendliness and interest shown to
you.
Very poor 1
Poor 2
Fair 3
Good 4
Very good 5
Excellent 6
Best 7