ArticlePatient preference and adherence2026
Adapting Beyond the Machine: A Roy Adaptation Model-Guided KTH Nursing Pathway and Real-World Outcomes in Maintenance Hemodialysis: A Propensity Score-Matched Cohort Study.
Article in Patient preference and adherence, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Maintenance hemodialysis (HD) carries a heavy psychosocial and self-management burden that routine nursing addresses incompletely. Whether a pathway coupling the Knowledge-Treatment-Health (KTH) structure to the four adaptive modes of the Roy Adaptation Model (KTH-RAM) improves outcomes is unknown. Methods: We analysed records of 322 adults on maintenance HD at a single centre between October 2021 and October 2025; 161 received routine nursing and 161 the KTH-RAM pathway (non-randomised). Fifteen baseline covariates (demographics, comorbidity, vascular access, laboratory values, dialysis adequacy, baseline symptom severity) were extracted. Patient-reported outcomes were assessed at four weeks, objective indicators at twelve weeks. Associations were estimated by propensity-score matching, inverse-probability weighting and multivariable regression, with E-value sensitivity analysis. Results: Matching yielded 122 balanced pairs (all standardized mean differences <0.10). The KTH-RAM pathway was associated with lower anxiety (Cohen's d -0.41) and depression (-0.33) and higher resilience (0.37), perceived social support (0.42), executive self-care (0.28), partnership (0.47) and emotional management (0.26); hope and problem-solving were directional but not robust. Higher dialysis compliance was more frequent with KTH-RAM across all estimators, although the difference did not reach statistical significance (adjusted OR 1.86, 95% CI 0.97-3.56; IPTW 1.79); nursing satisfaction showed the same pattern; complications were fewer (6.2% vs 13.7%). Objective indicators (albumin, phosphorus, Kt/V) favoured KTH-RAM modestly; vascular-access events and hospitalization differences were non-significant. Conclusion: In this propensity-matched cohort, the KTH-RAM nursing pathway was associated with modestly better psychological, self-management and objective dialysis outcomes. For nephrology nursing, the pathway offers a structured, theory-based template that links mode-specific adaptive assessment to concrete behaviour-change actions and may help frontline teams prioritise psychological and self-management support within routine dialysis care. Given the non-randomised design and contact-time imbalance, these hypothesis-generating associations require confirmation in a prospective, attention-matched randomised trial.
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