Psychological aspects of self-care and home dialysis.

Self-care and home dialysis encourages the patient's active participation in his treatment which may enhance coping and adaptation to his illness. The psychological issues of dependence-independence, activity-passivity, and control and mastery are frequently referred to in the literature as being important in understanding the chronic stress of illness and treatment. The measure of successful coping should be determined by adaptive or maladaptive value of behavior rather than traditional concepts of normality or abnormality. Treatment planning and patient selection should be tailored to the psychological needs of the patient, the family and the staff. Several clinical vignettes are presented to illustrate that initial impressions of patient suitability for self-care and home dialysis may be deceiving. The medical staff plays an important role in influencing the patient's adaptation and coping.