Implication for Nursing Approaches: Developing an Theoretical Framework for Patient-Centered Symptom Management in Hemodialysis Patients from the Perspective of Dual-Dimension to Enhancing and Mitigating Coping Strategies: A Cross-Sectional Study

Background Symptom burden among hemodialysis patients significantly impacts their quality of life. Effective symptom management, supported by social support and coping strategies, is critical to improve patient outcomes. However, the role of social support, self-regulatory fatigue, and different coping mechanisms in patient-centered symptom management is not well understood. Methods A cross-sectional study using Partial Least Squares Structural Equation Modeling (PLS-SEM). Data were collected from multiple hemodialysis centers in various regions across China, ensuring a representative sample of diverse geographical areas. Participants were recruited through convenience sampling across different regions, ensuring broad demographic representation. This study used PLS-SEM to develop and validate a theoretical model that describes the relationships among social support, self-regulatory fatigue, adaptation, patient activation, and symptom burden. Results A total of 1,120 patients participated, with a mean age of 51.6 years (SD = 13.8), and 59.1% were male. The Partial Least Squares Structural Equation Modeling (PLS-SEM) results showed that social support had a significant positive effect on both patient activation (β = 0.209, p < 0.001) and adaptation (β = 0.472, p < 0.001), indicating higher levels of social support were associated with increased patient activation and adaptation. Self-regulatory fatigue had a significant negative effect on adaptation (β = -0.131, p < 0.001) but no significant effect on patient activation (β = -0.026, p = 0.455). Patient activation (β = -0.024, p = 0.019) and adaptation (β = -0.023, p = 0.011) both had significant negative effects on symptom burden, indicating that higher levels of activation and adaptation were linked to lower symptom burden. Mediation analysis revealed that social support indirectly reduced symptom burden through both adaptation (β = -0.011, p = 0.011) and patient activation (β = -0.005, p = 0,032). Patient activation demonstrated greater importance in symptom management compared to adaptation based on the importance-performance analysis. Conclusions This study reveals that social support significantly enhances both patient activation and adaptation, leading to a reduction in symptom burden among hemodialysis patients. Self-regulatory fatigue, however, negatively affects adaptation but does not have a significant impact on patient activation. The dual coping strategies—adaptation (passive) and patient activation (proactive)—mediate the relationship between social support and symptom burden, with patient activation showing greater importance in symptom management. These findings emphasize the importance of enhancing social support, reducing self-regulatory fatigue, and fostering duel coping strategies to effectively alleviate the symptom burden in hemodialysis patients.