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Zhu B, Wu H, Lv S, Xu Y. Association between illness perception and social alienation among maintenance hemodialysis patients: The mediating role of fear of progression. PLoS One 2024; 19:e0301666. [PMID: 38564570 PMCID: PMC10986954 DOI: 10.1371/journal.pone.0301666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/17/2024] [Indexed: 04/04/2024] Open
Abstract
PURPOSE This study aimed to investigate the mediating role of fear of progression on illness perception and social alienation among maintenance hemodialysis (MHD) patients. BACKGROUND MHD 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. DESIGN A cross-sectional study guided by the STROBE. METHODS A 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. RESULTS The 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. CONCLUSIONS Illness 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.
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Affiliation(s)
- Beisha Zhu
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Hang Wu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Siyu Lv
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
| | - Yulan Xu
- Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P.R. China
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2
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Longley RM, Harnedy LE, Ghanime PM, Arroyo-Ariza D, Deary EC, Daskalakis E, Sadang KG, West J, Huffman JC, Celano CM, Amonoo HL. Peer support interventions in patients with kidney failure: A systematic review. J Psychosom Res 2023; 171:111379. [PMID: 37270909 PMCID: PMC10340538 DOI: 10.1016/j.jpsychores.2023.111379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Peer support has been associated with improved health-related outcomes (e.g., psychological well-being and treatment adherence) among patients with serious, chronic conditions, including kidney disease. Yet, there is little existing research evaluating the effects of peer support programs on health outcomes among patients with kidney failure being treated with kidney replacement therapy. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we conducted a systematic review using five databases to assess the effects of peer support programs on health-related outcomes (e.g., physical symptoms, depression) among patients with kidney failure undergoing kidney replacement therapy. RESULTS Peer support in kidney failure was assessed across 12 studies (eight randomized controlled trials, one quasi-experimental controlled trial, and three single-arm trials) with 2893 patients. Three studies highlighted the links between peer support and improved patient engagement with care, while one found peer support did not significantly impact engagement. Three studies showed associations between peer support and improvements in psychological well-being. Four studies underscored the effects of peer support on self-efficacy and one on treatment adherence. CONCLUSIONS Despite preliminary evidence of the positive associations between peer support and health-related outcomes among patients with kidney failure, peer support programs for this patient population remain poorly understood and underutilized. Further rigorous prospective and randomized studies are needed to evaluate how peer support can be optimized and incorporated into clinical care for this vulnerable patient population.
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Affiliation(s)
- Regina M Longley
- Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Lauren E Harnedy
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America
| | - Pia Maria Ghanime
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America
| | - Daniel Arroyo-Ariza
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America
| | - Emma C Deary
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA, United States of America
| | - Elizabeth Daskalakis
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA, United States of America
| | - Katrina G Sadang
- University of California San Francisco School of Medicine, San Francisco, CA, United States of America
| | - Jason West
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Jeff C Huffman
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Christopher M Celano
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Hermioni L Amonoo
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care, Boston, MA, United States of America.
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3
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Qureshi SP, Jones D, Dewar A. Physicians' Conceptions of the Dying Patient: Scoping Review and Qualitative Content Analysis of the United Kingdom Medical Literature. QUALITATIVE HEALTH RESEARCH 2022; 32:1881-1896. [PMID: 35981561 PMCID: PMC9511242 DOI: 10.1177/10497323221119939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Most people in high income countries experience dying while receiving healthcare, yet dying has no clear beginning, and contexts influence how dying is conceptualised. This study investigates how UK physicians conceptualise the dying patient. We employed Scoping Study Methodology to obtain medical literature from 2006-2021, and Qualitative Content Analysis to analyse stated and implied meanings of language used, informed by social-materialism. Our findings indicate physicians do not conceive a dichotomous distinction between dying and not dying, but construct conceptions of the dying patient in subjective ways linked to their practice. We argue that the focus of future research should be on exploring practice-based challenges in the workplace to understanding patient dying. Furthermore, pre-Covid-19 literature related dying to chronic illness, but analysis of literature published since the pandemic generated conceptions of dying from acute illness. Researchers should note the ongoing effects of Covid-19 on societal and medical awareness of dying.
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Affiliation(s)
- Shaun Peter Qureshi
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
| | - Derek Jones
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
| | - Avril Dewar
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
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4
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Lev-Wiesel R, Sasson L, Scharf N, Abu Saleh Y, Glikman A, Hazan D, Shacham Y, Barak-Doenyas K. "Losing Faith in My Body": Body Image in Individuals Diagnosed with End-Stage Renal Disease as Reflected in Drawings and Narratives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10777. [PMID: 36078494 PMCID: PMC9517917 DOI: 10.3390/ijerph191710777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 06/15/2023]
Abstract
Chronic kidney disease (CKD) and the dependency on dialysis is an abrupt life-changing event that harms a patient's life (e.g., social relationships, work, and well-being). This study aimed to examine how individuals who undergo chronic dialysis due to failure end-stage renal disease perceive their bodies, as reflected in drawings and narratives. Following ethical approval and signing a consent form to participate in the study, 29 adults between the ages of 20 and 85 who have undergone dialysis filled out an anonymous questionnaire that consisted of the following measures: The Center for Epidemiological Studies-Depression (CES-D), The Multidimensional Body-Self Relations Questionnaire (MBSRQ), and The MOS 36-Item Short-Form Health Survey (SF-36). After completion, they were asked to draw their self-figure before and after being diagnosed and narrate it. The data were quantitatively and narratively analyzed. The results revealed high levels of depression and concerns regarding body fitness and weight. Few significant differences were noted between self-figured drawings before and after the diagnosis, such as the body line and gender markers. Additionally, Fitness Evaluation and Overweight Preoccupation were significant among the participants.
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Affiliation(s)
- Rachel Lev-Wiesel
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Liraz Sasson
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Netta Scharf
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Yasmeen Abu Saleh
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Anat Glikman
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Denis Hazan
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Yarden Shacham
- Social Work Department, Tel Hai College, Qiryat Shemona 1220800, Israel
| | - Keren Barak-Doenyas
- The Sagol Center for Hyperbaric Medical Treatment and Research, Shamir Medical Center, Be’er Ya’akov 7035000, Israel
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McKeaveney C, Noble H, Courtney AE, Griffin S, Gill P, Johnston W, Maxwell AP, Teasdale F, Reid J. Dialysis, Distress, and Difficult Conversations: Living with a Kidney Transplant. Healthcare (Basel) 2022; 10:healthcare10071177. [PMID: 35885704 PMCID: PMC9321787 DOI: 10.3390/healthcare10071177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background: Providing holistic care to kidney patients is important; however, without full consideration of the perspectives of people living with a kidney transplant, the provision of truly ‘holistic healthcare’ cannot be possible. It is imperative to understand patient experiences by including kidney patients in key strategies and future renal service planning. Ignoring these important patient views means that there is a significant risk of inappropriate renal service provision and lack of adequate support, impacting overall health. The aim of this study was to develop an in-depth understanding of the lived experiences of kidney transplant recipients. Methods: A total of 23 participants were recruited between two regional nephrology units within the United Kingdom via clinical gatekeepers. In-depth interviews were undertaken. Interviews were digitally recorded, transcribed verbatim, and subjected to interpretative phenomenological analysis. Results: Two themes emerged: “managing ongoing fears of dialysis, distress, and COVID-19” and “dealing with difficult conversations”. Conclusions: Renal healthcare professionals need to understand more than the biological impact of receiving a kidney transplant. Understanding the holistic and multidomain experiences that these participants experience will help healthcare professionals to recognize the needs of this group and ensure more responsive psychosocial care.
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Affiliation(s)
- Clare McKeaveney
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | - Helen Noble
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
| | | | - Sian Griffin
- Department of Nephrology and Transplantation, Cardiff & Vale University Health Board, Cardiff CF14 4XW, UK;
| | - Paul Gill
- School of Healthcare Sciences, Cardiff University, Cardiff CF24 0AB, UK;
| | - William Johnston
- Northern Ireland Kidney Patients Association, Belfast BT9 7AB, UK;
| | | | | | - Joanne Reid
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 7BL, UK; (C.M.); (H.N.)
- Correspondence:
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Hansen MS, Tesfaye W, Sud K, Sewlal B, Mehta B, Kairaitis L, Tarafdar S, Chau K, Razi Zaidi ST, Castelino R. Psychosocial factors in patients with kidney failure and role for social worker: A secondary data audit. J Ren Care 2022; 49:75-83. [PMID: 35526147 DOI: 10.1111/jorc.12424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with kidney failure face a multitude of psychosocial stressors that affect disease trajectory and health outcomes. OBJECTIVES To investigate psychosocial factors affecting people with kidney failure before or at start of kidney replacement therapy (KRT) and kidney supportive and palliative care (KSPC) phases of illness and to explore role of social worker during the illness trajectory. METHODS We conducted a secondary data audit of patients either before or at start of KRT (Phase 1) and at the KSPC (Phase 2) of illness and had psychosocial assessments between March 2012 and March 2020 in an Australian setting. RESULTS Seventy-nine individuals, aged 70 ± 12 years, had at least two psychosocial assessments, one in each of the two phases of illness. The median time between social worker evaluations in Phase 1 and Phase 2 was 522 (116-943) days. Adjustment to illness and treatment (90%) was the most prevalent psychosocial issue identified in Phase 1, which declined to 39% in Phase 2. Need for aged care assistance (7.6%-63%; p < 0.001) and carer support (7.6%-42%; p < 0.001) increased significantly from Phase 1 to Phase 2. There was a significant increase in psychosocial interventions by the social worker in Phase 2, including supportive counselling (53%-73%; p < 0.05), provision of education and information (43%-65%; p < 0.01), and referrals (28%-62%; p < 0.01). CONCLUSION Adults nearing or at the start of KRT experience immense psychosocial burden and adaptive demands that recognisably change during the course of illness. The positive role played by the nephrology social worker warrants further investigation.
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Affiliation(s)
- Micaella Sotera Hansen
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Wubshet Tesfaye
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia.,Health Research Institute, University of Canberra, Canberra, Australia
| | - Kamal Sud
- Department of Renal Medicine, Nepean Hospital, Nepean and Blue Mountains Local Health District, Penrith, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Beena Sewlal
- Social Worker, Blacktown Hospital Western Sydney Local Health District (WSLHD), Blacktown, New South Wales, Australia
| | - Bharati Mehta
- Social Worker, Blacktown Hospital Western Sydney Local Health District (WSLHD), Blacktown, New South Wales, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Surjit Tarafdar
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Katrina Chau
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, New South Wales, Australia.,School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Syed Tabish Razi Zaidi
- School of Healthcare, University of Leeds, Leeds, West Yorkshire, England.,HPS Pharmacies, Institutional Care, Dockland, Melbourne, Australia
| | - Ronald Castelino
- Sydney Pharmacy School, The University of Sydney, Sydney, New South Wales, Australia.,Pharmacy Department, Blacktown Hospital, WSLHD, Blacktown, New South Wales, Australia
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7
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Shouket H, Gringart E, Drake D, Steinwandel U. “Machine-Dependent”: The Lived Experiences of Patients Receiving Hemodialysis in Pakistan. Glob Qual Nurs Res 2022; 9:23333936221128240. [PMID: 36405243 PMCID: PMC9669685 DOI: 10.1177/23333936221128240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/25/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to explore the lived experiences of patients receiving
maintenance hemodialysis in Pakistan. Purposive sampling was used to recruit 24
patients and six healthcare professionals, each participated in a
semi-structured interview. Interpretive Phenomenological Analysis was used to
analyze interviews’ data. Two superordinate themes, “The experience of
hemodialysis” and “The conceptualizations of hemodialysis” as well as six
sub-themes were identified. The experience of hemodialysis was related to, the
implications of HD procedure on everyday life, social, cognitive, emotional,
financial, and occupational influences. While all participants recognized the
importance of hemodialysis for their survival, their conceptualizations of the
treatment varied. Despite facing multiple challenges, optimism and independence
were observed among participants. Stigma related to hemodialysis, and role
adaptation, which appear unique to the Pakistani context, highlight a need for
tailored interventions designed to enhance and maintain the mental health of
patients receiving hemodialysis in Pakistan.
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Affiliation(s)
- Haseeba Shouket
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Eyal Gringart
- Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dierdre Drake
- Edith Cowan University, Joondalup, Western Australia, Australia
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Self-Participation Experiences among Well-Adapted Hemodialysis Patients. Healthcare (Basel) 2021; 9:healthcare9121742. [PMID: 34946468 PMCID: PMC8701990 DOI: 10.3390/healthcare9121742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/13/2021] [Accepted: 12/16/2021] [Indexed: 11/27/2022] Open
Abstract
A successful self-participation experience empowers patients to adapt to living with hemodialysis. However, few studies regarding the subjective experiences of such patient participation have been conducted. This study’s purpose was to describe hemodialysis patients’ perspectives on integrating hemodialysis into a new life regarding self-participation experience. A qualitative study using the grounded theory method was applied. Thirty-two well-adaptive hemodialysis Taiwanese patients attended in-depth interviews. “Integrating hemodialysis into a new life journey” was identified as the core category guiding the entire self-participation experience of hemodialysis patients. The three antecedent themes were “Sense of worthlessness”, “Life is still worth living”, and “Friendly and joyful atmosphere of the hemodialysis room”. Once the patients went through the three antecedent themes, they gradually began making efforts to participate more fully in their hemodialysis. Within this participation experience, the hemodialysis patients exhibited these four interactive themes: “Overcoming one’s predicament”, “Integrating self-care skills into my life”, “Resuming previous roles and tasks”, and “Adapting to independent living”. Finally, most adaptive patients master the hemodialysis life. Encouraging patients to discover that their life is worth living and providing a friendly and joyful atmosphere in hemodialysis units are the keys to facilitating patients’ self-participation more fully.
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Khodarahimi S, Veiskarami HA, Mazraeh N, Sheikhi S, Rahimian Bougar M. Mental Health, Social Support, and Death Anxiety in Patients With Chronic Kidney Failure. J Nerv Ment Dis 2021; 209:809-813. [PMID: 34238892 DOI: 10.1097/nmd.0000000000001386] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose: This study aimed to investigate the relationship between mental health, perceived social support, and death anxiety, and the predictive roles of mental health and perceived social support in the explanation of death anxiety in a sample of adults with chronic kidney disease. Methods: A demographic questionnaire, the Symptom Check List-25, the Social Support Survey Scale, and the Death Anxiety Scale (DAS) were used in the present study. The sample consisted of 58 adult patients with chronic kidney failure. Results: Findings showed that mental health had significantly positive relationships to the total score of the death anxiety and the fear of death, the fear of pain and disease, and the death thoughts subscales of the DAS. Social support had a significant negative relationship to the total score of the death anxiety and the fear of pain and disease, the death thoughts, and the transient time and the short life subscales of the DAS. Mental health and combined mental health and social support explained 14% and 21% of death anxiety variation in patients with chronic kidney failure, respectively. Conclusion: Mental health and social support constructs can relatively predict the variations of death anxiety in patients with chronic kidney failure.
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10
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Hansen MS, Tesfaye W, Sewlal B, Mehta B, Sud K, Kairaitis L, Tarafdar S, Chau K, Zaidi ST, Castelino RL. Psychosocial factors affecting patients with end-stage kidney disease and the impact of the social worker. J Nephrol 2021; 35:43-58. [PMID: 34181197 DOI: 10.1007/s40620-021-01098-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/10/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND End-stage kidney disease (ESKD) incidence has been increasing over time, contributing significantly to morbidity and mortality. However, there is limited data examining the psychosocial factors affecting people with ESKD and how the social worker fits within the multidisciplinary CKD care. This integrative systematic review aims to summarise the existing evidence on psychosocial determinants of outcomes in ESKD and the role of the social worker in nephrology care. METHOD The literature search was conducted using PubMed and MEDLINE, targeting articles published from database inception until May 2021. This systematic review was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The Joanna Briggs Institute tools were employed to assess the quality of included studies. RESULTS Of the 397 citations, 13 studies applicable to 1465 patients met the inclusion criteria. The studies were of cross-sectional, experimental, and exploratory qualitative design in nature. The findings of the studies were summarised into three major themes-psychosocial factors, role of the renal social worker, and impact of the renal social worker. The studies demonstrated that concerns related to adjustment, death and dying, family and social functioning, and loss were common amongst participants of the included studies indicating the need for a social worker. Three studies explored the impact of social workers in ESKD, revealing that people who received support from social workers had an improved quality of life, lower depression scores, and reduced hospitalisations and emergency room visits. CONCLUSION This review summarizes the multitude of physical and psychological stressors that patients with ESRD face, and highlights the positive role social workers can play in improving the psychosocial stressors in this patient group, and the need for large-scale randomised trials to understand the role of social workers as part of a multidisciplinary nephrology care.
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Affiliation(s)
- Micaella Sotera Hansen
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Wubshet Tesfaye
- Health Research Institute, University of Canberra, Canberra, Australia.
| | - Beena Sewlal
- Blacktown Hospital Western Sydney Local Health District (WSLHD), Blacktown, Australia
| | - Bharati Mehta
- Blacktown Hospital Western Sydney Local Health District (WSLHD), Blacktown, Australia
- Westmead and Blacktown Hospitals, Western Sydney, Local Health District (WSLHD), Blacktown, Australia
| | - Kamal Sud
- Department of Renal Medicine, Nepean Hospital, Nepean and Blue Mountains Local Health District, Kingswood, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Lukas Kairaitis
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Surjit Tarafdar
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Katrina Chau
- Department of Renal Medicine, Blacktown Hospital, WSLHD, Blacktown, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | | | - Ronald Lynel Castelino
- School of Pharmacy, University of Sydney, Sydney, Australia
- Pharmacy Department, Blacktown Hospital, WSLHD, Blacktown, Australia
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Sein K, Damery S, Baharani J, Nicholas J, Combes G. Emotional distress and adjustment in patients with end-stage kidney disease: A qualitative exploration of patient experience in four hospital trusts in the West Midlands, UK. PLoS One 2020; 15:e0241629. [PMID: 33152018 PMCID: PMC7644018 DOI: 10.1371/journal.pone.0241629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 10/16/2020] [Indexed: 01/31/2023] Open
Abstract
Objectives To explore patient perceptions and experiences of mild-to-moderate emotional distress and the support offered by kidney units to patients with end-stage kidney disease. Methods In-depth, semi-structured qualitative interviews with patients (n = 46) being treated for end-stage kidney disease in four hospital Trusts, with data analysed thematically. Results Patients described multiple sources of distress and talked about the substantial burden that emotional challenges raised for their ability to manage their condition and develop coping strategies. Many patients did not feel it appropriate to disclose their emotional issues to staff on the kidney unit, due to a perceived lack of time for staff to deal with such issues, or a perception that staff lacked the necessary skills to provide resolution. Five themes were identified from the patient interviews, broadly related to patients’ experience of distress, and the support offered by the kidney unit: i) the emotional burden that distress placed on patients; ii) patients’ relationship with the treatment for their condition; iii) strategies for coping and adjustment; iv) patient-staff interactions and the support offered by the kidney unit, and v) the mediating impact of the treatment environment on patient experience of distress and their ability to raise emotional issues with staff. Conclusions Many patients felt unprepared for the likelihood of experiencing emotional issues as part of their condition, for which pre-dialysis education could help in managing expectations, along with support to help patients to develop appropriate coping strategies and adjustments. These findings demonstrate the importance of recognising patient distress and ensuring that talking about distress becomes normalised for patients with end-stage kidney disease.
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Affiliation(s)
- Kim Sein
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
- * E-mail:
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, Birmingham, West Midlands, United Kingdom
| | - Johann Nicholas
- Renal Unit, Royal Shrewsbury Hospital, Shrewsbury, Shropshire, United Kingdom
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, West Midlands, United Kingdom
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12
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Jones J, Damery S, Allen K, Nicholas J, Baharani J, Combes G. 'You have got a foreign body in there': renal transplantation, unexpected mild-to-moderate distress and patients' support needs: a qualitative study. BMJ Open 2020; 10:e035627. [PMID: 32234745 PMCID: PMC7170619 DOI: 10.1136/bmjopen-2019-035627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore why transplant patients experience unexpected mild-to-moderate distress and what support they may need. DESIGN Qualitative study using individual in-depth interviews. SETTING Four National Health Service (NHS) Trusts in the Midlands, UK. PARTICIPANTS Fifteen renal transplant patients meeting the criteria for mild-to-moderate distress from their responses to emotion thermometers. MAIN OUTCOME MEASURES Identification of the reasons for distress and support options acceptable to renal transplant patients. RESULTS Three themes were interpreted from the data: 'I am living with a "foreign body" inside me', 'why am I distressed?' and 'different patients want different support'. Following their transplant, participants felt that they should be happy and content, but this was often not the case. They described a range of feelings about their transplant, such as uncertainty about the lifespan of their new kidney, fear of transplant failure or fear of the donor having health conditions that may transfer to them. A few experienced survivors' guilt when others they had met at the dialysis unit had not received a transplant or because someone had died to enable them to receive the transplant. No longer having regular contact with the renal unit made participants feel isolated. Some participants did not initially attribute the source of their distress to their transplant. Participants' preferred support for their distress and their preferences about who should deliver it varied from peer support to seeing a psychologist. CONCLUSIONS Raising the issue of post-transplant mild-to-moderate distress with patients and encouraging them to think about and plan coping strategies pretransplant may prove beneficial for the patient and healthcare provider. Patients should be able to choose from a variety of support options.
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Affiliation(s)
- Janet Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Johann Nicholas
- Renal Unit, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, Shropshire, UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Damery S, Sein K, Nicholas J, Baharani J, Combes G. The challenge of managing mild to moderate distress in patients with end stage renal disease: results from a multi-centre, mixed methods research study and the implications for renal service organisation. BMC Health Serv Res 2019; 19:989. [PMID: 31870358 PMCID: PMC6929506 DOI: 10.1186/s12913-019-4808-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 12/04/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Lower-level emotional and psychological difficulties ('distress') in patients with end stage renal disease (ESRD), can lead to reduced quality of life and poor clinical outcomes. National guidelines mandate provision of emotional and psychological support for renal patients yet little is known about the support that patients may require, or the challenges that staff experience in identifying and responding to patient distress. METHODS Mixed methods study in renal units at four NHS Trusts in the West Midlands, UK involving cross-sectional surveys of ESRD patients and renal unit staff and semi-structured interviews with 46 purposively-sampled patients and 31 renal unit staff. Interviews explored patients' experience of distress and personal coping strategies, staff attitudes towards patient distress and perceptions of their role, responsibility and capacity. RESULTS Patient distress was widespread (346/1040; 33.3%), and emotional problems were frequently reported. Younger patients, females, those from black and minority ethnic (BME) groups and patients recently initiating dialysis reported particular support needs. Staff recognised the value of supporting distressed patients, yet support often depended on individual staff members' skills and personal approach. Staff reported difficulties with onward referral to formal counselling and psychology services and a lack of immediate access to less formalised options. There was also a substantial training/skills gap whereby many staff reported lacking the confidence to recognise and respond to patient distress. Staff fell broadly into three groups: 'Enthusiasts' who considered identifying and responding to patient distress as integral to their role; 'Equivocators' who thought that managing distress was part of their role, but who lacked skills and confidence to do this effectively, and 'Avoiders' who did not see managing distress as part of their role and actively avoided the issue with patients. CONCLUSIONS Embedding the value of emotional support provision into renal unit culture is the key to 'normalising' discussions about distress. Immediately accessible, informal support options should be available, and all renal staff should be offered training to proactively identify and reactively manage patient distress. Emotional support for staff is important to ensure that a greater emphasis on managing patient distress is not associated with an increased incidence of staff burnout.
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Affiliation(s)
- Sarah Damery
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands UK
| | - Kim Sein
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands UK
| | - Johann Nicholas
- Royal Shrewsbury Hospital, Mytton Oak Road, Shrewsbury, Shropshire, Shrewsbury, SY3 8XQ UK
- Renal Unit, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton Road, Wolverhampton, WV10 0QP UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, B9 5SS UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, B15 2TT, Edgbaston, West Midlands UK
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Combes G, Damery S, Sein K, Allen K, Nicholas J, Baharani J. Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support. PLoS One 2019; 14:e0225269. [PMID: 31751382 PMCID: PMC6871782 DOI: 10.1371/journal.pone.0225269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 10/31/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore staff perceptions of barriers to the identification of mild to moderate distress and the provision of emotional support in patients with end-stage renal disease. METHODS Qualitative semi-structured interviews with staff in two hospitals (n = 31), with data analysed using a hybrid approach combining thematic analysis with aspects of grounded theory. RESULTS Staff appeared very aware that many patients with end-stage renal disease experience distress, and most thought distressed patients should be helped as part of routine care. However, practice was variable and looking for and addressing distress was not embedded in care pathways. Interviews identified six themes: i) staff perceptions about how distress is manifested and what causes distress were variable; ii) staff perceptions of patients could lead to distress being overlooked because patients were thought to hide their distress whilst some groups were assumed to be more prone to distress than others; iii) role perceptions varied, with many staff believing it to be their role but not feeling comfortable with it, with doctors being particularly ambivalent; iv) fears held back some staff, who were concerned about what might happen when talking about distress, or who found the emotional load for themselves to be too high; v) staff felt they lacked skills, confidence and training, vi) capacity to respond may be limited, as staff perceive there to be insufficient time, with little or no specialist support services to refer patients to. CONCLUSIONS Staff perceived significant barriers in identifying and responding to patient distress. Barriers related to skills and knowledge could be addressed through training, with training ideally targeted at staff with positive attitudes, but who currently lack skills and confidence. Barriers related to role perceptions would be harder to address. The study is relevant internationally as part of improving long-term condition pathways.
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Affiliation(s)
- Gill Combes
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Kim Sein
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom
| | - Johann Nicholas
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom
| | - Jyoti Baharani
- Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom
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Damery S, Brown C, Sein K, Nicholas J, Baharani J, Combes G. The prevalence of mild-to-moderate distress in patients with end-stage renal disease: results from a patient survey using the emotion thermometers in four hospital Trusts in the West Midlands, UK. BMJ Open 2019; 9:e027982. [PMID: 31097489 PMCID: PMC6530384 DOI: 10.1136/bmjopen-2018-027982] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To assess the prevalence of mild-to-moderate distress in patients with end-stage renal disease (ESRD) and determine the association between distress and patient characteristics. DESIGN Cross-sectional survey using emotion thermometer and distress thermometer problem list. SETTING Renal units in four hospital Trusts in the West Midlands, UK. PARTICIPANTS Adult patients with stage 5 chronic kidney disease who were: (1) On prerenal replacement therapy. (2) On dialysis for less than 2 years. (3) On dialysis for 2 years or more (4) With a functioning transplant. OUTCOMES The prevalence of mild-to-moderate distress, and the incidence of distress thermometer problems and patient support needs. RESULTS In total, 1040/3730 surveys were returned (27.9%). A third of survey respondents met the criteria for mild-to-moderate distress (n=346; 33.3%). Prevalence was highest in patients on dialysis for 2 years or more (n=109/300; 36.3%) and lowest in transplant patients (n=118/404; 29.2%). Prevalence was significantly higher in younger versus older patients (χ2=14.33; p=0.0008), in women versus men (χ2=6.63; p=0.01) and in black and minority ethnic patients versus patients of white ethnicity (χ2=10.36; p=0.013). Over 40% of patients (n=141) reported needing support. More than 95% of patients reported physical problems and 91.9% reported at least one emotional problem. CONCLUSIONS Mild-to-moderate distress is common in patients with ESRD, and there may be substantial unmet support needs. Regular screening could help identify patients whose distress may otherwise remain undetected. Further research into differences in distress prevalence over time and at specific transitional points across the renal disease pathway is needed, as is work to determine how best to support patients requiring help.
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Affiliation(s)
- Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Celia Brown
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Kim Sein
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
| | - Johann Nicholas
- Renal Unit, Shrewsbury and Telford NHS Trust, Shrewsbury, UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Edgbaston, UK
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Chilcot J, Hudson JL. Is successful treatment of depression in dialysis patients an achievable goal? Semin Dial 2018; 32:210-214. [PMID: 30418698 DOI: 10.1111/sdi.12755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Depression is undisputedly common among individuals with End-Stage Kidney Failure and associated with adverse outcomes. It is well recognized that effective treatments for depression are needed within routine dialysis care. But, are we any closer to successfully treating depression in dialysis patients? We consider this question here with respect to two common treatments, antidepressant medication and cognitive behavioural therapy (CBT). Currently, there are limited data from randomized placebo-controlled trials regarding the acceptability and efficacy of antidepressants. CBT trials appear to show more consistent treatment effects, albeit the feasibility of routine delivery remains unknown. No studies in dialysis patients has evaluated the combined effects of CBT with antidepressants. There is a need to consider pragmatic depression treatment trials in dialysis patients in order to increase study recruitment in order to have more reliable data from which to evaluate the evidence base. Furthermore, we need to understand why treatments work, and for whom do they work? Lastly, addressing issues surrounding treatment acceptability and implementation as part of regular care remain as key challenges that require attention if we are to improve the mental health of individuals on dialysis.
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Affiliation(s)
- Joseph Chilcot
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Joanna L Hudson
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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