From diagnosis to dialysis- improving the patient experience: Evaluation of a psycho-educational intervention for pre-dialysis patients and their families.

J Jenkins, G Fitzgibbon, A Jones, A Prichard, N Thomas, K Baboolal

University Hospital of Wales

Problem Meeting the psychological needs of pre dialysis patients and their families/carers has proved a challenge in our unit in light of ever increasing numbers of patients and limited resources. Patients often experience difficulty in adjusting and coping with chronic illness, and in addition carers/families often receive little or no support during this traumatic time. Moreover, the association between psychological status and survival is widely documented and it is vital to ensure the needs of patients and their carers/families are addressed in the pre dialysis phase.

Purpose The aim of the intervention was to promote well-being and a positive approach to chronic disease management for both patients and their carers/families. We wanted to enhance understanding of chronic illness and its treatments; promote adjustment and adaptation to illness, in particular positive coping, control and self efficacy; and reduce adverse psychological states such as anxiety, depression and ambivalence about the condition.

Design The intervention was developed from a previously successful model designed by our clinical psychologist and utilized with patients on haemo and peritoneal dialysis. Eight pre-dialysis patients were invited to attend a weekly 2 hour session for a period of 5 weeks. Each week consisted of 2 educational sessions from members of the multi disciplinary team (Table 1) which focused on sharing experiences and coping strategies – these sessions were facilitated by a clinical nurse specialist. Each patient and carer completed a Hospital Anxiety and Depression Scale (HADS) pre and post the intervention. Additionally, a focus group made up of the participants was asked to provide critical feedback which was tape recorded (with permission).

Findings 56% of the group had reduced anxiety scores on the HADS, thus highlighting the success of one of the aspects of the intervention. The main themes which emerged from the verbal and written evaluation from both patients and carers, centred on the perceived benefit of ‘meeting others’ and ‘sharing experiences’. Further, some patients and families have maintained contact with others in the group beyond the intervention..

Conclusion The introduction of a structured intervention has been an efficient way of providing groups of patients and their families/carers with information, peer support and psychological care, and following its success a rolling programme is now in place.

Relevance The reduction of morbidity and mortality associated with adverse psychological states has been addressed directly by this intervention. The intervention provides information, understanding and coping strategies to help manage this stressful time in the context of peer support and multidisciplinary teamwork, and could easily be applied to other patient groups.