P116
PSYCHOLOGICAL ISSUES FACED BY PATIENTS BEING WORKED UP FOR
KIDNEY TRANSPLANT
Low, S, Dean, J, Mawson, M
Salford Royal Hospital
INTRODUCTION: Transplantation is often described as the gold-standard in renal replacement
therapy and is usually seen in a very positive light by both patients and staff. However, the workup process can be lengthy and patients’ health will be poor as they reach the stage when they need
a transplant. Patients therefore often feel frightened or low in mood by the time that they are put
on the transplant waiting list. Research has shown that patients who suffer from mental health
problems such as depression may not be adherent to immuno-suppressant medication and may
therefore have worse transplant outcomes (Surman, Cosimi & DiMartini, 2009). Santos,
Gonçalves, Buzzo et al. (2012) reported that both depression and anxiety is common in transplant
patients and that this has a negative effect on their social relationships, activity levels and
finances. These factors may all result in difficulty in resuming a fulfilling lifestyle or quality of
life following transplantation.
PURPOSE: Whilst patients undergoing transplant work-up are offered thorough medical
assessment and support most renal units do not routinely screen patients for mental health
problems or emotional issues. This means that important conditions such as depression or
anxiety are not identified. As reported by Surman et al. (2009) these patients may have problems
with adherence which may lead to graft failure.
DESIGN: All patients undergoing transplant work-up were asked to fill in a survey as a routine
part of their investigations. The survey had been tailor-made for patients in order to identify
concerns that they have. A total of 8 surveys were filled in over a three-month period. In
addition to the survey, patients were also asked to fill in the Hospital Anxiety and Depression
Scale (HADS).
FINDINGS: Two out of the eight patients in the sample were found to have clinically significant
levels of anxiety according the HADS, as well as borderline levels of depression. The issues that
patients were most concerned about included fear, coping with illness and communication with
doctors and nurses. Five out of eight patients had ticked at least one box from the list of concerns
in the survey.
DISCUSSION: Although the sample in the present study was small, findings were striking as a
quarter of patients screened were found to suffer from significant mental health problems. If left
untreated, these problems tend to be exacerbated and patients are likely to struggle with taking
immuno-suppressants. For some of these patients the problems may escalate to the point where
they lose their transplant. This is immensely distressing for patients and lead to higher costs for
the NHS. Screening including psychometric tests provides a fast and cost-effective way of
ensuring that patients suffering from mental health problems are offered psychological therapy.
This will help patients to improve their mood and avoids additional healthcare costs for patients
losing their transplants. The survey showed that the transplant work-up is a situation where
62,5% of patients had at least one concern, even if they did not suffer from anxiety or depression.
This suggests that transplant work-up is a stressful process for patients even if it does not lead to
mental health difficulties. The survey used in the current study provides a way for patients to
express concerns that they may not feel comfortable raising with staff directly.