P119
HOLISTIC ASSESSMENT AND INTERVENTION REDUCES DISTRESS IN YOUNG
ADULTS WITH CHRONIC KIDNEY DISEASE
Lentell, L2, Wirz, L1, Barlow, K1, Matthews, B3, Lambert H1, Baines, L2
1
Department of Children’s Services, Royal Victoria Infirmary, 2Adult Renal Services,
Freeman Hospital, Newcastle upon Tyne, 3NHS Kidney Care
INTRODUCTION: Caring for young people living with chronic conditions requires an
understanding of their specific needs and preferences to plan support and access to information
relevant to the important aspects of their lives. The holistic assessment process offers an
opportunity to explore wider needs and identify actions necessary to meet them. There is a strong
focus on patient choice and decision-making, helping people to identify and achieve the outcomes
they want for themselves wherever possible.
METHODS: As part of the ‘Supporting Young Adults with Kidney Disease Project’ we adapted an
holistic assessment tool, created by the National Comprehensive Cancer Network, for use in young
adults with chronic kidney disease (CKD) to include problems commonly related to CKD and
dialysis and also including issues with transition and transfer from children’s to adult services.
The assessment tool assesses general wellbeing and also explores a number of specific needs
broadly categorised into medical, physical, social, emotional and practical. Concerns are formalised
and their impact assessed using a ‘distress thermometer’. Action plans are agreed to address
problems identified.
Assessments were performed in 27 young adults who were either referred or who self-referred to
the young adult coordinator. A second assessment was performed following a series of relevant
interventions prompted by the initial assessment. Level of distress scores were compared between
assessments using a paired t test.
RESULTS: First and second assessments were performed in 27 young adults at a mean (range)
interval of 68 (10 to 162) days. Median values for general distress and specific problems are given
in table 1. Distress was reduced following interventions by the young adult coordinator in general
and with regard to work / education, financial and emotional difficulties. Fatigue scores, however
remained unchanged.
Table 1. Median distress scores at first and second assessment using the adapted Holistic
Assessment Tool
First assessment
Second assessment
p
General distress (median (range))
5.0 (1 to 10 )
3.0 (1 to 9)
<0.05
Fatigue
5 (1 to 10)
4 (1 to 9)
ns
Work / education
6 (3 to 7)
2 (1 to 7)
<0.05
Finance
5 (2 to 8)
2.5 (1 to 5)
<0.05
Emotional difficulties
6.0 (3 to 7)
4.0 (1 to 5)
<0.05
CONCLUSIONS: These pilot results demonstrate improvements in general wellbeing and
reduction in specific areas of distress following holistic assessment and intervention by the young
adult coordinator. Fatigue however, was resistant to intervention even when other wellbeing
improved. This tool provides both a useful overview of the many problems young adults with CKD
face and a tool with which to begin addressing these needs. It requires further exploration over a
longer duration and in association with additional assessment tools in a larger patient group.