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An evaluation of interventions to support the emotional and psychological needs of patients with
end-stage renal disease
Gill Combes, Francesca Taylor, Jennifer Hare2
1. School of Health and Population Sciences, University of Birmingham 2. Renal Psychology
Department, The Royal Wolverhampton NHS Trust
The Problem
The impact of emotional and psychological problems on the health and wellbeing of patients with
end-stage renal disease can be considerable. This is most notable in terms of poor clinical outcomes,
behavioural compliance, medication adherence, and influence on acceptance and understanding of
diagnosis as well as treatment decision-making. Previous research has found that patients want
improved support particularly in the areas of coping and adjusting to the need for end-stage treatment.
Yet there is little data on low-cost interventions that could be used to provide support to patients who
do not need referral to psychology/psychiatry.
Purpose of the Study
There were two linked studies. The first study evaluated whether two simple pilot interventions
designed to adjust consultant-patient communication can encourage consultants to explicitly talk with
patients about their emotional feelings and concerns. One intervention involved consultants using
questions based on National Institute for Health and Clinical Excellence (NICE) evidence-based
guidance during routine consultations with patients. The second intervention involved patients using a
Patient Issues sheet to identify 2-3 issues they would like to talk about, which they used during
routine out-patient consultations. Issues ranged from feelings about treatment and the impact on
patients’ lives, to practical and clinical issues. Renal consultants were trained by a renal psychologist
to help them handle the issues raised by patients. The second study evaluated the views of patients
about 5 evidence-based interventions presented to patients as short audio-visual clips which included
patients talking about the benefits of: cycling whilst on haemodialysis; peer support; mindfulness;
computer cognitive behaviour therapy; and talking about emotional wellbeing with clinical staff.
Study Design
The evaluation used a qualitative design and took place in two renal units in the West Midlands. Five
consultants participated in the first study over 3-4 months. The two interventions were used with
patients on dialysis – haemodialysis (HD), home haemodialysis (HHD), and peritoneal dialysis (PD).
All eligible patients attending a consultation with one of the participating consultants during the study
period were invited to take part. Forty patients participated and semi-structured telephone interviews
were used to explore the effectiveness of the interventions. They had all been on dialysis for less than
12 months and were not currently accessing psychological support. Semi-structured, face-to-face
individual interviews were also conducted with the five consultants to explore the impact of using the
interventions on the consultation and how consultants responded to the issues patients raised.
The second study involved semi-structured individual interviews and mini-focus groups with sixteen
additional patients from the two research sites. The sample included both pre-dialysis adult patients
with a dialysis care plan, and adult patients who had been on dialysis (HD, HHD or PD) for less than
12 months, and were not currently accessing psychological support. Purposive sampling was used to
generate maximum variation in patient age, gender and ethnicity.
Findings
Early findings from the evaluation, due for completion March 2014, indicate a positive response from
patients to the two pilot interventions used in the first study. The interventions were found helpful in
enabling more and better discussion with consultants around patients’ emotional needs.
Relevance
The evaluation findings will be used to: 1. Provide guidance to renal consultants about how to
improve the emotional and psychological support of end-stage renal disease patients 2. Recommend
service improvements where appropriate 3. Design interventions to provide patients with suitable
emotional and psychological support, for larger-scale testing through a randomised controlled trial.
This abstract presents independent research funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in
Applied Health Research and Care West Midlands. The views expressed are those of the author(s) and not necessarily those of the
CLAHRC-WM collaborative organisations, the NIHR or the Department of Health.