B39(W)
REASONS FOR REFERRAL TO A RENAL CLINICAL PSYCHOLOGY SERVICE
Coyne, E, Bebb, C
Nottingham University Hospitals NHS Trust
BACKGROUND: Significant levels of psychological distress have been identified in patients
with CKD. NICE guideline (CG91) has specifically addressed the management of depression in
patients with a chronic physical health problem, particularly recommending the use of
medication and cognitive behavioural therapy 1. However, it has been argued that patients with
CKD experience a wide range of psychological distress which may require a broader set of
interventions2. There is a need to establish the type of difficulties for which renal patients are
referred for psychological support.
AIMS: (1) to identify the reasons for referral to a renal clinical psychology service (2) to
ascertain the uptake of the service.
DESIGN: A retrospective review was undertaken of all adult referrals to Renal Clinical
Psychology from the Nottingham Renal and Transplant Unit during a 12 month time period
from 1st August 2009 to 31st July 2010. Reason for referral was coded from the referral
form/letter.
RESULTS: Demographics: 98 Patients were referred to see a Clinical Psychologist. (45%
Male, 55% Female). Mean age at referral 51 (range 18-88). All age groups were represented
(18-25yrs: 9.18%, 26-35yrs: 12.24%, 36-45yrs: 15.31%, 46-55yrs: 24.49%, 56-65yrs: 12.24%,
66-75yrs: 17.35%, 76yrs +: 9.18%). The majority of referrals were dialysis patients (HD
62.24%, PD 13.27%, Pre-dialysis 15.31% and Transplant 9.18%). Referrals were made from all
members of the multidisciplinary team although predominantly from the medical and nursing
staff: Doctor 48.98%, Nurse 44.90%.
Reasons for referral: Patients often presented with more than one problem, however only the
primary reason for referral was coded:
Reason for referral
Adjustment (Coping with illness, dialysis, transplant or end of life care)
Low mood
Difficult decision making
Concordance (fluid, diet, medication, clinic or treatment attendance)
Trauma following medical/surgical procedure
Anxiety/ Panic
Fear/Phobia of medical or surgical procedure
Other (e.g. bereavement, confusion)
Denial of illness
Weight Management (lose or gain weight)
Percentage
30.61
19.39
9.18
8.16
7.14
6.12
6.12
5.10
4.08
4.08
Patient attendance: 88.78% attended an assessment appointment (6.12% DNA) (2.04% referred
elsewhere prior to appointment) (3.06% Patients health circumstances changed).
CONCLUSION/IMPLICATIONS: Renal patients are referred for a wide range of
psychological issues which include depression. However, referral reasons are broader than
depression and reflect the complexity of issues which occur within the renal care pathway. This
data supports the view that provision needs to consider the range of psychological distress and
not focus only on treatments for depression2. It also provides support for embedded
psychological support within a multidisciplinary renal service rather than referral to a separate
service for depression.
1
www.nice.org.uk/CG91
Attfield, R., Moran, J. & Mooney, A. (2010). The NICE guidance on depression in chronic
illness. British Journal of Renal Medicine, 15 (3), 6-8.
2