Psychosocial factors affecting patients with end-stage kidney disease and the impact of the social worker

Medication Adherence Among Patients With Kidney Disease: An Umbrella Review

Chronic kidney disease (CKD) imposes a significant medication burden on patients due to the necessity of multiple treatments to slow disease progression, manage coexisting conditions, and address complications. The complex medication regimen, in turn, has implications for clinical and patient-centered outcomes. This umbrella review provides comprehensive evidence on extent of medication nonadherence among adults with CKD, as well as associated risk factors, outcomes, and the effectiveness of interventions by synthesizing evidence from published systematic reviews and/or meta-analyses. We identified 37 works that met our inclusion criteria. These reviews covered various aspects of treatment adherence in people with CKD, which can be categorized into four main themes: (i) prevalence of treatment nonadherence; (ii) factors associated with (non)adherent behaviors; (iii) outcomes associated with treatment (non)adherence; and (iv) interventions to improve treatment adherence or overall self-management practices. Approximately half of the included studies (15/34) focused on interventions aimed at improving medication adherence or overall CKD management, while outcomes associated with medication (non)adherence were relatively underexplored in the literature. The reported prevalence rates of medication nonadherence varied widely among reviews and stages of CKD. The determinants of adherence identified included socioeconomic variables, disease or clinical conditions, and psychosocial factors. Common interventions to improve adherence included nurse-led interventions, pharmaceutical services, and eHealth technologies, which had varying effects on medication adherence or dialysis sessions.

The experience of transitioning into life-sustaining treatment: A systematic literature review

BACKGROUND

Being informed about treatment options for kidney failure and included in the related decision-making process can facilitate a smooth transition. Among patients with kidney failure the initiation of kidney failure replacement therapy is considered a traumatic event, causing physical and emotional distress and disrupting several aspects of one's social life. In order to ease the transition, health care personnel must ensure that the patient understands the parameters of each treatment option. It is imperative to increase the knowledge of patients' lived experiences around initiating kidney failure replacement therapy.

OBJECTIVES

To explore how adults with kidney failure describe the lived experience of transitioning into life-sustaining kidney failure replacement therapy.

DESIGN

A systematic review of qualitative literature.

METHODS

Primary qualitative studies published in English between 2010 and 2020 from CINAHL, PubMed and PsycINFO were included. Content analysis summarised the patients' lived experience.

FINDINGS

From 959 records screened, 17 studies were eligible for inclusion. A total of 5 themes that described the patients' lived experience were identified: an existential transformative feeling, a change in quality of life, limitation, safety, and ambivalence.

CONCLUSION

Being prepared and receiving emotional, physical, and social support can ease the transition for the patient. Among all available treatment options, dialysis and transplantation, the transition into kidney failure replacement therapy is experienced as a life-changing event. With this knowledge, it is imperative to clarify the importance of providing a patient with adequate support during the transition.

The Experience of Living with a Chronic Illness: A Qualitative Study among End-Stage Renal Disease Patients

The prevalence of End-Stage Renal Disease (ESRD) has been rising over time and substantially affects morbidity and mortality. ESRD requires lifelong treatment, and as a result, patients experience multiple physical and psychosocial stressors. ESRD patients struggle to retain their jobs, social lives, financial flexibility, and diet restrictions of liquids and solid foods. The present study aims to understand the experiences of ESRD patients undergoing hemodialysis. The study was conducted at Eldho Mor Baselious Dialysis Center in Perumbavoor, Kerala, in the hemodialysis outpatient unit. The Biopsychosocial model was used as the theoretical framework of the study. As the goal of the study was to investigate the inner experiences of ESRD patients, a qualitative research approach was employed. Twelve respondents were selected for the study using purposive sampling, and the data were organized and analyzed using Colaizzi's descriptive phenomenological method. Four theme categories emerged from data analysis: decline in physical function, psychosocial distress, economic hardships, and impact on the support system. The study shows that ESRD patients experience significant psychosocial and health-related issues. The role of the clinical social worker is vital as there is a need for social work interventions to resolve the psychosocial issues of patients with ESRD.

Sustained employment, work disability and work functioning in CKD patients: a cross-sectional survey study

INTRODUCTION

Kidney failure negatively affects opportunities for work participation. Little is known about work functioning of employed CKD patients. This study investigates work-related outcomes, and examines associations between patient characteristics and employment status.

METHODS

We performed a cross-sectional survey study in nine nephrology outpatient clinics in the Netherlands among working age (18-67 years) CKD Stage G3b-G5, dialysis and transplant patients (n = 634; mean age 53.4 years (SD 10); 53% male; 47% Stage G3b-G5, 9% dialysis, 44% transplantation). We assessed employment status, work disability, work-related characteristics (i.e., work situation, working hours, job demands), work functioning (i.e., perceived ability to work, productivity loss, limitations in work), work environment (i.e., work accommodations, psychosocial work environment), as well as health status and fatigue.

RESULTS

Sixty-five percent were employed reporting moderate work ability. Of those, 21% received supplementary work disability benefits, 37% were severely fatigued, 7% expected to drop out of the workforce, and 49% experienced CKD-related work limitations. Work accommodations included reduced working hours, working at a slower pace, adjustment of work tasks or work schedule, and working from home. Multivariable analysis of sustained employment showed associations with younger age, male gender, higher level of education, better general and physical health and pre-emptive transplantation. Transplant patients had the highest work ability and highest expectation to maintain work. Dialysis patients had the highest productivity loss and perceived the most limitations regarding functioning in work. Stage G3b-G5 patients reported the lowest social support from colleagues and highest conflict in work and private life.

CONCLUSIONS

Employed CKD patients experience difficulties regarding functioning in work requiring adjustment of work or partial work disability. In addition to dialysis patients, stage G3b-G5 patients are vulnerable concerning sustained employment and work functioning.

Kidney Failure Patients' Perceptions and Definitions of Health: A Qualitative Study

Rationale & Objective

Patients with kidney failure who have used multiple treatment modalities are a unique source of information for how different options may best fit their values. We aimed to understand how people interpret their health and kidney failure treatment experience to inform providers who facilitate shared decision-making conversations.

Study Design

This qualitative, interpretive phenomenological study explores how patients with kidney failure interpret health throughout their treatment trajectory.

Setting & Participants

We recruited a purposive sample of patients who had used 3 or more kidney failure treatment options, including transplant and dialysis from transplant clinics and online support groups, for semi-structured interviews. Eligible participants were over 18 and spoke English for a total of 7 current transplant, 10 current home dialysis, and 1 current in-center patient.

Analytical Approach

A 6-step iterative process of data analysis occurred concurrently with data collection.

Results

Half of the 18 participants were Black; 67% were women. Three interrelated themes emerged from interviews: ability to engage in meaningful activities; working for balance; and living in context. Participants evaluated health according to their ability to engage in meaningful activities while balancing their emotional and physical needs with their life goals. When their social and treatment environments supported their autonomy, participants also considered themselves healthy.

Limitations

The inclusion of only English-speaking patients limits the transferability of findings. A longitudinal design, repeated interviews, observation, and dyadic interviews would increase the health care providers' understanding and interpretation of health.

Conclusions

The themes demonstrated patients evaluated health based on ability to engage in meaningful activities while maintaining balance. The treatment context, particularly how health care providers responded to patients' physiological experience, autonomy, and power, influenced interpretation of patient treatment experiences. Integrating patient interpretations of health with quantitative measures of treatment effectiveness can help health care providers better partner with patients to provide effective care for kidney failure.

Mental health and its influencing factors of maintenance hemodialysis patients: a semi-structured interview study

BACKGROUND

Maintenance hemodialysis (MHD) is a commonly used renal replacement therapy for end-stage renal disease patients. MHD patients have undergone multiple physiological stressors, which may cause physical problems and affect their mental health; however, few qualitative studies have been done on the mental health of MHD patients. Such qualitative research becomes the basis for further quantitative research and is critical to validating its results. Therefore, the current qualitative study used a semi-structured interview format, and aimed to explore the mental health and its influencing factors of MHD patients who are not receiving intervention treatment to determine how best to ameliorate their mental health.

METHODS

Based on the application of Grounded Theory, semi-structured face-to-face interviews were conducted with 35 MHD patients, following consolidated criteria for reporting qualitative studies (COREQ) guidelines. Two indicators (emotional state and well-being) were used to assess MHD patients' mental health. All interviews were recorded, after which two researchers independently performed data analyses using NVivo.

RESULTS

Acceptance of disease, complications, stress and coping styles, and social support were found to be the influencing factors of MHD patients' mental health. High acceptance of disease, healthy coping styles, and high social support were positively correlated with mental health. In contrast, low acceptance of disease, multiple complications, increased stress, and unhealthy coping styles were negatively correlated with mental health.

CONCLUSION

One's acceptance of the disease played a more significant role than other factors in affecting MHD patients' mental health.

The psychosocial needs of patients who have chronic kidney disease without kidney replacement therapy: a thematic synthesis of seven qualitative studies

BACKGROUND

Limited quantitative data suggests that patients who have chronic kidney disease without kidney replacement therapy (CKD without KRT) may present with psychosocial needs just as patients who have acute kidney injury and are treated by dialysis (AKI stage 3D) do. This systematic review aims to synthesise qualitative research on patients' experiences of CKD without KRT to provide further insight into patients' experience of the healthcare they receive and simultaneously, their psychosocial needs, to inform the development of appropriate psychological interventions.

METHODS

The review followed ENTREQ guidelines. PubMed/MEDLINE, PsycINFO, EMBASE and CINAHL were searched in July and August 2021. Qualitative studies in English on the experiences of CKD without KRT care were included in the review. Thematic synthesis was conducted on the findings of the included studies.

RESULTS

The search identified 231 articles for screening. Eight studies met the inclusion criteria, and one was excluded at the quality assessment stage. The final seven articles [n = 130 patients] were analysed. Five themes on psychosocial needs were developed: addressing patients' CKD-related educational needs, supporting the patient's relationships, honouring the patient's need for control, adjusting to change, and recognising fear of disease and treatment.

DISCUSSION

This review highlights the range of psychosocial needs of patients who have CKD without KRT. There are numerous intervention options that clinicians may develop that could benefit patients and address multiple needs, such as group educational programmes.

"Losing Faith in My Body": Body Image in Individuals Diagnosed with End-Stage Renal Disease as Reflected in Drawings and Narratives

Chronic kidney disease (CKD) and the dependency on dialysis is an abrupt life-changing event that harms a patient's life (e.g., social relationships, work, and well-being). This study aimed to examine how individuals who undergo chronic dialysis due to failure end-stage renal disease perceive their bodies, as reflected in drawings and narratives. Following ethical approval and signing a consent form to participate in the study, 29 adults between the ages of 20 and 85 who have undergone dialysis filled out an anonymous questionnaire that consisted of the following measures: The Center for Epidemiological Studies-Depression (CES-D), The Multidimensional Body-Self Relations Questionnaire (MBSRQ), and The MOS 36-Item Short-Form Health Survey (SF-36). After completion, they were asked to draw their self-figure before and after being diagnosed and narrate it. The data were quantitatively and narratively analyzed. The results revealed high levels of depression and concerns regarding body fitness and weight. Few significant differences were noted between self-figured drawings before and after the diagnosis, such as the body line and gender markers. Additionally, Fitness Evaluation and Overweight Preoccupation were significant among the participants.

Guideline adherence by physicians for management of glucocorticoid-induced osteoporosis in Japan: a nationwide health insurance claims database study

Risk of fracture due to glucocorticoid-induced osteoporosis (GIO) can be reduced by anti-osteoporosis (OP) medications. The proportion of patients on long-term glucocorticoid therapy who received anti-OP medications according to the GIO management guidelines has increased in recent years, but is still suboptimal.

INTRODUCTION

Adherence of physicians to guidelines for glucocorticoid (GC)-induced osteoporosis (GIO) management is currently unclear. This study aimed to clarify the state of guideline adherence by physicians in Japan and identify factors associated with guideline adherence using a nationwide health insurance claims database (NDBJ).

METHODS

Patients aged ≥ 50 years who were prescribed GC for ≥ 90 days after 180 days without a GC prescription and who were followed up for osteoporosis (OP) management for the subsequent 360 days during the period spanning 2012-2018 were selected from the NDBJ. Guideline adherence was evaluated with the proportion of patients who received OP management as recommended by the Japanese guidelines. Information on previous vertebral and hip fractures, dementia, and polypharmacy was obtained. Factors associated with OP management were evaluated by logistic regression analysis.

RESULTS

A total of 512,296 patients were considered to be at high risk of fracture according to the guidelines. Proportions of patients receiving OP management (BMD testing or anti-OP medications) have increased in recent years. In 2017, 33.7% of men and 55.3% of women received OP management in the initial 90 days of GC therapy. Female sex, previous anti-OP medications, polypharmacy, and higher GC dose were significantly associated with receiving OP management, while dementia showed an inverse association. A prior history of hip fracture, a strong risk factor for future fracture, was not significantly associated with receiving OP management.

CONCLUSIONS

Although guideline adherence by physicians has increased in recent years, it remains suboptimal. Further efforts to improve guideline adherence are necessary.

TRIAL REGISTRATION NUMBER

The present study is not registered.

"Together We Stand": A Pilot Study Exploring the Feasibility, Acceptability, and Preliminary Effects of a Family-Based Psychoeducational Intervention for Patients on Hemodialysis and Their Family Caregivers

This pilot study aimed to assess the feasibility, acceptability, and preliminary effects of a family-based psychoeducational intervention for patients undergoing hemodialysis (HD) and their family members. This was a single-group (six dyads), six-week, pre–post pilot study, delivered in a multifamily group format. Feasibility was based on screening, eligibility, content, retention, completion, and intervention adherence rates. Acceptability was assessed at post-intervention through a focus group interview. Self-reported anxiety and depression and patients’ inter-dialytic weight gain (IDWG) were also measured. The screening (93.5%), retention (85.7%), and completion (100%) rates were satisfactory, whereas eligibility (22.8%), consent (18.4%), and intervention adherence (range: 16.7–50%) rates were the most critical. Findings showed that participants appreciated the intervention and perceived several educational and emotional benefits. The results from the Wilcoxon Signed-Rank Test showed that a significant decrease in anxiety symptoms (p = 0.025, r = 0.646) was found, which was followed by medium to large within-group effect sizes for changes in depression symptoms (p = 0.261, r = 0.325) and patients’ IDWG (p = 0.248, r = 0.472), respectively. Overall, the results indicated that this family-based psychoeducational intervention is likely to be feasible, acceptable, and effective for patients undergoing HD and their family caregivers; nonetheless, further considerations are needed on how to make the intervention more practical and easily implemented in routine dialysis care before proceeding to large-scale trials.