Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support

Haemodialysis distress thermometer scale: Turkish validity and reliability study

PURPOSE

This study aimed to translate and adapt the "Haemodialysis Distress Thermometer Scale" (HDDT) into Turkish and assess its validity and reliability.

METHODS

This study collected data from 223 haemodialysis patients across three public hospitals in Kütahya province, Türkiye, over a seven-week period.

RESULTS

In this study, the content validity index of the scale was determined to be 0.96. Validity analysis results indicated that factor loadings ranged between 0.45 and 0.82, the total variance explained was 59.25%, and the fit indices were X2/df = 1.149 and RMSEA = 0.026. Reliability analysis showed that the total Cronbach's α coefficient was 0.80, with item-total correlation coefficients ranging from 0.37 to 0.73. The cut-off score for the HDDT barometer was identified as 6.5. The final structure of the HDDT scale comprised 40 items, four factors, and an 11-point barometer, consistent with the original scale.

CONCLUSION

The Turkish version of the HDDT is a valid and reliable instrument for assessing distress in patients undergoing haemodialysis treatment. It may serve as a valuable tool for nurses in identifying and addressing patient distress during haemodialysis care.

Clinical Relevance of an Online Self-Management Intervention in Haemodialysis: A Secondary Data Analysis of the 'Connected We St@nd' Programme

BACKGROUND

The 'Connected We St@nd' programme is an Internet-mediated self-management intervention that combines health education with psychosocial support, with evidenced feasibility and acceptability in haemodialysis.

OBJECTIVES

To evaluate the clinical relevance of the programme and to better understand which intervention outcomes/health-related self-report measures are most sensitive to reflect changes between pre- and post-intervention assessments.

DESIGN

This study followed a pre-post quasi-experimental design.

PARTICIPANTS

Twenty-six individuals (16 people on haemodialysis and 10 family caregivers) completed the intervention.

MEASUREMENTS

Participants filled out a web-based assessment protocol before and after the intervention. To determine the clinical relevance of within-group pre-post changes, effect sizes, minimal clinically important differences, and reliable change indexes were calculated.

RESULTS

Clinically meaningful results were found on outcome measures with reasonable sensitivity to detect pre-post changes in the positive affect dimension of subjective well-being, purpose in life, overall quality of life, and psychological health. The latter was the variable that obtained the greatest number of respondents with reliable post-intervention improvements.

CONCLUSIONS

Participation in the programme led to clinically important and reliable improvements in several intervention outcomes, hinting that this evidence-informed intervention has the potential to be a valuable resource for promoting successful psychosocial adjustment among this population. Suggestions were made to fine-tune the evaluation and implementation of a large-scale trial to, in due course, encourage the integration of this technology-assisted interdisciplinary initiative into existing kidney care services.

The identification and management of depression in UK Kidney Care: Results from the Mood Maps Study

BACKGROUND

Depression is common in people with chronic kidney disease, yet little is known about how depression is identified and managed as part of routine kidney care.

OBJECTIVES

The primary objective was to survey all UK adult kidney centres to understand how depression is identified and managed. A secondary objective was to broadly describe the variability in psychosocial care.

DESIGN

Online survey.

METHODS

The survey comprised of three sections: (1) general kidney care, (2) psychological provision and (3) social work provision.

RESULTS

48/68 (71%) of centres responded to the general survey with 20 and 13 responses from psychological and social work module respectively. Only 31.4% reported having both in centre psychological and social work practitioners. Three centres reported no access to psychosocial provision. Of the 25 centres who reported on pathways, 36.0% reported having internal pathways for the identification and management of depression. Within services with psychological provision, screening for depression varied across modality/group (e.g., 7.1% in mild/moderate chronic kidney disease vs. 62.5% in kidney donors). Cognitive Behavioural Therapy and Acceptance and Commitment Therapy were the most common interventions offered. Most psychosocial services were aware of the National Institute for Health and Care Excellence guidelines for managing depression in long-term conditions (n = 18, 94.7%) yet few fully utilised (n = 6, 33.3%). Limited workforce capacity was evident.

CONCLUSIONS

There is considerable variability in approaches taken to identify and treat depression across UK kidney services, with few services having specific pathways designed to detect and manage depression. Workforce capacity remains a significant issue.

The Hemodialysis Distress Thermometer for Caregivers (HD-DT-C): development and testing of the psychometric properties of a new tool for screening psychological distress among family caregivers of adults on hemodialysis

PURPOSE

To develop and test the measurement properties of the HD-DT-C, a new tool designed to facilitate the screening of psychological distress and its sources in family caregivers of adults on hemodialysis.

METHODS

The present investigation was carried out in three phases: Phase 1 focused on the process of developing and exploring the content validity and clinical utility of the HD-DT-C using a mixed-methods approach and feedback panels; Phase 2, where the psychometric properties of this new tool were tested in a cross-sectional study (n = 106 caregivers); and Phase 3, where the European Portuguese version of the HD-DT-C was translated and culturally adapted into American English using a forward-backward translation procedure, followed by an expert panel review.

RESULTS

Findings suggested that the HD-DT-C was perceived by feedback panels as practical, appropriate, and useful for increasing dialysis provider/family caregiver communication in nephrology centers. The European Portuguese version of the HD-DT-C showed good test-retest reliability (ICC = 0.991 for the barometer and κ ≥ 0.80 in 77% of the checklist items), high diagnostic accuracy (AUC = 0.956), and strong convergent validity (all r ≥ 0.50) with reference measures that assess quality of life, caregiver burden, and symptoms of anxiety and depression. Cutoff scores with good clinical utility (CUI +  ≥ 0.70) were recommended for screening distress in research (≥ 6) and clinical practice (≥ 5).

CONCLUSION

The HD-DT-C is a brief, reliable, valid, and acceptable measure for identifying self-reported psychological distress and its sources among people caring for a family member or friend on hemodialysis. Future research is needed to explore the measurement properties of the American English version of this new tool.

Development process, clinical utility, and preliminary psychometric evidence of a new tool for screening psychological distress in renal care settings: the Hemodialysis Distress Thermometer (HD-DT)

OBJECTIVE

This study aimed to develop, evaluate the clinical utility, and test the psychometric properties of a new tool - the Hemodialysis Distress Thermometer (HD-DT) - designed to screen self-reported psychological distress and its sources in adults receiving hemodialysis.

METHODS AND MEASURES

Phase 1 focused on the process of developing and evaluating the content validity and clinical utility of the HD-DT using a stepwise mixed-methods approach; in Phase 2, the measurement properties of the European Portuguese version of the HD-DT were tested against reference measures in a cross-sectional study (n = 134 people on hemodialysis); while in Phase 3 the HD-DT was translated and culturally adapted into American English using forward-backward translation and review by a panel of experts.

RESULTS

Qualitative findings suggested that the HD-DT was perceived by feedback panels as practical and useful for rapidly screening psychological distress in nephrology centers. The European Portuguese version of this new tool showed good test-retest reliability and high diagnostic accuracy using a cutoff point of ≥ 6 for total distress. High convergent validity was found with reference measures that assess psychological health, and symptoms of anxiety and depression.

CONCLUSION

This study highlights the potential clinical utility of the HD-DT as an acceptable, reliable, and valid measure that can be used by health psychologists in clinical practice and research in renal care settings. Data collection to validate the American English version of the HD-DT is currently underway.

Effectiveness of educational interventions for nurses caring for patients with chronic kidney disease in improving nurse outcomes: A systematic review

AIM

The aim of the study was to evaluate the effectiveness of educational interventions for nurses caring for patients with chronic kidney disease in improving knowledge, nurse-patient interaction, performance, skills competence and clinical decision-making.

DESIGN

Systematic review.

METHODS

Search of literature for randomised controlled trials, quasi-experimental studies and pre-experimental studies on chronic kidney disease-related educational interventions for nurses was conducted across 10 databases. Two reviewers independently screened articles, appraised studies and extracted data.

DATA SOURCES

PubMed, Cochrane, Embase, CINAHL Complete, ERIC, Social Science Database, ASSIA, Scopus, Web of Science and ProQuest Thesis and Dissertations Global databases were searched from date of inception to 21 December 2022.

RESULTS

Three randomised controlled trials and eight pre-experimental studies were included in this review. Synthesis without meta-analysis was conducted due to high heterogeneity among studies. Interventions with teaching sessions, learning activities, self-study modules, discussion and a web-based training system were effective in improving nurses' knowledge, nurse-patient interaction, performance, skills competence and clinical decision-making. Patients experienced an improvement in nurse-patient interaction and no significant decrease in overall quality of life.

CONCLUSION

This review has shown the effectiveness of educational interventions for nurses caring for people with chronic kidney disease in improving outcomes for both nurses and patients, with sustained improvements up to a period of 1 year.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Study findings can guide the scope of future training for nurses caring for patients with chronic kidney disease.

IMPACT

Nurses often lack in-service training on how to improve care for patients with chronic kidney disease. This study found that training nurses on how to care for such patients can improve outcomes for nurses, which can translate to higher quality of patient care.

REPORTING METHOD

This paper adhered to the synthesis without meta-analysis (SWiM) reporting guideline.

Assessing knowledge of end-stage kidney disease and treatment options in hospitalized African American patients undergoing hemodialysis

OBJECTIVE

African Americans are more likely to develop end-stage kidney disease (ESKD) than whites and face multiple inequities regarding ESKD treatment, renal replacement therapy (RRT), and overall care. This study focused on determining gaps in participants' knowledge of their chronic kidney disease and barriers to RRT selection in an effort to identify how we can improve health care interventions and health outcomes among this population.

METHODS

African American participants undergoing hemodialysis were recruited from an ongoing research study of hospitalized patients at an urban Midwest academic medical center. Thirty-three patients were interviewed, and the transcribed interviews were entered into a software program. The qualitative data were coded using template analysis to analyze text and determine key themes. Medical records were used to obtain demographic and additional medical information.

RESULTS

Three major themes emerged from the analysis: patients have limited information on ESKD causes and treatments, patients did not feel they played an active role in selecting their initial dialysis unit, and interpersonal interactions with the dialysis staff play a large role in overall unit satisfaction.

DISCUSSION

Although more research is needed, this study provides information and suggestions to improve future interventions and care quality, specifically for this population.

Kindness, Listening, and Connection: Patient and Clinician Key Requirements for Emotional Support in Chronic and Complex Care

Emotional support for patients is critical for achieving person-centered care. However, the literature evidences an ongoing challenge in embedding emotional support within current health services. This study aimed to investigate the strategies to embed emotional support from the perspectives of patients and clinicians. This is an exploratory qualitative study that collected data through focus group discussions (FGDs) and interviews from 11 patients, 2 carers, and 7 clinicians in the multi-disciplinary care teams in an outpatient complex and chronic care setting in New South Wales, Australia. The FGDs and interviews were recorded, transcribed, and thematically analyzed. Three main themes emerged from the experience of both the patients and clinicians: (1) warmth and kindness, (2) deep listening, and (3) social connection in the process of treatment. Clinicians' and patients' shared experience of these themes was key to embed emotional support in care. Practical strategies including promoting shared understanding of emotional support, enhancing provider's capability to deliver emotional support, and building patient's networking opportunities in treatment processes were discussed to facilitate emotional support in patient care and health services.

Emotional distress and adjustment in patients with end-stage kidney disease: A qualitative exploration of patient experience in four hospital trusts in the West Midlands, UK

Objectives

To explore patient perceptions and experiences of mild-to-moderate emotional distress and the support offered by kidney units to patients with end-stage kidney disease.

Methods

In-depth, semi-structured qualitative interviews with patients (n = 46) being treated for end-stage kidney disease in four hospital Trusts, with data analysed thematically.

Results

Patients described multiple sources of distress and talked about the substantial burden that emotional challenges raised for their ability to manage their condition and develop coping strategies. Many patients did not feel it appropriate to disclose their emotional issues to staff on the kidney unit, due to a perceived lack of time for staff to deal with such issues, or a perception that staff lacked the necessary skills to provide resolution. Five themes were identified from the patient interviews, broadly related to patients’ experience of distress, and the support offered by the kidney unit: i) the emotional burden that distress placed on patients; ii) patients’ relationship with the treatment for their condition; iii) strategies for coping and adjustment; iv) patient-staff interactions and the support offered by the kidney unit, and v) the mediating impact of the treatment environment on patient experience of distress and their ability to raise emotional issues with staff.

Conclusions

Many patients felt unprepared for the likelihood of experiencing emotional issues as part of their condition, for which pre-dialysis education could help in managing expectations, along with support to help patients to develop appropriate coping strategies and adjustments. These findings demonstrate the importance of recognising patient distress and ensuring that talking about distress becomes normalised for patients with end-stage kidney disease.

Examining patient distress and unmet need for support across UK renal units with varying models of psychosocial care delivery: a cross-sectional survey study

OBJECTIVE

To examine in-centre haemodialysis patients' emotional distress and need for support across UK renal units with varying models of psychosocial service provision.

DESIGN

The study used a cross-sectional survey design. Logistic regression analysis was used to examine patient distress, as captured by the Distress Thermometer, and need for support, across different renal units.

SETTING

Seven renal units across England, Wales and Scotland. The units were purposively selected so that varying workforce models of renal psychosocial services were represented.

PARTICIPANTS

In total, 752 patients were on dialysis in the participating centres on the days of data collection. All adult patients, who could understand English, and with capacity (as determined by the nurse in charge), were eligible to participate in the study. The questionnaire was completed by 509 patients, resulting in an overall response rate of 67.7%.

OUTCOME MEASURES

The prevalence of distress and patient-reported need for support.

RESULTS

The results showed that 48.9% (95% CI 44.5 to 53.4) of respondents experienced distress. A significant association between distress and models of renal psychosocial service provision was found (χ²(6)=15.05, p=0.019). Multivariable logistic regression showed that patients in units with higher total psychosocial staffing ratios (OR 0.65 (95% CI 0.47 to 0.89); p=0.008) and specifically higher social work ratios (OR 0.49 (95% CI 0.33 to 0.74); p=0.001) were less likely to experience distress, even after controlling for demographic variables. In addition, a higher patient-reported unmet need for support was found in units where psychosocial staffing numbers are low or non-existent (χ²(6)=37.80, p<0.001).

CONCLUSIONS

The novel findings emphasise a need for increased incorporation of dedicated renal psychosocial staff into the renal care pathway. Importantly, these members of staff should be able to offer support for psychological as well as practical and social care-related issues.