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

Abstract

ObjectiveTo examine in-centre haemodialysis patients’ emotional distress and need for support across UK renal units with varying models of psychosocial service provision.DesignThe 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.SettingSeven renal units across England, Wales and Scotland. The units were purposively selected so that varying workforce models of renal psychosocial services were represented.ParticipantsIn 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 measuresThe prevalence of distress and patient-reported need for support.ResultsThe 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).ConclusionsThe 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.

Exploring the role of the UK renal social worker: The nexus between health and social care for renal patients

“…Indeed, the value of the RSW role to patients is in providing holistic care with a focus on advocacy, without adhering to strict eligibility criteria. This was found to significantly reduce distress and anxiety, thereby confirming findings of a recent study on the relationship between renal psychosocial staffing levels and distress [24].…”

Renal staffs’ understanding of patients’ experiences of transition from peritoneal dialysis to in-centre haemodialysis and their views on service improvement: A multi-site qualitative study in England and Australia

“…Similar to patient discussions reported in the paper by Allen et al staff explained how patients were resistant to transitioning for reasons such as family commitments, needle phobia and guilt [12]. The staff talked about how timely psychosocial support would be welcome for patients such as these because, as Seekles et al report, where psychosocial support is low, the needs of patients with kidney disease will often go unmet [26].…”

Dialysis, Distress, and Difficult Conversations: Living with a Kidney Transplant

“…For example, renal clinicians trained in motivational interviewing, a technique used to foster patient engagement and empowerment, has shown beneficial effects in ESKD and could be a useful tool in identifying and addressing emotional distress via informal pathways [ 35 , 36 , 37 , 38 ]. Despite recommendations for early screening, immediate and specialist access to more formal psychological support continues to require substantial investment in building a renal psychosocial workforce [ 39 ].…”

“…Prüfe and colleagues highlighted that “as patients’ need for support is not limited to medical questions… the roles of psychologists and social workers in a multidisciplinary setting need to be discussed and strengthened” (p. 9, [ 44 ]). Such multidisciplinary work has been previously recommended [ 39 ]. Alternative strategies have included digital intervention which has shown some promising improvements in self-management [ 45 ], however, adolescent, and young adult kidney transplantation groups require further investigation [ 46 , 47 ].…”