Improving clinical skills to support the emotional and psychological well-being of patients with end-stage renal disease: a qualitative evaluation of two interventions

Abstract

BackgroundMany patients with end-stage renal disease (ESRD) need and want improved emotional and psychological support. Explicit attention to patients' emotional issues during consultations can help, yet renal consultants rarely address emotional problems. This qualitative study aimed to evaluate whether two different low-cost interventions could individually enable consultants to talk with patients about their emotional concerns during routine outpatient consultations.MethodOne intervention involved patients using a Patient Issues Sheet to identify two to three issues they would like to talk about in their consultation and the second involved consultants asking patients a direct question about their emotional feelings. Consultants were trained to handle any emotional issues raised. Semi-structured interviews were conducted with five consultants and 36 ESRD patients from two UK renal units. Interviews were transcribed verbatim and analysed using the constant comparative method.ResultsAlthough consultants and patients tended to use the two interventions in different ways, they expressed generally positive views about how helpful the interventions were in promoting discussion of emotional issues. Consultants appreciated the training for facilitating empathetic handling of patients' emotional disclosures and containment of discussion. Most patients who raised emotional concerns were satisfied with their consultant's responses, while others were dissuaded from more explicit discussion by their consultant's concentration on physical considerations.ConclusionsThese qualitative study findings suggest that both interventions are feasible and acceptable and have the potential to help consultants improve emotional and psychological patient care, providing cognitive and behavioural tools to enable discussion of emotional issues during routine outpatient consultations.

Two Sides of the Same Coin: The Positive and Negative Impact of Spiritual Religious Coping on Quality of Life and Depression in Dialysis Patients

“…In fact, previous studies have shown that several factors are responsible for the well-being of hemodialysis patients, such as clinical (Cruz et al, 2016; F. Taylor, Combes, & Hare, 2016) and sociodemographic (Robinski, Mau, Wienke, & Girndt, 2016; Saffari et al, 2013) aspects. In addition to these factors, which have been widely discussed in the scientific literature, cultural issues and beliefs of individuals are increasing in importance in recent years.…”

The challenge of managing mild to moderate distress in patients with end stage renal disease: results from a multi-centre, mixed methods research study and the implications for renal service organisation

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Emotional disclosure in palliative care: A scoping review of intervention characteristics and implementation factors

“…The importance of creating an environment where people feel comfortable to share difficult feelings was frequently highligh ted. 25,[53][54][55]75,78,80 This related to the physical environment; for example, setting the intervention in a safe space, such as the participant's home, or a private room. 25 It also 78 and communication 68 Social integration and interaction models 33,60,57,68 Therapeutic value of game play 53 Supportive-expressive models 52 Interdependence theory 33 Intimacy and relationship satisfaction 62,67 Psychoanalytic Inhibition and catharsis 53,55,79…”

“…Continuity in chaotic illness model 78 Biographical disruption model/reconstruction of personal narrative 63,72,73,78 Health within illness model 78 Self Self-compassion 25,67,74 Self-regulation of attention 67 Self-efficacy and enablement 54,60,69,71 Non-directed client-centered approach 69,71,75 Ego-functioning, self-esteem, and tolerance of negative affect 59 referred to contextual factors, such as incorporating other soothing or positive elements that facilitate feelings of comfort 53,55 and healthcare professionals endorsing the intervention and framing it as safe and trustworthy. 54 The importance of creating a safe environment extended to ensuring that family carers felt comfortable with the participant taking part in the intervention; 33,55 this can be particularly salient in non-Western countries, such as China, where there are cultural barriers to expressing emotions. 53 Some noted that partner-based interventions improved retention and feasibility over private interventions, 62,67 suggesting the presence of a partner may contribute to feeling safe and supported.…”

“…25 Likewise, authors noted that there were individual differences in the format with which people felt comfortable disclosing their emotions, related to factors such as stage of disease, 33,52 differences in education, or simply personal preference. 25,54,66 Clarity and structure of instructions. A number of authors commented on clarity of instructions as an important factor in ensuring adherence to the core expressive components of the intervention, particularly for self-directed interventions.…”