The Psychosocial Experience of Patients with End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service
Background. A needs assessment was conducted on renal patients registered to a leading hospital trust in London in order to explore their psychological, social, and spiritual needs. The aim of the needs assessment was to create an evidence base for the development of a comprehensive health psychology service to run concurrently with a renal counselling support service within the department. Methodology. This study utilised a series of semistructured face-to-face interviews and focus groups with renal patients and their carers, to explore how ESRD impacted quality of life. Results. A thematic analysis was undertaken. Seven emergent themes were identified that influenced the quality of life of people with EDRD: physiological impact, impact of treatment, impact on daily life, psychological impact, impact on relationships, social impact and coping responses. Conclusion. The needs assessment clearly identified that ESRD carries with it emotional, physical, psychological, social, and existential burdens. The data from this needs assessment study has created an evidence base upon which future health psychology services can be built within this leading UK hospital. 1. Psychosocial Effects of Kidney Disease End-stage renal disease (ESRD) is a debilitating, chronic condition whereby the kidney failure requires artificial means of excretion for survival. The primary means to achieve this are by peritoneal dialysis or haemodialysis (done several times weekly). Consequently, patients with ESRD undergo a number of lifestyle, dietary, and fluid restrictions in order to accommodate their illness. These lifestyle restrictions significantly impact on social functioning with patients performing a balancing act to ensure maintenance of vitamin, iron, and protein levels. Such restrictions can impact on patients’ illness beliefs, sense of personal control leading to anxiety and depression, inhibiting coping, and adjustment [1, 2]. Kimmel et al. [1] investigated the impact of psychosocial factors on behavioural compliance and survival in urban haemodialysis patients. Depression was related to decreased adherence to treatment. Depression is strongly recognized as a common psychological problem in haemodialysis patients [3–6]. The rate of psychiatric disorders in a population of ESRD patients was considerably higher than in a population with other chronic medical conditions [3]. Chilcot et al. [7] reported that 20–30% of ESRD patients have significant depressive symptoms compared to the lifetime prevalence of depression in the general population of approximately 16% [8].
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