Volume 36, Summer 2012
Table of Contents
Psychosocial Barriers to Home Dialysis: A Literature Review
Julie Régimbald, MSW, RSW; Cindy Gill, MSW, RSW
This review of 35 research and anecdotal reports discussing psychosocial barriers to home dialysis explores the challenges and successes of home dialysis from the viewpoints of both patients and nephrology professionals. The literature identified multiple psychosocial barriers to successful home dialysis: physical ability, cognition, patient attitudes toward home dialysis,emotional impact on the patient, emotional impact on the family, support from family, whether patient or caregiver is responsible for treatment, time constraints, patient personality and mental health, safety and patient's adherence with procedures, suitability of patient's home and willingness to change it, cultural issues, language barriers, unplanned start on dialysis, policy differences between modalities, loss of relationships with staff and other patients, support from staff for home dialysis, knowledge barriers, cost to hospital/staff availability to train and maintain home dialysis patients, and cost to the patient. Assessment tools already exist. The Jo-Pre-training Assessment Tool (JPAT) is a screening instrument which assesses the suitability of candidates for home dialysis, either peritoneal dialysis (PD) or home hemodialysis (HHD). It is designed to identify health-related problems; candidates are then referred to the appropriate professionals among the multidisciplinary team for assessment and care before starting training. The Method to Assess Treatment Choices for Home Dialysis (MATCH-D) was also developed to assess patients' suitability for home dialysis (PD or HHD), screening for medical and social barriers. However, we were not able to find a comprehensive tool specific to psychosocial barriers experienced by patients and their families. Based on the literature review, we concluded that psychosocial aspects are significant factors influencing the patients' ability to maintain home dialysis. To this end, the authors are developing a new tool: the Psychosocial Assessment Tool for Home Dialysis (PATH-D).
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The Impact of State Budgets on the Kidney Industry and People with ESRD
Wendy Funk Schrag, LMSW, ACSW
While the economy in the United States is improving, states continue to struggle to balance their budgets. Over the past several years, negative effects of budget reductions have been experienced by people with end-stage renal disease (ESRD) and dialysis providers. This article explores the varied reductions, their impact on people with ESRD and dialysis providers, and describes advocacy efforts. Coalitions are especially valuable in advocating for continued funding of benefits and services related to ESRD.
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Psychological Symptoms and End-of-Life Decision-Making Confidence in Surrogate Decision Makers of Dialysis Patients
Mi-Kyung Song, PhD, RN; Sandra E. Ward, PhD, RN, FAAN; Laura C. Hanson, MD, MPH; Feng-Chang Lin, PhD; Jill B. Hamilton, PhD, RN; Gerald Hladik, MD; Jason P. Fine, ScD; Jessica C. Bridgman, RD, MPH; Summer K. Sun, MS; Margaret S. Miles, PhD, RN
This cross-sectional descriptive study explored surrogate decision makers' psychological symptoms and their own assessment of decision-making abilities before actual involvement in end-of-life decisions for their loved ones. One hundred twenty dialysis patients' surrogates (79 African Americans and 41 Caucasians) completed scales measuring decision-making confidence, anxiety, depression, post-traumatic stress symptoms (PTSS), and a sociodemographic questionnaire. Forty-two (35%) and 14 (11.7%) surrogates showed abnormal scores on the anxiety and depression scales, respectively. Seven (5.8%) surrogates showed abnormal scores on the PTSS scale. While surrogates' decision-making confidence was high (M = 17.70, SD = 2.88), there was no association between decision-making confidence and the three psychological variables. Surrogates' confidence was associated only with the quality of their relationships with patients (r = 0.33, p = 0.001).
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