Dialysis is often a stressful and emotional experience.
But renal healthcare professionals can help patients improve their quality of life.
As a renal healthcare professional, you are understandably focused on your patients’ physical health outcomes. Given that physical and mental health are closely intertwined, you are in a prime position to positively impact a patient’s overall health. Although this information is not new to you, it can still be difficult addressing mental health issues with your patients. Knowing that untreated mental health issues can lead to misunderstandings and missed opportunities for better health, many providers find ways to address these concerns more effectively.
Research indicates that approximately 20 percent of patients with chronic kidney disease suffer from major depressive disorder, compared to just 2 to 10 percent of the general population. Anxiety is also common among dialysis patients. A 2008 study, for example, found that 45 percent of people receiving dialysis for end-stage renal disease experienced some type of anxiety disorder.
Untreated mental health problems have a direct effect on patients’ wellbeing — influencing not only quality of life, but physical outcomes as well. Research has found that people undergoing dialysis who also have depression are twice as likely as those without depression to be hospitalized or to die in a given year. Depressive symptoms are also associated with missed and shortened hemodialysis treatments, so patients who are depressed are likely not getting optimal care.
But the good news is mental health conditions are treatable. By talking openly with patients and identifying their symptoms of emotional distress, you can help them stay healthy in body and mind.
Talking — and Listening
When patients first learn they need dialysis, they can experience any number of emotions, including guilt, anger, grief, denial and shock. And while they’re in the midst of sorting through these complicated feelings, they are often bombarded with complex information — details of the hemodialysis process, new drug prescriptions, and new dietary restrictions, on top of clinic and transportation schedules, insurance forms and other paperwork. It’s enough to make anyone’s head spin.
As a renal care professional, it helps to avoid the urge to impart a lot of information all at once. Rather than a monologue, a collaborative dialogue allows time for the patient to ask questions. It can help to prepare patients by saying, for example: “I’ll explain some things, and I’m hoping that by the time I’m done, you’ll have some questions for me.”
It’s often useful to repeat information more than once. After all, patients can’t follow your advice if they don’t fully understand it. You might gently ask patients to repeat what you’ve told them:
“I want to check in to make sure I’m not going too fast. Can you share with me what you’re understanding about what I am saying?” Then after, “What are you thinking about so far?”
Empathizing with patients can have a significant impact. When we acknowledge that dialysis is complicated and hard, patients know that they are not alone in feeling overwhelmed. It lets them know you are here to help them as they adjust to life on dialysis.
Dialysis is life changing. For many people, adapting to those changes will take some time. As a provider, you have a clear end goal in sight for your patient’s health. But the best way to move patients toward that goal isn’t with a single leap. Instead, we can help them set small, achievable steps along the way. Praise their efforts, no matter how minor they may seem. Positive reinforcement can go a long way.
Signs the Patient May Need Help
As a healthcare provider, you have a unique opportunity to intervene when a patient is showing signs of mental or
emotional distress.
Pay close attention to newly diagnosed patients; adjusting to the dialysis regimen is often a particularly hard time. Keep in mind, though, that mental health problems can emerge at any time. Patients on the list to receive a kidney transplant, for example, might start out optimistic. But if they find themselves waiting longer than they expected, they may begin to feel hopeless.
When meeting with patients, keep an eye out for signs that they are struggling. Is their appearance suddenly becoming unkempt? Do they seem listless and distracted rather than engaged in the conversation? Do they fail to ask questions? Are they coming late or
missing dialysis sessions?
Observing patients is only one piece of the puzzle. Don’t hesitate to ask directly about a patient’s mood, stress level, sleep habits and support systems. It’s not always easy to talk about mental health. But if you don’t ask the hard questions, who will? Patients often feel relieved that you have asked and appreciate that you are concerned.
Failure to follow medical advice is an important — and common — sign of emotional distress. Are patients taking their medications, monitoring their diet and fluid intake, and following their dialysis regimen?
It can be frustrating when patients don’t follow good health advice. But if patients aren’t following their treatment plan, it’s because something is getting in the way. Sometimes that’s something as simple as a misunderstanding. But often, emotional factors may be putting up roadblocks. Either way, lack of adherence is a sign that patients need an extra hand.
If you have concerns that a patient is experiencing depression, anxiety or other mental health problems, share those concerns directly. Unfortunately, mental health problems are still frequently stigmatized. When talking to your patients, it can help to underscore that these are common conditions that often accompany chronic diseases. And, importantly, such conditions are treatable. With help, they can begin to feel much better again.
Dialysis patients can safely take some antidepressant medications, but there are important non-drug options to consider, too. Studies have found that cognitive behavioral therapy and exercise therapy are both effective at treating depression in people with chronic kidney disease. Make sure you are familiar with local mental health resources so you are able to easily provide referrals to mental healthcare providers.
Dialysis may be life changing, but it’s also life sustaining. With your help, patients with kidney disease can overcome the psychological and emotional barriers to living a good quality of life with dialysis.
