Abstract
BackgroundWe aimed to describe (1) depressive and anxiety symptom burdens reported by adults on in-centre hemodialysis in Northern Alberta, Canada and (2) patients’ and nurses’ perceptions of managing such symptoms using routine patient-reported outcome measures (PROMs).MethodsA longitudinal mixed methods approach was employed. Cluster randomized controlled trial data exposed the prevalence of positive screens (scores ≥ 3) for depressive (PHQ-2) and anxiety (GAD-2) symptoms. A descriptive qualitative approach was used to understand patients’ and nurses’ perceptions of managing these symptoms using the ESAS-r: Renal and EQ-5D-5L. Using purposeful sampling, patients and nurses were invited for interviews. Field notes were documented from 6 dialysis unit observations. Patients’ responses to open-ended survey questions and nurses’ electronic chart notes related to mental health were compiled. Thematic and content analyses were used.ResultsAverage age of patients (n = 408) was 64.0 years (SD 15.4), 57% were male, and 87% were not working; 29% screened positive for depressive symptoms, 21% for anxiety symptoms, and 16% for both. From patient (n = 10) and nurse (n = 8) interviews, unit observations, patient survey responses (n = 779) and nurses’ chart notes (n = 84), we discerned that PROMs (ESAS-r: Renal/EQ-5D-5L) had the potential to identify and prompt management of mental health concerns. However, opinions differed about whether mental health was within kidney care scope. Nonetheless, participants agreed there was a lack of mental health resources.ConclusionsPrevalence of depressive and anxiety symptoms aligned with existing literature. Tensions regarding mental health management highlight the need for systemic decisions about how routine PROM use, including mental health assessment, may be optimized to meet patients’ needs.
Highlights
We aimed to describe (1) depressive and anxiety symptom burdens reported by adults on in-centre hemodialysis in Northern Alberta, Canada and (2) patients’ and nurses’ perceptions of managing such symptoms using routine patient-reported outcome measures (PROMs)
Our aim was to (1) describe the burden of depressive and anxiety symptoms reported by adults on in-centre hemodialysis in Northern Alberta, Canada, using PROMs, and (2) understand patients’ and nurses’ perceptions of managing such symptoms
30% screened positive for depressive symptoms (PHQ-2 ≥ 3) and 21% screened positive for anxiety symptoms (GAD-2 ≥ 3); 16% screened positive for both anxiety and depressive symptoms (Table 1)
Summary
We aimed to describe (1) depressive and anxiety symptom burdens reported by adults on in-centre hemodialysis in Northern Alberta, Canada and (2) patients’ and nurses’ perceptions of managing such symptoms using routine patient-reported outcome measures (PROMs). The burden of depression and anxiety to patients with kidney failure on dialysis and the healthcare system is substantial. Between 20 and 40% of adults on dialysis have depression [2] compared to 4.4% in the global, general population [3]. Schick‐Makaroff et al J Patient Rep Outcomes (2021) 5:111 Depression among those with kidney disease is associated with poor quality of life (QOL) [4, 5], lower odds of transplantation [6], and increased mortality [7]. Anxiety among those with kidney disease is associated with lower QOL [5, 12, 13]. Despite the high prevalence for those on dialysis, depression and anxiety remain underrecognised and under-managed [12]
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