Abstract
BackgroundEmerging evidence of psychosocial problems in CKD patients has led to an acceptance that a focus on the emotional wellbeing of the patient should be included in the provision of comprehensive CKD care. It is unclear if an increased attention for psychosocial needs in guidelines and policy documents has led to a rise in psychosocial staffing levels or change in composition of staff since the last workforce mapping in 2002. This paper offers a critical analysis and in-depth discussion of findings and their implications, in addition to providing an international perspective and exposing gaps in current knowledge.MethodsData on psychosocial staffing levels was taken from a survey based on the Scottish Renal Association’s (SRA) staffing survey that was sent to all units in England, Wales and Northern-Ireland in 2016. In addition, data from a psychosocial staffing survey designed by and distributed via psychosocial professional groups was used. This data was then completed with Freedom of Information (FOI) requests and collated to describe the current renal psychosocial workforce in all 84 UK renal units. This was compared to results from the last renal workforce mapping in 2002.ResultsThe results from this mapping show great variability in models of service provision, significant exceeding of benchmarks for staffing levels, and a change in staffing patterns over the past 15 years. Adult psychology services have increased in number, but provision remains low due to increased patient numbers, whereas adult social work and paediatric services have decreased.ConclusionA lack in the provision of renal psychosocial services has been identified, together with the absence of a general service provision model. These findings provide a valuable benchmark for units, a context from which to review and monitor provision alongside patient need. Along with recommendations, this paper forms a foundation for future research and workforce planning. Research into best practice models of service provision and the psychosocial needs of CKD patients lies at the heart of the answers to many identified questions.
Highlights
Emerging evidence of psychosocial problems in Chronic Kidney Disease (CKD) patients has led to an acceptance that a focus on the emotional wellbeing of the patient should be included in the provision of comprehensive CKD care
The four main providers of psychosocial services in the nephrology setting were identified as social workers (35.6, 95% confidence interval [Confidence Interval (CI)] =28.8, 42.8), psychologists (34%, CI = 27.3, 41.2), counsellors/psychotherapists (15.7%, CI = 10.5, 20.7) and youth workers (5.2%, CI = 2.1, 8.4)
The results from this mapping show great variability in models of service provision. It appears that the lack of clear policies and guidelines about the provision of psychosocial services has given units the freedom to design their own models, with some units seemingly prioritising psychosocial care more than others
Summary
Emerging evidence of psychosocial problems in CKD patients has led to an acceptance that a focus on the emotional wellbeing of the patient should be included in the provision of comprehensive CKD care. It is unclear if an increased attention for psychosocial needs in guidelines and policy documents has led to a rise in psychosocial staffing levels or change in composition of staff since the last workforce mapping in 2002. In CKD patients, depressive symptoms were found to be independent predictors of adverse clinical outcomes, including faster progression to end-stage-renal disease and RRT, increased hospitalization, and mortality [14, 15]
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