Burden of mental health symptoms and perceptions of their management in in-centre hemodialysis care: a mixed methods study

Kara Schick‐Makaroff; Lisa Wozniak; Hilary Short; Sara N. Davison; Scott Klarenbach; Robert Buzinski; Michael Walsh; Jeffrey Johnson

doi:10.1186/s41687-021-00385-z

October 28, 2021Journal of Patient-Reported OutcomesOpen Access

Burden of mental health symptoms and perceptions of their management in in-centre hemodialysis care: a mixed methods study

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Why the study?

The study aimed to describe depressive and anxiety symptom burdens in adults on in-centre hemodialysis and examine perceptions of managing these symptoms using routine patient-reported outcome measures.

Does routine use of patient-reported outcome measures (PROMs) improve the identification and management of mental health symptoms in adults on in-centre hemodialysis?

Structured PICO

Does routine use of patient-reported outcome measures (PROMs) improve the identification and management of mental health symptoms in adults on in-centre hemodialysis?

P

Population

408 adults undergoing chronic in-centre hemodialysis, mean age 64.0, 57% male, in Northern Alberta, Canada.

I

Intervention

Routine patient-reported outcome measures (PROMs) using ESAS-r: Renal and/or EQ-5D-5L

C

Comparator

Usual care (control group)

O

Outcome

Prevalence of depressive (PHQ-2) and anxiety (GAD-2) symptoms, and patients' and nurses' perceptions of managing these symptoms using routine PROMspatient reported

Routine use of PROMs in hemodialysis care can identify significant burdens of depression and anxiety, but effective management is hindered by differing views on care scope and a lack of mental health resources.

Implication

Routine PROM screening identifies prevalent depression and anxiety in hemodialysis patients yet management is limited by resources and scope views; extends implementation evidence in kidney care.

Abstract

BACKGROUND: 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). METHODS: A 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. RESULTS: Average 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. CONCLUSIONS: Prevalence 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.