S 19 Parallel Session

GUEST SPEAKER

Patient centred renal care - perceptions from the patient perspective
M. Kelly^1
1Irish Kidney Association, Dublin, Ireland

Background
With the development of the dialysis machine the possibility of life saving treatment became a reality. Yet from the very beginning, while the physical needs of patients could be met through dialysis, there was a growing recognition that dialysis treatment brought with it psychological trauma. This psychological trauma finds expression in many different ways, for example, aggression and anger, depression, fear, non-adherence to diet and medication. It is often the nurse or allied health professional who has to contain the psychological trauma their patients experience. This they do in a variety of ways, sensitivity to patient needs, listening and understanding and giving time. Yet are there other areas that are overlooked, not because we miss them but perhaps because they are too obvious. In this presentation some of these areas will be illustrated and explored enabling a deeper understanding of the significant impact they have on our patients and on their accommodation to treatment regimes. The hope is that this will lead to a deeper understanding and awareness of what our patients experience leading to a more holistic approach to their care.

BIOGRAPHY OF THE GUEST SPEAKER

O 34
Assessment of depression and anxiety in patients with chronic kidney disease on dialysis
A. Gomes¹, F. Loureiro¹, M. Machado¹, F. Vieira¹, J. Fazendeiro Matos^2
1NephroCare Dialysis Centre Braga, Fresenius Medical Care, Braga, Portugal; ²NephroCare Nursing Care Management, Fresenius Medical Care, Porto, Portugal

Background: In Europe, Portugal ranks first in terms of the percentage of its population suffering from mental illnesses. Chronic kidney disease is an irreversible health condition involving an increased risk for the onset of depression and/or anxiety due to its effects on patients’ well-being and their social role.
Objectives:
- To assess depression and anxiety in patients of a Portuguese dialysis clinic
- To describe different relationships among depression, anxiety, medication, clinical, and socio-demographic variables
Methods:We conducted a descriptive, exploratory quantitative study. The Hospital Anxiety and Depression Scale was applied to 60 patients on dialysis for more than one year and able to answer verbally.
Results: In more than half of the patients depression and anxiety were not observed. About 27% exhibited depression or were at risk, and 36.7% exhibited or were at risk of developing anxiety. We found statistically significant positive correlations between anxiety and depression. About 50% of the patients reported taking anxiolytics while antidepressants were only used in rare cases. Female gender, age, time on haemodialysis and co-morbidities were positively related to anxiety and depression. Higher levels of anxiety were related to intradialytic events. Living alone or in foster care was determined as risk factors for anxious or depressive states. In contrast, family support and satisfaction with the health care team seemed to be protective elements.
Conclusion/Application to practice:About one third of our chronic kidney disease patients exhibited depression and/or anxiety or were at risk for these conditions. Systematic and periodic assessment of anxiety and depression levels allows us to identify patients concerned.

Disclosure: No conflict of interest declared

O 35
Spiritual well-being of dialysed people with end stage renal disease
F. Loureiro¹, A. Gomes¹, M. Machado¹, F. Vieira¹, J. Fazendeiro Matos^2
1NephroCare Dialysis Centre Braga, Fresenius Medical Care, Braga, Portugal; ²NephroCare Nursing Care Management, Fresenius Medical Care, Porto, Portugal

Background: The consequences of ESRD may result in suffering, anxiety and depression for the patient. Spiritual well-being of people with chronic illness helps them to see a sense in the suffering caused by the disease and to maintain hope and optimism.
Objectives:To analyse patients’ spirituality, anxiety and depression, medication, clinical and socio-demographic variables and to describe relationships among these factors.
Methods: In 60 patients on dialysis for more than 1 year, we applied the evaluation scale of spirituality in health contexts with two subscales - beliefs and hope/optimism - and the hospital anxiety and depression scale. We collected socio-demographic and clinical data.
Results:Patients with a higher spirituality were mostly female, reported less anxiety and depression, higher education, better economic situation and took less anxiolytic and antidepressant medication. Patients who had been on dialysis for a longer period suffering from progressive kidney disease were those with the lowest level of spirituality, with less hope and optimism for the future. Patients without any co-morbidity and those who claimed that the treatment sessions went well had higher levels of spirituality. There was a statistically significant relationship between age and the scale of beliefs, support of family and friends and hope/optimism.
Conclusion/Application to practice: Patients’ spirituality was associated with better wellbeing, lower levels of anxiety and depression and lower consumption of drugs. Spirituality might have been developed by the patients as a coping mechanism and may improve patients´ quality of life.

Disclosure: No conflict of interest declared

O 36

Association between home haemodialysis and cognitive function, quality of life, anxiety, and depression
E. Badak¹, M. Varilsuha², M. Can¹, B. Günes³, F. Ersoy⁴, F. Calisir⁵, I. Hasturk³, S. Momin Adam⁶, C. Demirci^2
1Karsiyaka Dialysis Center, Fresenius Medical Care, Izmir, Turkey; ²Ege Nefroloji Dialysis Center, Fresenius Medical Care, Izmir, Turkey; ³Avcılar 2 Dialysis Center, Fresenius Medical Care, Istanbul, Turkey; ⁴Tatil Dialysis Center, Fresenius Medical Care, Antalya, Turkey; ⁵Bolu Dialysis Center, Fresenius Medical Care, Bolu, Turkey; ⁶Yuregir Dialysis Center, Fresenius Medical Care, Adana, Turkey

Background:Despite technical progress in dialysis, haemodialysis patients still have restrictions in their quality of life (QoL) and life expectancy. This may be improved by means of flexibility in choosing treatment time and by prolonged treatment times.
Objectives:To evaluate cognitive function, QoL, anxiety, and depression in nocturnal home haemodialysis (HHD) patients (3 times / week, 7-8 hours in comparison to conventional in-centre haemodialysis three times / week).
Methods: From 30 centres the following patients were randomly chosen: 136 patients with a mean time on home-HD of 13±4 months and 199 conventional haemodialysis patients with a similar age, gender, time on haemodialysis, and diabetes frequency as controls. We applied the SF-36 QoL test, standardized “mini mental test” to assess cognitive function and the Hospital Anxiety and Depression Scale. Comparison of data was performed using the t-test.
Results:The following significant results were observed:
-      All mental health and QoL parameters were better in home haemodialysis patients, e.g. QOL scores were 77.0±25.9 vs. 66.6±27.7 for physical functions, 80.7±23.2 vs. 74.7±27.0 for social functions, and 64.2±22.8 vs. 52.1±25.9 for general health perception when comparing HHD treated patients with patients treated at the centre.
-      Home haemodialysis patients had lower anxiety and depression scores.
Conclusion/Application to practice:In our study prolonged HHD was associated with better QoL, physical and social performance, cognitive and emotional status as compared to conventional in-centre HD, although a causal relationship cannot be claimed because the study was not randomized.

Disclosure: No conflict of interest declared

O 37
Family support and family burnout in haemodialysis patients
H. Demirbilek¹, A. Kutan Fenercioglu², N. Cekin², B. Salman¹, F.N. Ozdemir Acar^3
1Dialysis Unit, Baskent University Medical Faculty, Istanbul Hospital, Istanbul, Turkey; ²Department of Family Medicine, Baskent University Medical Faculty, Istanbul Hospital, Istanbul, Turkey; ³Department of Nephrology, Baskent University Medical Faculty, İstanbul Hospital, Istanbul, Turkey

Background: In our study, we aimed to demonstrate the level of family support in patients with Chronic Renal Failure (CRF) and the status of family burnout. We also aimed to show whether there is a correlation between these two issues.
Methods:Fifty five CRF patients with one or more of identified criteria of psychosocial non-compliance (eating disorders, sleep disorders, drug abuse or unnecessary drug use, alcohol abuse, chronic pain, depression, hearing and visual impairment, refusal of treatment) were included in this study.  After consent of the patients and their families was undertaken, Perceived Family Support Scale questionnaires were distributed to the patients; and Maslach Burnout Inventory questionnaires were distributed to family members living with these patients. The statistical analyses in this study was performed by NCSS (Number Cruncher Statistical System) 2007 Statistical Software (Utah, USA) program. Evaluation of the data  was attended by descriptive statistical methods (mean, standard deviation, median, interquartile range); one-way variance analysis to analyse the differences between group means; independent t-test for comparison of two groups of variables with a normal distribution, and Pearson correlation test to determine the relation of variables. P value <0.05 was accepted as statistically significant.
Results: A statistically significant relationship was observed in the negative direction between Perceived Family Support Scale scores and age of dialysis (r = -0.322, p = 0.016). Families of dialysis patients at a younger age provide more support. The emotional burnout score of the economic stress group was significantly higher than the score of the  non-economic stress group (p=0,034). The mental burnout score of the economic stress group didn’t reflect  any statistical difference than the score of the non-economic stress group (p=0,686). The physical burnout score of the economic stress group was significantly higher than the score of the  non-economic stress group (p=0,015).
Conclusion/Application to practice:No evident correlation was identifiable between patients’ family support and their family burnout. But, there was a statistically significant negative correlation between Perceived Family Support Scale scores and patients’ dialysis ages. We detected that patients on dialysis at a younger age have more family support. The emotional burnout and the physical burnout were seen more often in economic stress group compared to non-economic stress group.

Disclosure: No conflict of interest declared

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