Enhanced Psychosocial Support for Caregiver Burden for Patients With Chronic Kidney Failure Choosing Not to Be Treated by Dialysis or Transplantation: A Pilot Randomized Controlled Trial

• Published in: American journal of kidney diseases Vol. 67; no. 4; pp. 585 - 592
• Main Authors: Chan, Kwok Ying, MRCP (Ireland), FHKCP, Yip, Terence, MRCP (UK), FHKCP, Yap, Desmond Y.H., MD, Sham, Mau Kwong, FRCP (London), Wong, Yim Chi, RN, Lau, Vikki Wai Kee, BBA, Li, Cho Wing, MRCP (UK), FHKCP, Cheng, Benjamin Hon Wai, MRCP (UK), FHKCP, Lo, Wai Kei, FRCP (London), Chan, Tak Mao, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016
• Subjects: Adult; Aged; Aged, 80 and over; anxiety; caregiver burden; Caregivers - psychology; chronic kidney failure; conservative management; Cost of Illness; depression; Enhanced psychosocial support; Female; Hospital Anxiety and Depression Scale (HADS); Humans; Kidney Failure, Chronic - therapy; Kidney Transplantation; Male; Middle Aged; Nephrology; Pilot Projects; quality of life (QoL); randomized controlled trial (RCT); Renal Dialysis; renal palliative care; Social Support; social worker; Treatment Refusal; social support; anxiety; quality of life (QoL); conservative management; randomized controlled trial (RCT); renal palliative care; social worker; Hospital Anxiety and Depression Scale (HADS); depression; chronic kidney failure; Enhanced psychosocial support; caregiver burden
• ISSN: 0272-6386; 1523-6838
• DOI: 10.1053/j.ajkd.2015.09.021

Background Family caregivers of patients with chronic kidney failure have increased burden, as reflected by their high frequency of physical and mental disturbances. The impact of enhanced psychosocial support to caregivers of patients with chronic kidney failure remains unclear. Study Design Open-label randomized controlled trial. Setting & Participants All new patients referred to the renal palliative clinic were screened. Caregivers of patients who met the following criteria were recruited: (1) chronic kidney failure as defined by creatinine clearance < 15 mL/min, (2) opted for conservative management by nephrology team or patient, (3) never treated with dialysis or transplantation, and (4) able to provide informed consent. Interventions Random assignment to treatment with enhanced psychosocial support or standard renal care (control). Enhanced psychosocial support included counseling and psychosocial interventions by an on-site palliative care nurse and designated social worker. Each caregiver was followed up at 2- to 4-week intervals for up to 6 months. Outcomes Zarit Burden Inventory (ZBI) and Hospital Anxiety and Depression Scale (HADS) in caregivers and McGill Quality of Life scores in patients of both groups were compared. Results 29 pairs of family caregivers/patients with chronic kidney failure were randomly assigned (intervention, n = 14; control, n = 15). Mean ages of patients and caregivers were 81.6 ± 5.1 and 59.8 ± 14.2 (SD) years, respectively. The intervention group showed significantly lower ZBI scores than the control group at 1 and 3 months (22.0 ± 5.3 vs 31.6 ± 9.5 and 21.3 ± 6.6 vs 33.4 ± 7.2; P = 0.006 and P = 0.009, respectively). HADS anxiety scores of caregivers who received the intervention were significantly lower than those of controls at 1 and 3 months (7.1 ± 3.2 vs 10.1 ± 2.2 and 6.5 ± 4.5 vs 11.0 ± 3.1; P = 0.01 and P = 0.03, respectively). Insignificant reductions in ZBI and HADS scores were found at 6 months. 19 patients died (intervention, n = 10; control, n = 9) during the study period. Limitations The study is limited by a relatively small sample size and short duration. Conclusions Enhanced psychosocial support program in patients with chronic kidney failure and caregivers resulted in an early significant reduction in caregiver burden and anxiety.