Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-20T11:25:14.913Z Has data issue: false hasContentIssue false
  • English
  • Français

Psychological intervention in fluid management

Published online by Cambridge University Press:  25 October 2006

LINDA FISHER ,
HUGH S. CAIRNS ,
BEHZAD AMIR-ANSARI ,
JOHN E. SCOBLE ,
TRUDIE CHALDER  and
JANET TREASURE
LINDA FISHER
Affiliation:
Academic Department of Psychological Medicine, Section of General Hospital Psychiatry, GKT School of Medicine & Institute of Psychiatry, Weston Education Centre, London, UK
HUGH S. CAIRNS
Affiliation:
King's College Hospital NHS Trust, London, UK
BEHZAD AMIR-ANSARI
Affiliation:
King's College Hospital NHS Trust, London, UK
JOHN E. SCOBLE
Affiliation:
Guy's & St. Thomas' NHS Trust, Guy's Hospital, London, UK
TRUDIE CHALDER
Affiliation:
Academic Department of Psychological Medicine, Section of General Hospital Psychiatry, GKT School of Medicine & Institute of Psychiatry, Weston Education Centre, London, UK
JANET TREASURE
Affiliation:
Department of Academic Psychiatry, Guy's Campus, London, UK
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Hemodialysis is a palliative treatment for patients with established renal failure (ERF), and volume overload is a common problem for hemodialysis patients with low urinary output. Volume overload is thought to be mostly attributable to interdialytic fluid intake by the patient and is associated with an increased symptom burden and the development of serious medical complications. Repeated episodes of volume overload may adversely affect staff–patient relationships and the perception of care in this patient population. The aim of this case series study was to evaluate the effect and experience of a psychological intervention on interdialytic weight gain in a small group of patients.

Methods: Five patients were treated. The intervention involved using techniques derived from both cognitive behavior therapy and motivational interviewing. The main outcome measures were interdialytic weight gain and patient perception of the intervention.

Results: Three of the five patients reduced both mean interdialytic weight gain and the frequency with which they gained in excess of 3% of their dry weight during the intervention phase. The intervention was found to be acceptable to patients.

Significance of results: The intervention was effective in helping three of the five patients to reduce both the frequency and the severity of volume overload, and two of these patients maintained this for at least 6 months post intervention. The intervention used actively engaged the patients and appeared to be experienced positively. The methods used to mobilize patient resources and optimize staff–patient relationships as vehicles of change are discussed. Both may have implications for treatment concordance and the perception of care delivered.

Keywords

Supportive carePatient satisfactionHemodialysisCognitive behavior therapyChronic disease management
Type
CASE REPORT
Information
Palliative & Supportive Care , Volume 4 , Issue 4 , December 2006 , pp. 419 - 424
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Department of Health. (2004). The National Service Framework for Renal Services. Part 1: Dialysis and Transplantation, DH Renal Team.
Fisher, L. (2004). Psychological factors influencing thirst and drinking in haemodialysis patients on a fluid restriction. Journal of British Association of Behavioural and Cognitive Psychotherapists, 32, 347–352.Google Scholar
Fisher, L. (2005). Enhancing effective fluid management. British Journal of Renal Medicine, 9, 21–23.Google Scholar
Kovac, J.A., Patel, S.S., Peterson, R.A., et al. (2002). Patient satisfaction with care and behavioural compliance in end-stage renal disease patients treated with haemodialysis. American Journal of Kidney Diseases, 6, 1236–1244.Google Scholar
Leggat, J.E., Orzol, S.M., Hulbert-Shearon, T.E., et al. (1998). Noncompliance in hemodialysis patients: Predictors and survival analysis. American Journal of Kidney Diseases, 32, 139–145.Google Scholar
Levy, J., Chambers, E.J., Brown, E.A., et al. (2004). Supportive care for the renal patient. Nephrology Dialysis Transplantation, 19, 1357–1360.Google Scholar
Levy, J., Morgan, J., Brown, E., et al. (2001). Oxford Handbook of Dialysis. New York: Oxford University Press.
Rollnick, S., Mason, P., Butler, C., et al. (1999). Health Behaviour Change. A Guide for Practitioners. Edinburgh: Churchill Livingstone.
Saran, R., Bragg-Gresham, J.L., Rayner, H.C., et al. (2003). Nonadherence in hemodialysis: Associations with mortality, hospitalization, and practice patterns in the DOPPS. Kidney International, 64, 254–262.Google Scholar
Sharp, J., Wild, M.R., & Gumley, A.I. (2005a). A systematic review of psychological interventions for the treatment of nonadherence to fluid-intake restrictions in people receiving hemodialysis. American Journal of Kidney Diseases, 45, 15–27.Google Scholar
Sharp, J., Wild, M.R., Gumley, A.I., et al. (2005b). A cognitive behavioral group approach to enhance adherence to hemodialysis fluid restrictions: A randomized controlled trial. American Journal of Kidney Diseases, 45, 1046–1057.Google Scholar
Zrinyi, M., Juhasz, M., Balla, J., et al. (2003). Dietary self-efficacy: Determinant of compliance behaviours and biochemical outcomes in haemodialysis patients. Nephrology Dialysis Transplantation, 18, 1869–1873.Google Scholar