Discussion, use of decision aids can improve mental health of patients with kidney disease
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Key takeaways:
- Patients with kidney disease are at an increased risk for mental health issues.
- Allowing patients to choose their treatment plan can improve their mental health.
With May serving as Mental Health Awareness Month, Healio spoke with experts to discuss how nephrologists and dialysis staff can improve the mental health of patients with kidney disease.
According to Dori Schatell, MS, from the Medical Education Institute, 20% of patients on dialysis were clinically depressed in 2010.
“It’s now 40%,” she told Healio.
In the past decade, research has revealed that COVID-19 had a negative impact on the mental health of patients with chronic kidney disease. Additionally, nearly half of young adults with kidney failure report issues with mental health.
However, these reported increases might not be catching all patients experiencing mental health issues.
According to Rajnish Mehrotra, MD, MS, division head of nephrology at the University of Washington School of Medicine, the Medicare mandate for depression screenings has increased awareness in nephrology, but “it is not picking up the full scope of depression in people.”
Both Schatell and Mehrotra discussed how the mental health of a patient on dialysis can radically affect their treatment outcome. For example, a patient with depression may be less likely to adhere to medication and might ask to stop treatment, Schatell said. However, it is not common for a patient to disclose symptoms of depression or other issues without being asked.
Therefore, it is up to the medical staff to take notice and consider signs of depression.
Talk about mental health
“In my experience, patients often don't bring up issues regarding their symptoms, including mental health, in conversations with nephrologists,” Mehrotra told Healio. “Nephrologists have not thus far frequently engaged in conversations to understand the patients better, and as a result of that, a lot of mental health issues are left unsaid in that patient-physician encounter.
Do patients feel empowered to talk about this in routine clinical care? I am worried [that the answer is] not quite yet.”
If patients do not share their experiences with nephrologists, research has revealed that peer mentorship programs can provide a comfortable space for this.
As Healio previously reported, a program tested by Satellite Health paired new patients on dialysis with mentors to talk about their lived experiences with dialysis. Mental health was among the many topics covered, and 86% of participants indicated that they wanted to continue the mentorship. Moreover, mentees reported the mentorship helped with anxiety.
Elizabeth Witten, advisory board member of the National Dialysis Accreditation Commission, suggested that dialysis facilities offer support groups.
“There are support groups that can improve depression and feelings of hopelessness in spite of having kidney disease. They give patients the ability to have a full life and enjoy the things they want,” Witten told Healio. “Not only can support groups improve patient outcomes, but they can also save hospitals money.”
Still, nephrologists have the ability to diagnose patients and provide them with the treatment they need.
“I hear some people say, ‘The burden of disease is so high, it’s not a surprise that a patient is depressed. If I had all of this going on, I'd be depressed as well,’” Mehrotra said. “The question then is: What is the solution?”
Decision aids
“There are seven ways to do dialysis, plus transplant, plus conservative management, depending on who you are, and at what stage of life and what your goals are,” Schatell said. “One of those may be a better fit than the others. But 85% of people are still ending up doing standard in-center hemodialysis, which is the harshest treatment with the most side effects, the poorest quality of life and the worst survival.”
In 2022, the Medical Education Institute released a free online tool called My Life, My Dialysis Choice for patients on dialysis. It is designed to match patient values to the modality that is best for them. The goal is to inspire hope and prevent depression.
Schatell encourages nephrologists to use this tool with patients when diagnosing kidney failure to help prevent depression. Not only does the tool allow providers to get to know their patients, it gives insight into what patients want out of their care.
By being aware of the mental health issues kidney disease and its treatments can cause, nephrologists can be proactive in bettering their patients’ health and overall lives.
“In my perfect world,” Schatell said, “people consistently and systematically use our free evidence-based decision aid to help patients make a better choice and that would reduce depression.”
References:
Decision aids give patients with chronic kidney disease hope. https://www.healio.com/news/nephrology/20220305/decision-aids-give-patients-with-chronic-kidney-disease-hope. Published March 5, 2022. Accessed May 13, 2023.
Dialysis peer mentorship program feasible, beneficial to patients. https://www.healio.com/news/nephrology/20230306/dialysis-peer-mentorship-program-feasible-beneficial-to-patients. Published March 5, 2023. Accessed May 12, 2023.
Limited research, guidance on depression screening tools for patients with kidney failure.
https://www.healio.com/news/nephrology/20201120/limited-research-guidance-on-depression-screening-tools-for-patients-with-kidney-failure. Published Nov. 20, 2020. Accessed May 12, 2023.
Nearly half of young adults with kidney failure self-reported issues with mental health. https://www.healio.com/news/nephrology/20230427/nearly-half-of-young-adults-with-kidney-failure-selfreported-issues-with-mental-health. Published April 26, 2023. Accessed May 12, 2023.
Patients with CKD report COVID-19 negatively affected mental health, quality of care. https://www.healio.com/news/nephrology/20220418/patients-with-ckd-report-covid19-negatively-affected-mental-health-quality-of-care. Published April 18, 2022. Accessed May 12, 2023.
Valuing patients’ dialysis preferences, reported symptoms improves their lived experiences. https://www.healio.com/news/nephrology/20230415/valuing-patients-dialysis-preferences-reported-symptoms-improves-their-lived-experiences. Published April 15, 2023. Accessed May 12, 2023.
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