Systematic screening guided management of psychosocial distress to reduce distress, to improve Health Related Quality of Life and to facilitate access to psychosocial care among patients with advanced chronic kidney disease

We are planning a study to test the following primary hypothesis: a systematic, screening guided management of psychosocial distress in patients with advanced chronic kidney disease (CKD) will reduce psychosocial distress and improve health related quality of life.

Patients CKD experience a wide range of psychosocial stressors in relation to the intrusiveness of both their underlying medical condition and the intrusive nature of the renal replacement therapies, including maintenance dialysis. Clearly, these stressors also have an impact on the family and caregivers of the patient, which requires a complex bio-psycho-social approach in the whole-person care of patients with CKD.

Findings from an extended body of recent studies highlight not only the alarmingly high prevalence of mental health and psychosocial concerns among this patient population, but also demonstrate a concerning association between psychosocial co-morbidity and clinical outcomes (including morbidity and mortality). Although current guidelines appreciate the role of symptom management, psychological care and spiritual care in the “comprehensive conservative management” of CKD, currently no systematic approach is utilized to target these concerns in the routine clinical management of patients with CKD.  Distress is considered the “6th vital sign” endorsing the expectation that it is assessed as a standard of care in oncology care. The effectiveness of systematic distress screening and appropriate management has been demonstrated in patients with malignancies.

The Distress Assessment and Response Tool (DART) was originally designed for use in oncology patients, developed by Dr. Madeline Li and co-workers at Princess Margaret Cancer Centre, University Health Network (UHN). It is an electronic screening tool for physical symptoms, depression, anxiety, and practical concerns linked to an inter-professional distress response triaged to the level of distress. DART was successfully implemented at Princess Margaret Hospital between 2010-2012 and is now part of standard care for all patients throughout the treatment trajectory.  DART implementation was feasible and highly acceptable to both patients and staff, and the program was shown to increase patient satisfaction with care, patient-physician communication, and access to psychosocial care. DART offers a comprehensive assessment of psychosocial distress and a systematic multidisciplinary approach to care which has promise in a nephrology setting.

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