This is the second part of a two part series. Read part one here.
By focusing on physiological survival measures, doctors are only able to see the most basic survival data, which has very little impact on the psychosocial health of the patient. No matter how intensely these measures are scrutinized and analyzed, the fact that patients are more than mere biological machines is largely being ignored.
There is a need to build a quality of life (QOL) model that includes the things dialysis patients find important. This is the only way to move forward and achieve a better patient satisfaction. Increased patient satisfaction will lead to better mortality outcomes.
Between one third and half of dialysis patients are at least moderately depressed (1). Alleviating depressive symptoms leads to better morbidity and mortality outcomes. By curbing only a fraction of the widespread depression and anxiety in dialysis patients morbidity and mortality rates will drop. Factoring in the high mortality rate for depressives in general, a better survival for this sub-group is inevitable.
It is time to look at the whole patient instead of looking at the disease as something isolated from the patient. By isolating the person from the disease the patient and treatment team are prevented from working together in a complementary way in the effort to restore health and wellbeing. If an intervention is solely focused on treating symptoms without acknowledging the impact the intervention has on the whole patient it is fundamentally wrong. Such treatment is a sign of a flawed system.
What can be done to improve the quality of life for people on dialysis?
The first thing treatment teams need to realize is that the present system is not working for patients. Patients’ psychosocial needs are obviously not met by the way dialysis is administered. One solution is home dialysis.
Moving out of the clinic and into the home allows the individual patient involved in their own treatment. Such a move will change the responsibility for many aspects of the treatment regime from the team to the individual. Then the personal understanding of things like diet, time on the machine and the importance of taking one’s medicine can be improved. This won’t just improve morbidity and mortality as well as many other biomarkers often monitored. It will also greatly improve the true QOL aspects important to patients: like self-efficacy treatment satisfaction, physical and spiritual wellbeing etc.
One outcome could be a more compassionate relationship between the patient and the team since there will be a greater mutual understanding of everybody’s role and interests.
However, home treatments are not for everyone on dialysis even if it could be the answer for many people. The big question is: How will nephrologists and care teams start embracing the concept of “full Maslow” care?
It is no longer enough to keep people alive. They also need to have something to live for. Most people on dialysis are so sick—partly because of inadequate treatment—they are not able to see beyond their physical survival. This directly leads patients to stop caring which in turn leads to non-compliance and a vicious cycle with higher morbidity and mortality rates.
Focusing on the whole patient will not only improve true QOL, it will also improve morbidity and mortality rates by giving patients something to live for, creating a win-win situation for patients and treatment teams.
1. Finkelstein, FO & Finkelstein, SH (2000) Depression in chronic dialysis patients: assessment and treatment. Nephrol.