SP370
PSYCHOSOCIAL NEEDS AND CHARACTERISTICS OF CKD PATIENTS ATTENDING A PREDIALYSIS CLINIC FOR THE FIRST TIME

Introduction and Aims: Chronic kidney disease stage 4 and 5 can often be associated with a greater symptom burden and more restrictions to individuals’ daily functioning. In the UK, patients at these stages are routinely referred to an ‘Advanced Kidney Care’ (AKC) or ’Low Clearance Clinic’. In addition to having to adjust to a new team and pathway (e.g. more frequent hospital appointments), patients and families are also called to make significant decisions about their future, sometimes facing the prospect of long-term dialysis and/or transplantation. Despite this being a significant ‘transition’, little is known about the potential physical and psychosocial difficulties experienced by this population. The present study aimed to investigate this as well as look at individual factors associated with such difficulties.

Methods: Individuals referred to an AKC clinic between 2012 and 2013 were identified and asked to complete a self-report questionnaire during their first appointment to the clinic. The questionnaire, developed by Dr J Cove, Consultant Clinical Psychologist, included physical and psychological symptoms (low mood and anxiety) and also asked patients about their understanding of their condition and overall ability to adjust to it and make decisions about their future treatment. Completed questionnaires were collected at the end of the clinic and data was analysed using SPSS vs 22.

Results: Forty three patients completed the questionnaire (56% men, median age= 67 years). Tiredness and skin problems were the most commonly reported physical symptoms, identified by 60% and 58% of the sample, respectively. A little more than half of the sample (54%) reported feeling anxious in the past month and a third reported low mood. Fifty three percent reported difficulties accepting their condition and making decisions about the future. There was a trend for women and people of a working age (<65 years) to report higher levels of psychological distress (low mood and anxiety).

Conclusions: Although for many patients, a referral to an AKC clinic may be seen as a routine and expected transition, the present results indicate that a proportion of people may struggle to come to terms with their condition and experience emotional difficulties, particularly anxiety. The latter could be linked to the uncertainty surrounding their future, poor understanding or information about their illness as well as having to face important decisions with respect to future treatments. Although the small size of the sample precludes us from drawing general conclusions, findings highlight the importance of focusing - in addition to the medical needs of this population - on potential adjustment difficulties and signs of psychological distress. This could mean offering routine psychological screening to all patients during their first visit to the AKC clinic so that those at risk of experiencing psychological difficulties can be promptly identified and referred for more specialist psychological input.