Researcher from CINTESIS – Center for Health Technology and Services Research are developing a project that uses family intervention to improve the life of patients with End-Stage Chronic Renal Failure, who are currently undergoing haemodialysis.
The project’s title is “Together We Stand”, and it has just received more than 210 thousand euros from the Portuguese Foundation for Science and Technology. Daniela Figueiredo, from CINTESIS/University of Aveiro, is the lead researcher of this study in which other researchers from CINTESIS, such as Óscar Ribeiro and Constança Paúl, are involved.
The aim is to design and evaluate a family-centered self-management intervention of disease for adult hemodialysis patients and their families. “The intervention assumes that a health condition such as End-Stage Chronic Renal Failure does not only affect the patient, but each family member and the family as a system or unit. In this sense, a psychoeducational program will be developed with the aim of enabling the patient and his/her relatives to better manage the disease and adapt to it,” explains Daniela Figueiredo.
Arranged in 6 to 8 sessions, in the form of multifamily discussion groups, this intervention should contribute to increase patient adherence to hemodialysis treatments. It is known that the prevalence of nonadherence is high. Non-adherence to fluid restriction, for example, may amount to 60%, while inadequate frequency of sessions may reach 35%.
“Hemodialysis is very tough for the person with End-Stage Chronic Renal Failure, but also for the closest relatives who represent the patient’s main source of support. The treatments require very significant changes in lifestyle because patients have to adhere to a complex treatment regimen that involves attending hemodialysis sessions three to four times a week, four to five hours per session,” says the CINTESIS researcher .
Indeed, “the family often provides emotional support, that is, the family helps to manage the emotions that result from the impact of hemodialysis treatments, helps in drug management, in the care for vascular access, in the restructuring of the whole social life, including vacation travel; the family accompanies the patient to consultations and dialysis sessions. That is, the whole family has to reorganize to adapt to this new condition and this, at times, can also lead to the overload of those who are closer.”
According to Daniela Figueiredo, “there is an association between the survival rate of these patients and the family support. For example, perception of high family support has been associated with a higher rate of utilization of health services by people with this condition. Considering this, it is also important to support family members in order to avoid disrupting the support they provide to the person with End-Stage Chronic Renal Failure. ”
It is also expected that a family-centered intervention will have more significant effects, when compared to other methods, on the psychosocial adjustment of patients and family members, helping to maintain behavioral change in the mid term and preventing the rupture of family support.
“Depression is undoubtedly one of the most important signs of maladjustment, with prevalence values ranging from 12% -40%. It has been shown that depression, in turn, is associated with poor nutrition and inadequate adherence to hemodialytic treatments and drug regimen. There are even some studies that have observed depression as a predictor of withdrawal from hemodialysis,” Says Daniela Figueiredo.
Hemodialysis is a substitute treatment for renal function used in people with impaired renal function. The others are peritoneal dialysis and renal transplantation. When the kidneys fail, hemodialysis can eliminate toxic waste from the body. Once started, it should be done until the end of life, or until a kidney transplant. In Portugal, there are about 12,000 patients undergoing hemodialysis, of which 60% are over 65 years of age.