title: Renal provider perceptions and practice patterns regarding the management of pain, sexual dysfunction, and depression in hemodialysis patients.
abstract: BACKGROUND
  Although pain, sexual dysfunction, and depression are common in patients receiving chronic hemodialysis, these symptoms frequently remain untreated. We sought to characterize renal provider perceptions and practice patterns regarding the treatment of these symptoms.
  
  
  METHODS
  We surveyed renal providers whose patients were participating in a clinical trial of symptom management at nine hemodialysis units in southwestern Pennsylvania. We used Spearman's correlation to assess the association of provider characteristics with the reported frequency of providing treatment.
  
  
  RESULTS
  Overall, 27 of 35 (77%) providers completed the survey. While 21 (78%) believed symptom management to be "very" important and 23 (85%) reported spending a "moderate" to "a lot" of time managing symptoms, <50% reported treating pain and <20% reported treating sexual dysfunction or depression "most" or "all" of the time. Most providers believed it was nonrenal providers' responsibility to treat these symptoms. A greater reported comfort level managing symptoms was associated with a higher reported frequency of treating pain (r=0.6; p<0.01), sexual dysfunction (r=0.67; p<0.01), and depression (r=0.43; p<0.03). Providers who believed it was nonrenal providers' responsibility to treat these symptoms reported treating pain (r=-0.62; p<0.01) and depression (r=-0.48; p=0.02) less frequently.
  
  
  CONCLUSIONS
  Despite reporting considerable importance and substantial time managing symptoms in general, renal providers commonly describe not treating pain, sexual dysfunction, and depression in hemodialysis patients. Given renal providers' beliefs that nonrenal clinicians are primarily responsible for treating these symptoms, multidisciplinary approaches to symptom management in these patients are needed.
authors.affiliation: University of Pittsburgh, PA, USA. greenja@upmc.edu
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Green
authors.forename: Maria K
authors.initials: MK
authors.lastname: Mor
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Shields
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Sevik
authors.forename: Paul M
authors.initials: PM
authors.lastname: Palevsky
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
authors.forename: Robert M
authors.initials: RM
authors.lastname: Arnold
authors.forename: Steven D
authors.initials: SD
authors.lastname: Weisbord
mesh_terms: D003863:Depression / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010414:Pennsylvania; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D006435:Renal Dialysis / Q000009:adverse effects* / Q000523:psychology; D012735:Sexual Dysfunction, Physiological / Q000209:etiology / Q000517:prevention & control*; D020018:Sexual Dysfunctions, Psychological / Q000209:etiology / Q000517:prevention & control*; D018709:Statistics, Nonparametric