title: Enhanced Psychosocial Support for Caregiver Burden for Patients With Chronic Kidney Failure Choosing Not to Be Treated by Dialysis or Transplantation: A Pilot Randomized Controlled Trial.
abstract: BACKGROUND
  Family caregivers of patients with chronic kidney failure have increased burden, as reflected by their high frequency of physical and mental disturbances. The impact of enhanced psychosocial support to caregivers of patients with chronic kidney failure remains unclear.
  
  
  METHODS
  Open-label randomized controlled trial.
  
  
  METHODS
  All new patients referred to the renal palliative clinic were screened. Caregivers of patients who met the following criteria were recruited: (1) chronic kidney failure as defined by creatinine clearance < 15 mL/min, (2) opted for conservative management by nephrology team or patient, (3) never treated with dialysis or transplantation, and (4) able to provide informed consent.
  
  
  METHODS
  Random assignment to treatment with enhanced psychosocial support or standard renal care (control). Enhanced psychosocial support included counseling and psychosocial interventions by an on-site palliative care nurse and designated social worker. Each caregiver was followed up at 2- to 4-week intervals for up to 6 months.
  
  
  RESULTS
  Zarit Burden Inventory (ZBI) and Hospital Anxiety and Depression Scale (HADS) in caregivers and McGill Quality of Life scores in patients of both groups were compared.
  
  
  RESULTS
  29 pairs of family caregivers/patients with chronic kidney failure were randomly assigned (intervention, n=14; control, n=15). Mean ages of patients and caregivers were 81.6 ± 5.1 and 59.8 ± 14.2 (SD) years, respectively. The intervention group showed significantly lower ZBI scores than the control group at 1 and 3 months (22.0 ± 5.3 vs 31.6 ± 9.5 and 21.3 ± 6.6 vs 33.4 ± 7.2; P=0.006 and P=0.009, respectively). HADS anxiety scores of caregivers who received the intervention were significantly lower than those of controls at 1 and 3 months (7.1 ± 3.2 vs 10.1 ± 2.2 and 6.5 ± 4.5 vs 11.0 ± 3.1; P=0.01 and P=0.03, respectively). Insignificant reductions in ZBI and HADS scores were found at 6 months. 19 patients died (intervention, n=10; control, n=9) during the study period.
  
  
  CONCLUSIONS
  The study is limited by a relatively small sample size and short duration.
  
  
  CONCLUSIONS
  Enhanced psychosocial support program in patients with chronic kidney failure and caregivers resulted in an early significant reduction in caregiver burden and anxiety.
authors.affiliation: Palliative Medical Unit, Grantham Hospital, Hong Kong. Electronic address: cky842@yahoo.com.hk.
authors.forename: Kwok Ying
authors.initials: KY
authors.lastname: Chan
authors.affiliation: Renal Unit, Tung Wah Hospital, Hong Kong.
authors.forename: Terence
authors.initials: T
authors.lastname: Yip
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
authors.forename: Desmond Y H
authors.initials: DY
authors.lastname: Yap
authors.affiliation: Palliative Medical Unit, Grantham Hospital, Hong Kong.
authors.forename: Mau Kwong
authors.initials: MK
authors.lastname: Sham
authors.affiliation: Palliative Medical Unit, Grantham Hospital, Hong Kong.
authors.forename: Yim Chi
authors.initials: YC
authors.lastname: Wong
authors.affiliation: Palliative Medical Unit, Grantham Hospital, Hong Kong.
authors.forename: Vikki Wai Kee
authors.initials: VW
authors.lastname: Lau
authors.affiliation: Palliative Medical Unit, Grantham Hospital, Hong Kong.
authors.forename: Cho Wing
authors.initials: CW
authors.lastname: Li
authors.affiliation: Medical Palliative Medicine Team, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong.
authors.forename: Benjamin Hon Wai
authors.initials: BH
authors.lastname: Cheng
authors.affiliation: Renal Unit, Tung Wah Hospital, Hong Kong.
authors.forename: Wai Kei
authors.initials: WK
authors.lastname: Lo
authors.affiliation: Division of Nephrology, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
authors.forename: Tak Mao
authors.initials: TM
authors.lastname: Chan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010865:Pilot Projects; D006435:Renal Dialysis; D012944:Social Support; D016312:Treatment Refusal
keywords: Enhanced psychosocial support; Hospital Anxiety and Depression Scale (HADS); anxiety; caregiver burden; chronic kidney failure; conservative management; depression; quality of life (QoL); randomized controlled trial (RCT); renal palliative care; social support; social worker