End Stage Renal Disease and Nonadherence to Hemodialysis: Evaluation of a Psychodynamic Intervention

Abstract

Background: Skipping and shortening hemodialysis treatments are common and result in increased morbidity and mortality. Objective: The goal was to test whether a psychodynamic intervention reduced the number of skipped and the minutes of shortened hemodialysis sessions. Methods: A quasi-experiment conducted at one hemodialysis outpatient center was used to test a psychodynamic intervention. The intervention was delivered weekly for eight weeks to intervention group patients (n=13). Comparison group (n=8) patients received routine care. Results: Adherence improved for the intervention group from the Before Phase to the Treatment Phase and After Phase on all outcomes. The mean number of hemodialysis sessions skipped was 1.9 in the Before Phase and .9 in the Treatment Phase (p=.01) and .5 in the After Phase (p=.01). During the Treatment Phase the intervention group skipped less than one session while the comparison group skipped 3.5 hemodialysis sessions (p<.001). Adherence did not improve for comparison group patients. Conclusions: A psychodynamic intervention may be an acceptable and effective treatment for reducing nonadherence to hemodialysis.