THE EFFECT OF PALLIATIVE CARE TEAM INTERVENTION ON QUALITY OF LIFE OF PATIENTS WITH END STAGE RENAL DISEASE ON MAINTENANCE HEMODIALYSIS

Abstract

Background: Chronic kidney disease, with high prevalence, morbidity, and mortality, is an important public health problem.  Although haemodialysis improves the quality of life of patients by relieving most of the symptoms due to uraemia, they can still have lots of social, psychological, and spiritual issues which are amenable to multidisciplinary palliative care team intervention. The present study aimed to assess the effect of palliative care team intervention on the quality of life of patients with ESRD receiving maintenance haemodialysis in comparison with controls. Methodology: The present controlled clinical trial was conducted among the patients attending the dialysis unit of tertiary care hospital . Patients aged more than 18  years, undergoing maintenance hemodialysis at YMCH at least for the last 6 months,  coming for dialysis on working days (Monday to Saturday) who gave consent for the  study were included after informed consent. Patients coming on Monday, Wednesday,  and Friday were randomized to palliative care intervention. Patients coming on  Tuesday, Thursday, and Saturday were waitlisted as controls and underwent only assessments. Symptom burden was  assessed using the Palliative care need assessment questionnaire, Quality of life before  and after the intervention was measured using WHO- SF-36 and theSMiLE  questionnaire.Result: A total of 64 patients fulfilling inclusion criteria are included in the present  study .32 patients were allotted to the intervention group and 32 to the control group.  There was significant reduction in symptom burden in intervention  scores with decline in physical symptom scores from 3.56 1.77 to  2.65 2.009(p=0.002),social need score from 1.9±1.98 to 0.53 0.62(p=0.01) and  spiritual score from 6.25±3.78 to 1.31±1.28 (p=0.01) Control group also showed  significant improvement in physical scores from 4.46±3.02, to 3.28±2.65(p=0.005) Social needs from 2.21±2.02 to 0.78±0.83(p=0.01),spiritual score from 6.63±3.36 to  1.68 1.22(p=0.001).SF -36 scores also showed improvement in intervention group in  physical functioning (p=0.001), general health (p=0.001) and pain reduction (p=0.055).  SF-36 scores also improved in controls in Physical functioning (p=0.001), social  functioning (p=0.001), pain reduction (p=0.006), and in general health  (p=0.006).However there was no significant difference between the pre and post  symptom burden by YEmpathy Questionnaire and Quality of life by SF -36 between the  intervention and control groups. SMiLE Questionnaire scores improved in both groups; however, this was not statistically significant.Conclusion:  Palliative care intervention reduced symptom burden and improved quality of life significantly in the intervention group. However, this was not statistically significant