Any chronic illness is a potential life crisis for patients and their family. Chronic renal failure is no different, in-fact it is a psychosocial as well as economic burden to the family (Jha, 2004). Proper medical care requires not only optimal biomedical outcomes, but also careful attention to psychological outcomes (Barendse et al, 2005). Psychosocial aspect has been shown to be an independent predictor of survival (Kimmel, 2000). Early identification of psychosocial problems can prevent the development of depression in these patients. Therefore, it is important to have an accurate estimate of frequency and nature of psychosocial problems faced by these patients.
Despite the long treatment regimes and costly treatment, only few psychological measure have been designed for renal patients. Most of the assessment tools available so far are from the developed world and the treatment is either state-sponsored or covered under insurance. These tools do not take into account the living conditions, social structure, and personal values of patients from the Indian subcontinent and therefore are difficult to apply in Indian patients.
We undertook this study to develop an assessment tool to estimate the extent of various& psychosocial problems in patients of chronic renal failure undergoing haemodialysis, in Indian population, which we have called psychosocial assessment tool-5 (PAT-5).
Objectives
This study sought to construct a tool for assessment and quantification of psychosocial status of renal patients in developing countries, who are on haemodialysis, waiting for renal transplantation,
Methods
Patients in age group of 18 to 60 years, undergoing haemo-dialysis and registered for renal transplantation, who were free from pre-existing depression, were included in the study. Patients with co-morbidities like primary cardiac disease and primary vascular disease and those with failed previous transplantation were excluded. Initial qualitative work and the drafting of PAT-5 included visits to haemodialysis, renal clinic and renal transplant counselling clinic of our hospital.
Patients were allowed to elaborate their problems by a single question- __ampersandsignacute;What problems you face due to this illness__ampersandsignquot;__ampersandsignmicro; Investigator acted as listener and gave direction where needed.
Major areas / themes were extracted out after writing their statements. Extensive review of literature, expert__ampersandsignmiddot;s opinion and investigator__ampersandsignmiddot;s own experience in haemodialysis unit as practicing nurse and interview findings provided the foundation for the construction of the tool. Preliminary questionnaire was prepared based on the guidelines of Maslow__ampersandsignmiddot;s Hierarchy of Human Needs (Maslow, 1943) but incorporated social and economic issues pertaining to Indian society. The preliminary questionnaire was applied to another 10 patients and their ease of understanding and response patterns were observed. Items were extended, modified taking into account the views and expressions of interviewees. Findings were analysed for the spectrum of problems faced by the patients and they were classified into five domains, including health awareness, occupation, family and social environment, financial and psychological. Tool items were constructed and compiled
The study was approved by the ethical committee of our institute and written informed consent was taken from all patients participating in the study.
Validity of the tool: The tool was thus drafted and its content validity was determined by five experts__ampersandsignmiddot; opinion on relevance of the items. Experts were from different specialties including Medical and Surgical Nursing, Psychiatric Nursing, Nephrologists and Clinical Psychologist. Items were modified and refrained and content validity.index of 100 percent was achieved.
Keywords: