Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support

Autoři: Gill Combes aff001;  Sarah Damery aff001;  Kim Sein aff001;  Kerry Allen aff002;  Johann Nicholas aff003;  Jyoti Baharani aff004
Působiště autorů: Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, United Kingdom aff001;  Health Services Management Centre, University of Birmingham, Edgbaston, Birmingham, United Kingdom aff002;  New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, United Kingdom aff003;  Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225269



To explore staff perceptions of barriers to the identification of mild to moderate distress and the provision of emotional support in patients with end-stage renal disease.


Qualitative semi-structured interviews with staff in two hospitals (n = 31), with data analysed using a hybrid approach combining thematic analysis with aspects of grounded theory.


Staff appeared very aware that many patients with end-stage renal disease experience distress, and most thought distressed patients should be helped as part of routine care. However, practice was variable and looking for and addressing distress was not embedded in care pathways. Interviews identified six themes: i) staff perceptions about how distress is manifested and what causes distress were variable; ii) staff perceptions of patients could lead to distress being overlooked because patients were thought to hide their distress whilst some groups were assumed to be more prone to distress than others; iii) role perceptions varied, with many staff believing it to be their role but not feeling comfortable with it, with doctors being particularly ambivalent; iv) fears held back some staff, who were concerned about what might happen when talking about distress, or who found the emotional load for themselves to be too high; v) staff felt they lacked skills, confidence and training, vi) capacity to respond may be limited, as staff perceive there to be insufficient time, with little or no specialist support services to refer patients to.


Staff perceived significant barriers in identifying and responding to patient distress. Barriers related to skills and knowledge could be addressed through training, with training ideally targeted at staff with positive attitudes, but who currently lack skills and confidence. Barriers related to role perceptions would be harder to address. The study is relevant internationally as part of improving long-term condition pathways.

Klíčová slova:

Emotions – Fear – Chronic kidney disease – Medical dialysis – Medical doctors – Mental health and psychiatry – Nurses – Patients


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