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postgraduate thesis: The impact of renal palliative service on patient outcomes and caregiver stress burden
Title | The impact of renal palliative service on patient outcomes and caregiver stress burden |
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Authors | |
Issue Date | 2022 |
Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
Citation | Chan, K. Y. [陳國瑛]. (2022). The impact of renal palliative service on patient outcomes and caregiver stress burden. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. |
Abstract | Patients with end-stage kidney disease (ESKD) who are not on dialysis often
experience significant symptoms and psychosocial stress, and their families also have
considerable caregiver burdens. Renal palliative care (RPC) emerges as an important
management strategy in ESKD patients not on dialysis and shows growing demands in
different localities including Hong Kong. There are substantial differences in the
healthcare set-up and culture between different localities. In this context, data regarding the effect of RPC on symptom alleviation and psychosocial issues in Asian ESKD
patients is lacking. The RPC service in Hong Kong West Cluster started in 2012. This
thesis investigated the impact of RPC on clinical outcomes and psychosocial aspects of
local ESKD patients who are not on dialysis. Anaemia is a common symptom that leads
to fatigue and acute admissions in ESKD patients. Data from this thesis demonstrated
that the use of erythropoietin-stimulating agents in RPC patients could improve
haemoglobin levels and fatigue and reduced all-cause hospitalizations. Fluid overload
is also a common complication in ESKD patients not on dialysis. My findings showed
that metolazone, when added to loop diuretics, could effectively manage fluid overload
in RPC patients. In addition, a psycho-educational programme on fluid intake was also
effective in improving fluid control, oedema, dyspnoea, sleep quality, and reduction of
hospital admissions related to fluid overload. My work also showed that sertraline
could improve itchiness that was refractory to antihistamines. Another study revealed
that a considerable proportion of RPC patients experienced pain, of which more than
50% were moderate to severe at presentation. My findings showed that the collaborative
RPC approach might help alleviate pain symptoms.
Measures implemented to improve the psychosocial wellbeing of ESKD patients
and their family included an intensified follow-up schedule under a dedicated RPC
outpatient service, as well as Advanced Care Planning (ACP) and Enhanced
Psychosocial Support (EPSS) programmes. The results showed that intensified
outpatient follow-up improved clinic attendance rates and reduced unnecessary hospital admissions. The ACP programme contributed to a high concordance rate between the
final wish of patients and the type of end-of-life care they did receive, thereby
improving patient and family satisfaction. The EPSS programme led to early
improvement of family burden and anxiety scores observable within 3 months.
The findings presented in this thesis demonstrate the benefits of RPC on symptom
alleviation, healthcare service utilization, and the psychosocial wellbeing of patients
and their family.
|
Degree | Doctor of Medicine |
Subject | Chronic renal failure - Palliative treatment Chronic renal failure - Patients - Care Caregivers - Psychological aspects |
Dept/Program | Medicine |
Persistent Identifier | http://hdl.handle.net/10722/323419 |
DC Field | Value | Language |
---|---|---|
dc.contributor.author | Chan, Kwok Ying | - |
dc.contributor.author | 陳國瑛 | - |
dc.date.accessioned | 2022-12-23T09:47:18Z | - |
dc.date.available | 2022-12-23T09:47:18Z | - |
dc.date.issued | 2022 | - |
dc.identifier.citation | Chan, K. Y. [陳國瑛]. (2022). The impact of renal palliative service on patient outcomes and caregiver stress burden. (Thesis). University of Hong Kong, Pokfulam, Hong Kong SAR. | - |
dc.identifier.uri | http://hdl.handle.net/10722/323419 | - |
dc.description.abstract | Patients with end-stage kidney disease (ESKD) who are not on dialysis often experience significant symptoms and psychosocial stress, and their families also have considerable caregiver burdens. Renal palliative care (RPC) emerges as an important management strategy in ESKD patients not on dialysis and shows growing demands in different localities including Hong Kong. There are substantial differences in the healthcare set-up and culture between different localities. In this context, data regarding the effect of RPC on symptom alleviation and psychosocial issues in Asian ESKD patients is lacking. The RPC service in Hong Kong West Cluster started in 2012. This thesis investigated the impact of RPC on clinical outcomes and psychosocial aspects of local ESKD patients who are not on dialysis. Anaemia is a common symptom that leads to fatigue and acute admissions in ESKD patients. Data from this thesis demonstrated that the use of erythropoietin-stimulating agents in RPC patients could improve haemoglobin levels and fatigue and reduced all-cause hospitalizations. Fluid overload is also a common complication in ESKD patients not on dialysis. My findings showed that metolazone, when added to loop diuretics, could effectively manage fluid overload in RPC patients. In addition, a psycho-educational programme on fluid intake was also effective in improving fluid control, oedema, dyspnoea, sleep quality, and reduction of hospital admissions related to fluid overload. My work also showed that sertraline could improve itchiness that was refractory to antihistamines. Another study revealed that a considerable proportion of RPC patients experienced pain, of which more than 50% were moderate to severe at presentation. My findings showed that the collaborative RPC approach might help alleviate pain symptoms. Measures implemented to improve the psychosocial wellbeing of ESKD patients and their family included an intensified follow-up schedule under a dedicated RPC outpatient service, as well as Advanced Care Planning (ACP) and Enhanced Psychosocial Support (EPSS) programmes. The results showed that intensified outpatient follow-up improved clinic attendance rates and reduced unnecessary hospital admissions. The ACP programme contributed to a high concordance rate between the final wish of patients and the type of end-of-life care they did receive, thereby improving patient and family satisfaction. The EPSS programme led to early improvement of family burden and anxiety scores observable within 3 months. The findings presented in this thesis demonstrate the benefits of RPC on symptom alleviation, healthcare service utilization, and the psychosocial wellbeing of patients and their family. | - |
dc.language | eng | - |
dc.publisher | The University of Hong Kong (Pokfulam, Hong Kong) | - |
dc.relation.ispartof | HKU Theses Online (HKUTO) | - |
dc.rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works. | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject.lcsh | Chronic renal failure - Palliative treatment | - |
dc.subject.lcsh | Chronic renal failure - Patients - Care | - |
dc.subject.lcsh | Caregivers - Psychological aspects | - |
dc.title | The impact of renal palliative service on patient outcomes and caregiver stress burden | - |
dc.type | PG_Thesis | - |
dc.description.thesisname | Doctor of Medicine | - |
dc.description.thesislevel | Master | - |
dc.description.thesisdiscipline | Medicine | - |
dc.description.nature | published_or_final_version | - |
dc.date.hkucongregation | 2022 | - |
dc.identifier.mmsid | 991044618505003414 | - |