Developing an in-house resource for clinical social work services in the dialysis setting: a pilot program

In 2005, the Renal Care Group's social work department in Arizona launched a pilot program to show the viability of an in-house resource for clinical social work services to address depression and treatment adherence among hemodialysis patients. Sixty-three participants were divided into an intervention group that was counseled by a licensed clinical social worker over a span of 3 months and a comparison group that received no additional services. Quantitative data were collected by using the Center for Epidemiological Studies-Depression scale, the short form of the Kidney Disease Quality of Life survey, and attendance records. Qualitative data were collected as narrative descriptions of patients' reasons for missing treatment time, their readiness for change, and the benefits they observed with improved adherence. Although no significant differences in outcomes were found between the intervention and comparison groups, women and patients with catheters were significantly more depressed than men and patients with fistulas. The qualitative data indicated that loss of confidence in the healthcare team undermined adherence even though patients described the potential benefits of dialysis in terms of increased energy, emotional well-being, and the ability to resume familiar activities. The findings supported the feasibility of establishing a clinical role within the social work department that would be dedicated to clinical social work practice in the dialysis setting.