Psychosocial problem assessment and end-stage renal disease patient outcomes

The diagnostic process of psychosocial problem assessment enhances the end-stage renal disease (ESRD) treatment team's ability to identify or rule out in a timely and consistent way problematic circumstances that may contribute to poorer patient outcomes, both psychosocial and medical. Psychosocial diagnostic reasoning is informed by empirical and clinical knowledge concerning the characteristic impact of psychosocial factors in illness generally and ESRD specifically. The focus and process of problem assessment is explained and illustrated with four signal medical conditions-anemia, low albumin level, inadequate dialysis, and high blood pressure-that are negative indicators for chronic dialysis (CD) patient medical outcomes. Use of a norm-referenced assessment tool and a standardized psychosocial problem list aids clinicians both in systematic identification of priority concerns and in documenting circumstances and changes for outcomes monitoring.