Spiritual Deserts in the Dialysis Unit: A Mixed-methods Needs Assessment of Psychological Distress and Spiritual Coping among Hemodialysis Patients in Kerala, India

Description

Vinod Joseph and Clarissa F. Delariarte (Department Clinical Psychology, University of Santo Tomas, Manila, Philippines)

Patients receiving maintenance hemodialysis for end-stage renal disease often experience significant psychological distress, yet their spiritual resources to cope is overlooked in renal care. In Kerala, India, where spirituality and religion play a crucial role in managing life, there is a “spiritual desert” for HD patients. A convergent mixed-methods research study assessed the psychological distress, spiritual well-being, and spiritual coping strategies of 267 HD patients across five units in Kerala. Data were collected using the K10 scale, the FACIT-Sp-Ex scale, and interviews and focus group discussions with the patients and expert care providers. More than half of the patients in this study experienced high levels of psychological distress (55.1%; K10 = 30.89), exhibited low levels of spiritual well-being (mean FACIT-Sp-Ex = 41.24), and indicated that their levels of spiritual well-being were negatively correlated with their psychological distress (r = -.285, p <.001). Qualitative study indicated the contributing factors to the patients’ low spiritual well-being included fatigue, the role disruption due to their sickness, the financial pressures and treatment costs, and the neglect that they felt their psychological distress received from the care providers in hemodialysis clinics. The spirituality of these patients is high but ineffective in addressing their psychological distress. Accordingly, incorporating spiritual strategies into the care that is provided to these populations is crucial. The findings of this research support the need for an integrated care model for HD patients, such as the development and implementation of the SHANTI (Spirituality-enhanced Holistic Approach for Nurturance and Treatment Integration) program.