1. Evaluating the Effectiveness of Social Work Interventions:
Applications with Pediatric Dialysis Patients
Christopher C. Wilson, Master of Social Work Student, Texas Christian University
Background
End-stage renal disease (ESRD), a form of chronic kidney disease (CKD), occurs when the kidneys are unable to function properly and is treated by dialysis 1,2
Two types of dialysis: peritoneal dialysis is conducted in the home environment by family; hemodialysis is conducted in a medical facility by medical staff
Statistics (2012): 14.1 out of every one million children in the United States were diagnosed with ESRD and 7,522 American children were receiving ESRD treatment 3
Children with ESRD are susceptible to having a lesser quality of life due to being at a greater risk for academic, social, psychological, behavioral, and developmental problems 4,5,6,7
Quality of life is measured using measurement tools such as the PedsQL
Results from recent studies utilizing this measure have varied in regards to identifying the greatest struggle(s) for children with ESRD 7,8,9
However, these studies all acknowledged that parents scored their children lower than the child scored themselves and that the presence of a chronic illness is a threat to one’s quality of life 7,8,9
Purpose
Examined the effectiveness of social work interventions with pediatric dialysis patients from the Nephrology and Dialysis Clinic at Cook Children's Medical Center in Fort Worth, Texas
Discussion
Initial Hypothesis: 75% of patients would see improvement in quality of life based on an increase of at least 5 points on final scores in comparison with baseline scores
Only 50% of patients met the outcome
It is important that these measurement tools are properly scored and compared on an annual basis to asses the quality of life of pediatric patients
Social work interventions should be considered and implemented alongside medical treatment to effectively address the quality of life domains: physical, social and psychological 4
Further research is required to determine factors attributing to higher/lower scores from parents in comparison to their children
Further research is needed to examine how the two types of dialysis may impact quality of life
Methods
Longitudinal panel study design
Initial sample: 30 patients ages 7-18
Participants randomly selected from an official census of current patients
PedsQL 3.0 ESRD Module child self-reports and parent proxy-reports were individually scored and averaged
Mean scores obtained were plotted and examined in order to reveal the occurrence of positive or negative changes in the quality of life for participants
Changes in quality of life were determined by an increase or decrease in overall scores
Sample Characteristics
26 participants excluded from study:
Treatment duration: N = 17, 65.38%
Incompatible measures: N = 5, 19.23%
Missing measures: N = 4, 15.38%
4 participants comprised the final sample:
Peritoneal dialysis: n = 2, 50%
Hemodialysis: n = 2, 50%
Mean Age: 14 years
Male: n = 1, 25%
Female: n = 3, 75%
White: n = 5, 100%
Hispanic: n = 2, 50%
Not Hispanic: n = 2, 50%
Results
Mean child self-report scores increased by points over the course of treatment
Mean parent proxy-report scores increased by points over the course of treatment
Parents scored higher than their children scored themselves
Peritoneal dialysis patients had an increase in scores in comparison with hemodialysis patients whose scores decreased
Limitations
Small sample size does not adequately represent the study population
Low internal validity due to no comparison or control group
Potential inability to generalize findings
References
Available upon request