Ms Angela Daffey1, Mr Matthew Harvey1, Dr Louis Huang1
1Eastern Health Integrated Renal Service, Box Hill, Melbourne, Australia
Needle phobia is a common issue amongst patients training for home haemodialysis. A validated method of identifying patient barriers is through the use of motivational interviewing (MI). We discuss two cases using this technique.
A case study comparison of two Eastern Health renal patients with complex needle phobia issues was conducted (Mr B, 72 yo male, and Mrs T, 57yo female). A multi-disciplinary team comprising the home dialysis nurses, doctor, dietitians and psychologist were involved in the patients’ home haemodialysis training. The psychologist used MI techniques during clinical interviews with the patients to help determine their motivations for home dialysis, and identify potential barriers.
Despite several occasions when he was ready to give up, Mr B successfully completed his home dialysis training and needles independently. He has been performing home dialysis for over two years. By contrast, Mrs T struggled to progress with her home dialysis training and made the decision to transfer to satellite haemodialysis. This was due to a combination of ongoing needling problems and psychosocial issues that made her home environment unsuitable. Her wishes were respected and supported by the home dialysis team.
In both of these cases the multi-disciplinary home dialysis team provided a consistent model of care, following the principles of MI. According to the MI tenet “honouring patient autonomy” it is the patients who ultimately decide what they want to do.
After many years of working as an accountant in the corporate sector, I sought a new direction and retrained as a health psychologist, graduating in 2013. I commenced in the role of renal psychologist with EHIRS in late 2016, and enjoy working with a combination of both dialysis and transplant patients. My previous job roles and areas of interest in the health psychology field include chronic pain and chronic disease management; health behaviour change; infertility and perinatal counselling; and oncology.