Distress in patients with end-stage renal disease: Staff perceptions of barriers to the identification of mild-moderate distress and the provision of emotional support

Research output: Contribution to journalArticlepeer-review


  • Gill Combes
  • Johann Nicholas
  • Jyoti Baharani

External organisations

  • New Cross Hosp
  • Department of Renal Medicine, Birmingham Heartlands Hospital


Objectives: To explore staff perceptions of barriers to the identification of mild to moderate distress and the provision of emotional support in patients with end-stage renal disease.

Methods: Qualitative semi-structured interviews with staff in two hospitals (n=31), with data analysed using a hybrid approach combining thematic analysis with aspects of grounded theory.

Results: Staff appeared very aware that many patients with end-stage renal disease experience distress, and most thought distressed patients should be helped as part of routine care. However, practice was variable and looking for and addressing distress was not embedded in care pathways. Interviews identified six themes: i) staff perceptions about how distress is manifested and what causes distress were variable; ii) staff perceptions of patients could lead to distress being overlooked because patients were thought to hide their distress whilst some groups were assumed to be more prone to distress than others; iii) role perceptions varied, with many staff believing it to be their role but not feeling comfortable with it, with doctors being particularly ambivalent; iv) fears held back some staff, who were concerned about what might happen when talking about distress, or who found the emotional load for themselves to be too high; v) staff felt they lacked skills, confidence and training, vi) capacity to respond may be limited, as staff perceive there to be insufficient time, with little or no specialist support services to refer patients to.

Conclusions: Staff perceived significant barriers in identifying and responding to patient distress. Barriers related to skills and knowledge could be addressed through training, with training ideally targeted at staff with positive attitudes, but who currently lack skills and confidence. Barriers related to role perceptions would be harder to address. The study is relevant internationally as part of improving long-term condition pathways.


Original languageEnglish
Article numbere0225269
Pages (from-to)1-20
Number of pages20
JournalPLoS ONE
Issue number11
Publication statusPublished - 21 Nov 2019


  • end-stage renal disease, patient distress, emotional support, staff barriers