Evaluation of the Psychological and Pedagogical Audio Therapy Methodology for Haemodialysis Patients
This valuable piece of research carried out by Prof Nina P. Vanchakova and her team at the First St Petersburg State Medical University offers yet another tool to support patients make the psychological adjustments necessary to see this life giving treatment (haemodialysis) in a more positive way.

Those working with haemodialysis patients are well aware of the demands — both physical and psychological — made on patients when on haemodialysis treatment. As the research points out it is a time of uncertainty, loss of independence and other psychological trauma. This requires each patient not simply to adjust to the physical demands made on them but also confront the psychological aspect, which in time, will lead to the patient making the necessary psychological adjustments necessary to live well on dialysis. This adjustment process takes time and for some patients it will take a lot of time. Much depends on the patient’s circumstances; for some it may mean some not too significant adjustments, while for others it may demand a complete change in lifestyle which can usher in other psychological and personal difficulties that have to be confronted and dealt with, for example, loss of identity or loss of employment due to the condition. This is clear to anyone working with haemodialysis patients, the question is, however, what support mechanisms can be accessed and offered to patients within the limits that each dialysis unit has to live with.

It has long been recognised, and this piece of research adds to that recognition, that providing psychological support by a specialist in the field offers unique support to the patient in the adaptation process to life on haemodialysis. This piece of research is framed within the context of holistic care, which includes not only the physical care of patients but also their educational and psychological needs. This framework is important to keep in mind, the patient is seen as a 'whole person' with many different and diverse needs, all of which need to be addressed if holistic care is the model offered.

There are different ways of offering psychological support and audiotherapy is yet another valuable method which can be employed. As the research shows audiotherapy can act as an incentive, stimulating both the patient’s memory and imagination which results in a more positive patient experience. Key to making this form of psychological support of value is the educational component. The research points out that it is not simply by providing musical pieces suitable to the patient that is of value but also that "pre and post listening work should take place". In other words, helping the patient to utilise the positive results brought about by this support mechanism. This research underlines the importance of the role of the 'specialist' in both helping the patient decide what music/sounds of nature would be to their benefit and afterwards enabling the patient build on the positive results achieved through this form of therapy. The work of the 'specialist' is vital if this form of support it to achieve its aims.

The research results show that the provision of audiotherapy — whether it is through music or sounds of nature — promotes a positive patient experience. For example, one of the more common complaints of patients is the level of boredom they experience while on dialysis. The provision of audiotherapy, according to this research, led to 88% of patients feeling that the "time went quicker" on dialysis, alleviating to some degree that sense of boredom many patients complain about.

What comes across clearly from this research is that the patient is front and centre. It is patient led, and if this form of therapy is to be offered, it may affect the rhythm of the dialysis unit. This may call from some minor adjustments to the working of the unit. The value of this form of therapy is attested to by this piece of research. The results reflect the positive impact it had on patients which suggests a more positive experience for those on haemodialysis.

Personal Opinion

I have long advocated for the provision of robust psychological services for patients on dialysis. There is a general acceptance among those working in dialysis that diagnosis and treatment does have psychological consequences that need to be addressed. In my opinion, such services must be led by a qualified professional, described in this article as 'a specialist'. I would also include under the title 'specialists'; psychologists, psychotherapists, counsellors and social workers. Failure to address the psychological distress of patients is, as I see it, a failure to adequately care for the patient.

The background to this research is the recognition by Professor Vanchakova and her team of the fact that being on haemodialysis has negative psychological consequences and that these need to be acknowledged and addressed. This piece of research adds to that body of evidence of the need to be innovative in thinking about how to address the often myriad psychological needs of the patient. The goal, as always, is to make the patient experience of this necessary treatment as positive and as life-giving as possible.

This research raises two points which I believe should be recognised and underlined. Firstly, in offering psychological support through audiotherapy, the patient’s needs are paramount. What I mean by this is that we all have our own individual tastes in music. There is little point providing a particular style of music to a patient if they don’t like it. In order to have the necessary positive impact, as this research points out, the music provided must be tailored to the musical tastes of the patient. The results of this research clearly point to the value and necessity of doing this.

The second point of importance is; what Professor Vanchakova describes as the educational component. The meaning of this is specific. While the music itself has a positive impact, in order for it to have maximum affect, 'the specialist' - as Professor Vanchakova describes them — role is to help and support the patient utilise to the full the positive results of this form of therapy.

It is obvious from this research that if this form of therapy was to be made available to patients in a haemodialysis unit it requires the employment of a suitably qualified person who will have the time to assess the patient’s needs and follow-up — the educational component — to ensure that the full positive effect of this therapy is maintained.

I applaud the work done by Professor Vanchakova and her team. This research should be widely circulated and should add to the discussion on the provision of robust psychological services for patients on haemodialysis. The question, as always, will be; will the necessary resources be made available so that this form (among others) of therapy will be available to patients?
Mike Kelly
EDTNA/ERCA Psychological Care Consultant
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