Needle fear: A point prevalence survey of dialysis patients

Abstract

To the Editor, For adults with end stage kidney disease (ESKD) needle fear can severely affect their treatment choices and outcomes. The prevalence of needle fear in the ESKD population has had minimal evaluation. The limited research available suggests that needle distress, anxiety and phobia may result in avoidance of hemodialysis treatments including home-based options, and can be underestimated by healthcare professionals. Such avoidance of treatment may have implications for patients, immediate carers, and dialysis providers. To better understand the extent of needle fear in a chronic dialysis cohort, we surveyed English speaking patients in a large South Australian dialysis service, during each hemodialysis shift and via phone call to home hemodialysis and peritoneal dialysis patients, over the course of 1 week. We asked the question “Have you ever been afraid of needles?”; a similar question to one previously used in the study of needle fear in general practice where heightened levels of fear were identified in a patient population. The question was worded to capture both current and previous experiences of needle fear in this population. Patients were also asked “Has your fear of needles ever impacted on your choice of treatment?” and were offered the opportunity to receive further information if desired. Basic demographic data was collected. Data analyses were performed using STATA IC15 (College Station, TX, USA). The study was approved as a quality audit by the Central Adelaide Local Health Network Human Research Ethics Committee #R20180621. We collected responses from 551 of 675 eligible patients in 19 South Australian dialysis centers (10 rural, 9 urban); a response rate of 82%. The mean (SD) age was age 63 14 years, 59% of patients were male, 83% were receiving center based hemodialysis (HD), 6% were receiving home hemodialysis (HHD), 11% were receiving peritoneal dialysis (PD) and 83% of participants had a functioning arteriovenous fistula (AVF). Thirty-six percent of all patients responded that they had experienced needle fear. Needle fear was more prevalent in those receiving peritoneal dialysis (43%) compared to hemodialysis (35%). There was no statistical significance when comparing responses by access type, although needle fear tended to be higher in those with Tenckhoff (43%) than CVC (38%) and AVF/AVG (34%). The reason for this variation is not clear and requires further investigation. Gender, current age and locality of dialysis treatment were not associated with differences in needle fear (Figure 1). Of those who reported needle fear, 37% responded that needle fear had impacted their choice of ESKD treatment and 22% of these patients requested more information on coping with needle fear. Our study is the largest reported survey to confirm the high prevalence of needle fear a chronic in dialysis population. Our finding of needle fear in 36% of the cohort compares to a smaller Dutch study that observed 44% of 45 patients reported needle fear. The high level of needle fear observed in our study may be clinically significant, and highlights that needle fear may have implications on treatment adherence and the choice of treatment modality. Although not reaching statistical significance in this survey, the finding that needle fear was higher in PD patients, may reflect needle-avoidance as part of the decision making process regarding the choice of renal replacement therapy; however, this requires further investigation.