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Sixty children and adolescents in end-stage renal failure who were undergoing either haemodialysis or continuous ambulatory peritoneal dialysis at one of five United Kingdom dialysis centres were assessed on psychosocial adjustment and adherence to their fluid intake, diet and medication regimes. Parental adjustment was also measured and data on sociodemographic and treatment history variables collected. A structured family interview and standardised questionnaire measures of anxiety, depression and behavioural disturbance were used. Multiple measures of treatment adherence were obtained, utilising children's and parents' self-reports, weight gain between dialysis, blood pressure, serum potassium level, blood urea level, dietitians' surveys and consultants' ratings. Correlational analyses showed that low treatment adherence was associated with poor adjustment to diagnosis and dialysis by children and parents (P < 0.01), self-ratings of anxiety and depression in children and parents (P < 0.001), age (adolescents tended to show poorer adherence than younger children, P < 0.001), duration of dialysis (P < 0.05), low family socioeconomic status (P < 0.05) and family structure (P < 0.01). These findings demonstrate the importance of psychosocial care in the treatment of this group of children. Future research should develop and evaluate psychosocial interventions aimed at improving treatment adherence.

Seventy-three children and adolescents in end-stage renal failure (ESRF) undergoing haemodialysis (n = 32), continuous ambulatory peritoneal dialysis (CAPD) (n = 28) or with a functioning transplant (n = 13), were assessed, with their parents, on adjustment to dialysis and psychological functioning. Quantitative assessment techniques were used; the three treatment groups were compared using the Mann-Whitney U test. Findings showed a number of advantages of transplantation over dialysis, and of CAPD over haemodialysis. Children with transplants suffered less functional impairment (P = 0.007), less social impairment (P = 0.001) and fewer practical difficulties associated with treatment (P = 0.000) than children undergoing dialysis. Parents of children with transplants also reported fewer practical difficulties than parents of children on dialysis (P = 0.002). Dialysis and transplant groups did not differ on children's or parents' reports of psychological stress associated with treatment, parents' reports of marital strain, children's and parents' levels of anxiety and depression or children's behavioural disturbance. Compared with children undergoing hospital haemodialysis, those using CAPD suffered less social impairment (P = 0.004), reported better adjustment to dialysis (P = 0.031) and fewer practical problems associated with treatment (P = 0.005), had lower depression scores (P = 0.054), and showed less behavioural disturbance (P = 0.013). Parents of children undergoing either CAPD or hospital haemodialysis reported similar practical difficulties, psychological stress or marital strain associated with treatment, but mean depression and anxiety scores were lower in the parents of children undergoing CAPD (P = 0.042 and P = 0.054).(ABSTRACT TRUNCATED AT 250 WORDS)

We make three recommendations based on the conclusion that improvements could be implemented in the psychological aspects of stoma care and, in particular, the enabling of patient perceived self-efficacy. First, improvements could be made in doctor-patient communication with doctors becoming more aware of their psychological impact on patients. Second, specialist stoma care nurses could be trained to recognize patients with dysfunctional self-efficacy beliefs and/or delayed psychological adaptation. Finally, we identify a need for more prolonged practical and emotional support for at least some stoma out-patients.