Abstract
We report a patient with chronic renal failure (CRF) who had refused hemodialysis (HD) and blood access who was subsequently persuaded to accept dialysis therapy.
In March 1990, a 45-year-old male with chronic glomerulonephritis who had been undergoing treatment at another hospital since 1979 was referred to us for HD treatment. However, he refused HD and discontinued receiving medical treatment.
On June 16, he was admitted to our hospital with loss of consciousness. Emergency HD was performed under a diagnosis of uremia. His consciousness was restored and other symptoms of CRF improved. Although we stressed the importance of maintenance HD and the patient apparently understood the factors involved in this treatment, he again refused HD and blood access 5 days later.
Thereafter, from June 21 to August 31, members of our staff attempted to persuade him to accept dialysis therapy using a comprehensive consultation-liaison psychiatric approach; consisting of hospitalization, frequent counseling from a private nurse, and the supportive efforts of a therapeutic team comprised of his doctor, physicians specializing in psychosomatic medicine, and nurses.
The patient was undergoing a process of grief related to the loss of his health. Because of his lack of understanding of his condition, our explanations of renal function and HD were to no avail. We therefore made an effort to help him to control his reaction to his situation. As a consequence, although he continued to refuse HD, he did not reject us.
This comprehensive approach provided supportive understanding of his feelings and may have hastened the progress of his grief. At last he was psychologically prepared to accept HD and on September 1, faced with progressing renal anemia, he began HD therapy.
Our success in persuading this patient to accept HD therapy suggests that a supportive consultation-liaison service is a useful approach in the total health care of patients about to start HD treatment.
