Needle Fears In Dialysis Treatment: Implications for Social Work Practice

BACKGROUND AND PURPOSE: Federal Medicare regulations require a Master's level social worker in every U.S. dialysis clinic because of the many psychosocial barriers to optimal dialysis outcomes. Needle fears, which constitute a significant treatment barrier for many dialysis patients, impede the national Fistula First Breakthrough Initiative's crucial efforts to reduce the number of hemodialysis patients who use central venous catheters (CVC) compared to permanent vascular accesses. CVC use among hemodialysis patients is associated with greater infection rates (Nassar & Ayus, 2001), a higher risk of hospitalization (Lacson et al., 2010), higher rates of morbidity and mortality (Astor et al., 2005), and a lower quality of life (Wasse et al., 2007), compared to using a permanent access. Needle fear is a common condition in the general population (Bienvenu & Eaton, 1998) that inhibits patients from receiving optimal medical care (Ost, 1992). For example, in a study of hemodialysis patients, 47% reported that their needle phobia served as a barrier to doing self-care dialysis (McLaughlin et al., 2003). The aim of this pilot study was to determine the prevalence of needle fear in hemodialysis patients.

METHODS: A convenience sample of 134 hemodialysis patients was obtained from three community-based clinics. The sample was predominantly male (64.9%), ethnically diverse (48.4% White, 42.1% African American, 18.8% Hispanic), with mean age = 59.6 years and mean time on dialysis = 2.70 years. The majority of patients (97, 72.4%) dialyzed with a permanent access and 37 dialyzed with a catheter. This study administered a survey that contained 33 items developed by the researchers and the 17-item Blood-Injection Symptom Scale (BISS; Page et al., 1997). Four dialysis needle fear questions were used: (1) fear of “seeing” needles, (2) fear of “handling” needles, (3) fear of “cannulation by other”, and (4) fear of “self-cannulation.”

RESULTS: About 26% of patients reported fears of “seeing” needles and 29% reported fears of “handling” needles. More than twice as many catheter patients (30.5%) reported moderate to severe cannulation-by-other fear compared to patients with a permanent vascular access (12.4%), X (2, N = 120) = 6.97, p = 0.03. With regard to self-cannulation, the majority of patients using a catheter (66.7%) and permanent access (62.8%) reported moderate to severe fear. Further, a greater proportion of women than men reported moderate to severe self-cannulation fear in the total sample [X (2, N = 118) = 5.86, p = 0.05] and permanent access subsample [X (2, N = 94) = 6.52, p = 0.04].

CONCLUSIONS AND IMPLICATIONS: Dialysis needle fears interfere with patients getting a permanent vascular access or electing a dialysis modality such as home hemodialysis that can involve self-cannulation. These pilot findings will inform the development of clinical interventions to reduce dialysis needle fear in an effort to decrease the risks of catheter-related infections and even death. Social workers can play a key role in providing clinical interventions to help patients overcome their needle fear so that they are more likely to obtain and use a permanent vascular access for their dialysis treatment.