Original Investigation
Dialysis Therapy
Observational Study of an Arts-in-Medicine Program in an Outpatient Hemodialysis Unit

Presented at the American Society of Nephrology 38th Annual Meeting, Philadelphia, PA, November 10, 2005.
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Background: Long-term hemodialysis is associated with impaired quality of life (QOL) and depression, which are thought to worsen compliance with the treatment regimen. With the success of our hospital’s Arts-in-Medicine Program, we launched a similar set of activities in the long-term dialysis unit and sought to measure their effects. Methods: At baseline and 6 months, we administered the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) and Beck depression scales to 46 patients (44% men; mean age, 52 years) and assessed their percentage of achieved dialysis time, interdialytic weight gain, and predialysis laboratory results. We tested for a relationship between these variables and Arts-in-Medicine Program participation (low and high; 51% and 49%). Arts in Medicine was offered each shift, led by artists, and included artwork, crocheting, crafts, seasonal displays, poetry, and playing musical instruments. Results: At 6 months, the patients, nurses, technicians, and physicians subjectively believed that Arts in Medicine had a positive impact on the unit. In paired comparisons to baseline, there was significant improvement in SF-36 scores for Role–Physical (mean values, 34.4 to 38.7; P = 0.04), less weight gain (3.6 to 3.2 kg; P = 0.02), greater serum carbon dioxide content (20.4 to 22.5 mEq/L [mmol/L]; P < 0.01), greater phosphate levels (5.3 to 5.7 mg/dL [1.71 to 1.84 mmol/L]; P = 0.04), and a trend to less depression (Beck score, 15.3 to 12.1; P = 0.07). Regression analyses showed that high participation correlated with improved SF-36 scores for Social Function (11.1-unit increase; P = 0.01), Bodily Pain (7.6-unit increase; P = 0.04), and Role–Physical (6.6-unit increase; P = 0.06), as well as a trend to greater albumin levels (0.11 g/dL [1.1 g/L]; P = 0.08), but with greater phosphate (0.8 mg/dL [0.26 mmol/L]; P = 0.01) and lower calcium levels (0.3 mg/dL [0.07 mmol/L]; P = 0.07). Conclusion: Participation in a new Arts-in-Medicine Program correlated with improved QOL measures, and there were encouraging trends for depression, as well as certain laboratory and hemodialysis parameters.

Section snippets

Objective Measures

With Institutional Review Board approval (University of Florida, Gainesville, FL), the AIM Program was offered to all long-term hemodialysis patients (n = 96) in the UF and Shands Outpatient Dialysis Unit. Participants completed the SF-36 and Beck Depression Inventory Scales. These instruments were repeated after 6 months, with patient participation in the art program assessed by the artists (as either low or high). The extent of participation was rated subjectively because of the varied nature

Results

Sixty-three patients provided informed consent and started the AIM Program. Of these, 2 patients died and 2 patients underwent transplantation. Thirteen patients did not have a complete data set because they were missing 1 or more laboratory, dialysis, or QOL values. The remaining 46 patients stayed in our unit the entire 6-month period and were evaluated fully by means of the scoring instruments, as well as chart extraction of clinical and laboratory parameters. Patients had a mean age of 51.7

Discussion

Impaired QOL has been shown consistently in patients with end-stage renal disease on long-term dialysis therapy and has been described by using a variety of databases encompassing local,1, 3, 6, 8, 9, 10 national,2, 5 and international4 experiences. Despite the breadth of geographic, ethnic, and cultural diversity, these studies have had remarkably similar findings. Regardless of the measurement instrument (SF-36, Beck Depression Inventory, or scales unique to certain centers), dialysis

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Support: None. Potential conflicts of interest: None.

Originally published online as doi:10.1053/j.ajkd.2005.11.030 on February 2, 2006.

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