How Addressing Spiritual Needs Can Improve Dialysis Treatment Adherence

Dialysis providers have long recognized the challenge of treatment non-adherence. Patients miss treatments for many reasons, including transportation barriers, competing responsibilities, financial hardship, and declining health. Yet these explanations do not fully account for why some patients gradually disengage from care while others remain committed despite facing similar obstacles.

A growing body of research suggests another important driver: spiritual and existential distress.

Patients receiving maintenance dialysis frequently experience depression, grief, hopelessness, social isolation, loss of identity, and questions about meaning and purpose. These experiences are more than emotional reactions to chronic illness. Increasingly, the literature suggests they contribute directly to treatment adherence.

The Clinical Burden of Missed Dialysis Treatments

Treatment adherence is one of the strongest predictors of outcomes among patients receiving hemodialysis.

The average patient misses approximately 15 dialysis treatments each year, and for a typical dialysis population, those missed treatments accumulate quickly. Missed treatments are associated with increased hospitalization, emergency department utilization, and mortality. For dialysis providers, they also represent lost treatment opportunities under fee-for-service reimbursement and increased total cost of care under value-based payment models.

Although treatment non-adherence is common, it is not evenly distributed across the patient population. A relatively small subgroup of patients accounts for a disproportionate share of missed treatments, suggesting that targeted interventions may produce meaningful clinical impact.

What the Research Says About Depression, Mental Health, and Spiritual Needs

Research increasingly points to psychosocial and existential factors as important predictors of dialysis adherence.

In an international study of patients receiving hemodialysis, individuals with symptoms of depression were 51% more likely to miss one or more dialysis treatments than patients without depressive symptoms (Al Salmi). Patients who missed treatments also demonstrated significantly lower Mental Component Summary (MCS) scores, indicating poorer mental and emotional well-being.

Other research has found that spiritual needs are highly prevalent among people living with chronic kidney disease. Approximately 69% report at least one spiritual need, while nearly one-third report high levels of unmet spiritual need (Davison). These needs frequently involve questions of meaning, identity, relationships, forgiveness, hope, and purpose following life-changing illness.

Taken together, these findings suggest that treatment non-adherence is not solely an operational challenge. For many patients, it is also a behavioral response to unresolved emotional, spiritual, and existential distress.

Why Existing Care Teams Often Cannot Address These Needs

Dialysis providers employ highly skilled interdisciplinary teams that include nephrologists, nurses, dietitians, and social workers. Each plays an essential role in helping patients manage a complex chronic disease.

However, spiritual assessment and longitudinal spiritual care typically fall outside the scope of these disciplines. Social workers often identify patients experiencing grief, hopelessness, or loss of purpose, but limited time and competing responsibilities can make ongoing intervention difficult. Community clergy may provide valuable religious support, but they generally are not integrated into the healthcare team or trained to document care, coordinate with clinicians, or address the complex psychosocial challenges associated with serious illness.

Professional healthcare chaplains fill this gap. Working as members of the interdisciplinary care team, they assess spiritual distress, develop individualized care plans, provide ongoing counseling and support, and communicate with referring clinicians as patients progress through care.

A Targeted Intervention for Unmet Spiritual Needs

The opportunity is to incorporate spiritual care into the care model for every dialysis patient.

Just like other psychosocial needs, providers can identify patients who demonstrate signs of spiritual or existential distress and refer them through existing clinical workflows, often from social work or palliative care teams. This approach focuses resources on patients most likely to disengage from treatment.

By addressing underlying drivers such as hopelessness, grief, depression, loss of meaning, and social isolation, professional spiritual care seeks to improve patient activation, strengthen engagement with treatment, and support continued participation in dialysis.

This mechanism is supported by both published literature and SpirituWell’s experience delivering virtual professional chaplaincy services across a national dialysis provider, where referred patients demonstrated high engagement over multiple visits and meaningful reductions in spiritual distress.

Supporting Dialysis Provider Operational Goals

Spiritual care has traditionally been viewed as an important component of whole-person care because it improves quality of life during serious illness.

Emerging evidence suggests it may also have important operational implications. By addressing one of the underlying contributors to treatment non-adherence, professional spiritual care has the potential to improve patient engagement while supporting organizational goals related to treatment adherence, clinical outcomes, and total cost of care.

As kidney treatment reimbursement continues to evolve toward value-based models, interventions that improve both patient experience and patient outcomes will become increasingly important.

Financial ROI

SpirituWell recently published a white paper exploring the relationship between spiritual distress, dialysis treatment adherence, and kidney provider organizational goals. The report reviews the clinical literature, outlines how targeted spiritual care interventions may improve adherence among high-risk patients, and demonstrates the financial ROI of spiritual care interventions.

Download the full white paper to learn more about the research, the clinical rationale behind this approach, and kidney provider financial ROI.

Learn more about how we partner with healthcare providers here:
https://spirituwell.health/partnerships/