Lessons from psychosocial studies of chronic renal failure.

Medical advances have resulted in considerable improvements in life expectancy and in associated morbidity for many childhood chronic conditions, but what is the cost in terms of the quality of life for the child and family and in the child's psychiatric adjustment? In many of these illnesses (for example renal failure and cystic fibrosis) treatment only ameliorates the illness. In others (for example cancer) although 'cure' of the primary disease is possible the risks of second malignancies, late recurrence, and late side effects of treatment remain. Thus even successful treatment, whether it is curative or palliative, has its burdens. There is an obligation to identify the burdens of the condition and its treatment so that all available social and psychological supports and treatments may be provided and appropriately targeted. Problems may arise that affect the child or family. They vary in complexity ranging from relatively simple problems such as coping with specific procedures and family stress to more complex problems such as the recognition of psychiatric conditions whose presentation is modified by the physical illness or non-adherence that might crucially affect the outcome. Increasing attention has been directed to this area in recent years.'" There are a number of problems in designing studies in this area. This review discusses some of the potential pitfalls and possible solutions in the context of studies of the psychosocial consequences of renal failure in children. A further purpose of this report is to emphasise the collaborative nature of such research. Such cooperation in research studies is facilitated by close liaison between the paediatric medical team and mental health professionals in day to day practice. This allows the training and expertise in research methodology, which is a strength of psychiatric personnel, to be integrated with paediatric clinical expertise.