International maPping exercise of Arts Interventions in reNal uniTs: the PAINT project

Introduction
People living with end-stage kidney disease (ESKD) often experience reduced quality of life1, depression and a higher prevalence rate for anxiety compared to the general population2. Using the arts to promote and support health and wellbeing has received ongoing attention since the publication of the All-Party Parliamentary Group on Arts, Health and Wellbeing report in 2017 outlining the benefits of the arts on psychological, social and physical health and wellbeing3, and the World Health Organisation 2019 report on the evidence for arts4.
The Renal Arts Group (RAG) is a collaborative research group established in 2016 between patients with ESKD, carers, clinicians, academics, and artists to develop a programme of research aimed at developing and evaluating arts interventions to improve the physical and psychological quality of life of those living with kidney disease. This programme of research includes the PAINT project, which includes an international mapping exercise to identify the current provision of arts programmes for renal patients across the world. Collaborators include a consortium made up of members of RAG in partnership with arts programmes based in the Philippines, United States, Ireland and at the World Health Organisation.

Methods
A mixed methods approach was adopted to identify the current provision of arts interventions in renal units globally. An online survey was conducted using Qualtrics and a series of semi-structured interviews were conducted with individuals from units identified from the survey to further explore the delivery of arts activities.

Results
The PAINT Survey was live from January to October 2023. 118 responses were collected from participants representing 29 countries. There was a wide range of respondents in terms of role - i.e. consultant nephrologists, nephrology fellows, arts manager/coordinator, nurses. 39 respondents (33%) indicated that arts activities are available to patients in their units. The main barrier for those who did not have arts activities available in their units was a lack of resource in some regard. Arts activities were mostly delivered to adult patients undergoing haemodialysis.
In terms of the qualitative interviews, 16 individuals representing 11 countries took part. These semi-structured interviews further explored themes emerging from the survey data and developed the benefits and challenges of implementing arts activities for renal patients. Preliminary themes and sub-themes identified include:
• Positive outcomes for patients
o Increased wellbeing
o ‘Happier’ coming to dialysis
o More positive in their outlook
o Lower levels of boredom
• Staff engagement and enthusiasm
o Types of arts activities
o ‘Legacy’ of the patients (e.g. exhibitions / publications)
• Barriers to participation
o Resources – funding and staffing
o Infection control
o ‘Red tape’
o Developing countries – emphasis on ‘surviving rather than thriving’

Discussion
By providing an overview of what is being offered globally in terms of arts activities for renal patients, the PAINT project will identify policy recommendations for future development of arts in health programmes.

References:
1. Hackett, M.L., and Jardine, M.J. (2017) We need to talk about Depression and Dialysis: But what questions should we ask, and does anyone know the answers? Clinical Journal of the American Society of Nephrology, 120, pp. 222-224.
2. Murtagh, F.E., Addington-Hall, J., Higginson, I.J. (2007). The prevalence of symptoms in end-stage renal disease: a systematic review. Advances in Chronic Kidney Disease. 14(1), pp. 82–99.
3. All-Party Parliamentary Group on Arts, Health and Wellbeing Inquiry Report 2017 Creative Health: The Arts for Health and Wellbeing [Accessed Online] Available at: https://www.culturehealthandwellbeing.org.uk/appg-inquiry/
4. Fancourt, D. and Finn, S. (2019). What is the evidence on the role of the arts in improving health and well-being? A scoping review. World Health Organisation [online] Available at: http://www.euro.who.int/en/publications/abstracts/what-is-the-evidence-on-the-role-of-the-arts-in-improving-health-and-well-being-a-scoping-review-2019