Feasibility evaluation of a tailored online cognitive-behavioural therapy intervention for improving distress in dialysis (iDiD)

Abstract

BACKGROUND: Psychological distress is common in haemodialysis patients, yet provision of psychological treatment is scarce. The Improving Distress in Dialysis (iDiD) study aimed to assess the feasibility and acceptability of a tailored seven session online cognitive-behavioural therapy (CBT) programme for distress in dialysis. METHODS: This feasibility randomised controlled trial aimed to randomise 60 haemodialysis patients to either online CBT with three therapist support calls or online CBT alone. Participants with mild-moderate depression (patient health questionnaire; PHQ-9) and/or anxiety (generalised anxiety disorder; GAD-7) were eligible. Patients completed baseline and three months follow-up questionnaires, and a qualitative exit interview. Statistical analysis: preliminary descriptive statistics on recruitment rates and treatment adherence. RESULTS: Ninety-nine patients (53% of those screened) had mild-moderate depression and/or anxiety. Sixty-one patients met additional inclusion criteria and 25 (41%) were randomised. The main reason for non-consent was patients not identifying with the distress “labelâ€. Patients with no therapist support completed a mean of four online sessions compared with a mean of three sessions in the telephone support arm. Only 38% of patients randomised to receive telephone calls completed all three calls; work/family commitments or illness exacerbation/hospitalisation were reasons for telephone non-adherence. DISCUSSION: Uptake and adherence to an online intervention for the management of distress in dialysis was relatively low. Reasons for low engagement were not challenges unique to online modes of CBT delivery. Presenting CBT as an intervention that can improve overall illness management as opposed to distress may improve treatment engagement in people with co-morbid distress and physical illness.