A mixed-methods feasibility study of an arts-based intervention for patients receiving maintenance haemodialysis

Abstract

Background Haemodialysis can negatively impact quality of life and mental health. Arts-based interventions used successfully in other settings to improve health and well-being, could help address the impact of haemodialysis. This study aimed to evaluate the feasibility and acceptability of conducting a randomised controlled trial (RCT) of an arts-based intervention for patients receiving haemodialysis. Methods A parallel convergent mixed-methods design was used, including a pilot cluster RCT and qualitative process evaluation. Phase 1 evaluated recruitment and retention rates through a pilot cluster RCT at a single haemodialysis unit in Northern Ireland. Participants included patients who received haemodialysis for ESKD, were over the age of 18 and had the capacity to consent. These participants were randomised to the intervention or control group according to their haemodialysis shift. The intervention involved six one-hour, one-to-one facilitated arts sessions during haemodialysis. Phase 2 explored intervention and trial acceptability through a qualitative process evaluation using semi-structured interviews based on the RE-AIM framework. Participants included 13 patients who participated in phase 1 of the study, including 9 participants from the experimental group and four participants from the control group, and nine healthcare professionals who were present on the unit during implementation. Results Out of 122 outpatient haemodialysis patients, 94 were assessed as eligible for participation. Twenty-four participants were randomised, meaning 80% of the target sample size was recruited and the attrition rate at 3 months was 12.5% (n = 3). Participants viewed the arts as more accessible and enjoyable than anticipated following implementation. All participants who started the intervention (n = 11) completed the full six sessions. Qualitative benefits of the intervention suggest improvements in mental well-being. Patient choice and facilitation were important factors for successful implementation. Conclusion An arts-based intervention for patients receiving haemodialysis is acceptable for both patients and healthcare professionals, and a definitive trial is feasible. The intervention may help improve mental-wellbeing in patients receiving haemodialysis, but this requires further investigation in a definitive trial. Trial registration The trial was prospectively registered on clinicaltrials.gov on 14/8/2018, registration number NCT03629496.

The Experiences of a Complex Arts-Based Intervention for Patients with End-Stage Kidney Disease Whilst Receiving Haemodialysis: A Qualitative Process Evaluation

“…Qualitative process evaluation. The process evaluation was conducted in parallel to a pilot cluster randomised controlled trial (RCT) that aimed to evaluate the feasibility of evaluating a complex arts-based intervention within the framework of an RCT [12,13].…”

“…Participants included both patients who had been recruited into a pilot cluster RCT of a complex arts-based intervention [12] and healthcare professionals working on the haemodialysis unit in the UK during the implementation of the intervention. The mean age of participants in the pilot cluster RCT was 69 years, while the mean years participants had been receiving haemodialysis was 4.3 years.…”

“…The mean age of participants in the pilot cluster RCT was 69 years, while the mean years participants had been receiving haemodialysis was 4.3 years. The protocol for the pilot cluster RCT [13] and results of the pilot cluster RCT [12] have been published in detail previously. All participants in the pilot cluster RCT who started the intervention completed the full six sessions of the intervention.…”

Development of a complex arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis

“…The framework and approach to intervention development promoted acceptability and delivery within both a highly specialised clinical setting and trial framework. The subsequent feasibility study [ 1 ] demonstrated that evaluation of this intervention is feasible within a definitive trial.…”

Developing Guidance on Implementing Volunteer-Led Intradialytic Arts Activities in Haemodialysis Units

“…The initiative builds upon Dr Carswell's PhD study [2,3], which consisted of a pilot feasibility trial of an arts-based intervention for patients receiving haemodialysis. The study aimed to address quality of life and mental health of patients who have end-stage kidney disease (ESKD) and are receiving haemodialysis.…”