Technology-assisted cognitive-behavioral therapy intervention for end-stage renal disease

Abstract

Technology-assisted cognitive-behavioral therapy (CBT) interventions have been conducted for symptoms including depression, pain, and fatigue in patients with chronic illnesses but not in end-stage renal disease (ESRD). The purpose of this study was to pilot the feasibility and acceptability of a technology-assisted CBT intervention in ESRD patients on hemodialysis (HD), share design and implementation lessons learned, and provide preliminary results on changes in select patient-reported symptoms. This was a single-center pilot feasibility study of adult ESRD patients on HD. Study eligibility required clinically elevated levels of at least one symptom (depression, pain, or fatigue). Patients met weekly with a CBT therapist for eight sessions, each 45–60 min, during HD sessions via a video-conferencing platform. Symptom questionnaires were completed at baseline and 3 months follow-up. Of 10 patients screened, 100% screened positive for at least one symptom, 100% of eligible patients consented, and eight (of 10) completed the intervention (mean age 59 years, 50% male, 50% African American). Patient adherence and satisfaction was high, and seven of the eight patients completed all eight prescribed sessions. Minimal interference with HD was reported. Preliminary results indicate no statistically significant changes in depression, fatigue, or pain at follow-up. However, there was small improvement in SF-36 Physical Component score [t(7) = −2.60, p = .035], and four of the six patients (67%) with clinically elevated pain at baseline reported improvement at follow-up. A technology-assisted CBT intervention for ESRD patients was feasible, well-accepted, and required minimal additional resources in the HD setting. Larger, adequately powered clinical trials are needed to evaluate the effect on ESRD patient-reported outcomes.

“Together We Stand”: A Pilot Study Exploring the Feasibility, Acceptability, and Preliminary Effects of a Family-Based Psychoeducational Intervention for Patients on Hemodialysis and Their Family Caregivers

“…This modality can also help to increase the consent rates, as it can be attended at home and does not involve transportation expenses. A recent feasibility study of technology-assisted cognitive-behavioral therapy for patients on HD showed promising effects, good adherence rates (80%), and high acceptability and satisfaction with the video-conferencing sessions [66]. Since these interventions have been patient-oriented, studies are needed to better understand the feasibility and acceptability of family-based psychoeducational online interventions in ESRD.…”

Telemental Health Care: A Review of Efficacy and Interventions

“…The intervention was feasible and well accepted, with seven of the eight participants completing all the eight prescribed sessions and agreeing that they were comfortable in the sessions and found them to be helpful. 15 A similar study focusing on the impact of trauma-focused CBT via Telehealth found that this model resulted in statistically significant clinical improvements and high satisfaction ratings from providers and patients comparable to office-based settings. 16 Carpenter et al demonstrated that delivering family-based cognitive therapy via videoconferencing directly to the patient's home was shown to have high treatment retention, high client satisfaction, strong therapeutic alliance, and low barriers to participation for treatment of child anxiety.…”

Rapid Electronic Capturing of Patient-Reported Outcome Measures in Older Adults With End-Stage Renal Disease: A Feasibility Study

“…31 Items are rated on a 4-point Likert-type scale, ranging from 0 (not at all) to 3 (nearly every day). Items were summed to create a total score that represents no depression symptoms (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), moderately severe (15)(16)(17)(18)(19), or severe (20)(21)(22)(23)(24)(25)(26)(27).…”

“…32 Each item is scored on a 4-point Likert scale indicating symptom frequency, ranging from 0 (not at all) to 3 (nearly every day). The GAD-7 total score can range from 0 to 21, further categorized as no anxiety (0-5), mild (6-10), moderate (11)(12)(13)(14)(15), or severe (16)(17)(18)(19)(20)(21) anxiety.…”

“…Electronic PROMs (ePROMs) offer patients the ability to "electronically" enter data via a smartphone, tablet device, or computer and grants clinicians the ability to review these data in real-time. 18 Previous studies have indicated that implementation of ePROMs is feasible. [19][20][21][22] For example, Schick-Makaoff et al demonstrated that using tablet computers to assess the KDQOL-36 along with Edmonton Symptom Assessment Scale was feasible among home dialysis patients.…”