Background: Initiation onto hemodialysis marks a critical transition with intense psychosocial demands. Interventions using cognitive-behavioral therapy to improve distress have been variably effective but require trained staff and are typically delivered only to those who screen positive for clinically significant distress. Interventions guided by positive psychology are lacking.
Purpose: To investigate the effectiveness of a brief positive-skills RCT in improving psychological adjustment in new hemodialysis patients.
Methods: Using a parallel (2:1) design, blinded cluster-randomized controlled trial (cRCT) design, incident patients (<6 months at NKF dialysis centers) undergoing hemodialysis were randomized to intervention or usual care (UC). HED-Start intervention comprised four group sessions delivered by healthcare staff on positive emotions, acceptance, and life-orientated goal setting. Measures were taken at baseline (pre-randomization) and at 12 weeks: distress/mood (HADS; SPANE); quality of life (KDQOL-SF, WHOQOL-BREF); benefit-finding (BFS, BIPQ); life-oriented skills (HEIQ, CD-RISC-2); self-efficacy (CD-SES).
Results: A total of 147 participants enrolled in the trial (response rate, 51.0%; retention [assessment], 90.5%). Study arms were comparable on all baseline and outcome variables except for age, diabetic nephropathy, and hypertensive nephrosclerosis which were subsequently controlled for. Repeated measures ANCOVAs (intention to treat) were used. HED-Start yielded significant reductions over time in depression, and increased quality of life, self-efficacy, benefit finding, and skills relative to UC (moderate effect sizes). Rates of clinically significant depression significantly decreased in HED-Start (p < .001) and increased in UC (p = .002).
Conclusions: The significant positive effects of HED-Start, a low-intensity and cost intervention, on several adjustment indices, suggest that programs focusing on positive life skills can value add to existing renal care services.
Keywords: Incident hemodialysis; Positive-skills intervention; Psychological adjustment; Randomized controlled trial; Renal replacement therapy.
Starting hemodialysis is stressful and emotionally demanding for patients. Interventions using cognitive–behavioral therapy can lower distress but require trained staff and may not be offered to all patients new on dialysis. This study developed and evaluated if a brief positive-skills intervention (called HED-Start) can support emotional adjustment for patients new on dialysis. We recruited a total of 147 patients new on hemodialysis who were randomly assigned to either the HED-Start intervention or usual care (UC). All participants completed measures of distress/mood, quality of life, benefit finding, and skills before being assigned to a group, and 12 weeks later. We found that patients who completed HED-Start reported better quality of life and skills and lower symptoms of depression compared to those in UC. The proportion of patients with clinically significant depression went down in HED-Start participants but increased over time in those on UC. HED-Start, a brief low-cost program to build positive skills, is beneficial and can support adaptation to hemodialysis.
© Society of Behavioral Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.