HED-Start: A Brief Positive Psychology Cluster-Randomized Controlled Trial to Improve Psychological Adjustment in Patients New on Hemodialysis.

IF 3.6 2区心理学 Q1 PSYCHOLOGY, MULTIDISCIPLINARY

Annals of Behavioral Medicine Pub Date : 2024-11-16 DOI:10.1093/abm/kaae052

Konstadina Griva, Phoebe X H Lim, Frederick H F Chan, Yen Peng Wong, Job Loei, Thuan Quoc Thach, Judith Moskowitz, Behram A Khan, Jason Choo

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Abstract

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.

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HED-Start：一项旨在改善血液透析新患者心理适应的简短积极心理学分组随机对照试验》（HED-Start: A Brief Positive Psychology Cluster-Randomized Controlled Trial to Improve Psychological Adjustment in Patients New on Hemodialysis）。

背景：开始血液透析是一个关键的过渡时期，对患者的心理要求很高。使用认知行为疗法进行干预以改善患者的痛苦，效果不一，但需要训练有素的工作人员，而且通常只提供给那些临床痛苦筛查呈阳性的患者。目的：研究一项简短的积极技能 RCT 对改善血液透析新患者心理适应的有效性：方法：采用平行（2:1）设计、盲法群组随机对照试验（cRCT）设计，对入院患者（结果：共有147名参与者入院）进行干预：共有 147 人参加了试验（应答率为 51.0%；保留率 [评估]为 90.5%）。除年龄、糖尿病肾病和高血压肾硬化外，各研究臂在所有基线变量和结果变量方面均具有可比性。采用了重复测量方差分析（意向治疗）。与 UC 相比，随着时间的推移，HED-Start 能显著减少抑郁，并提高生活质量、自我效能、获益发现和技能（中等效应大小）。HED-Start疗法显著降低了临床意义上的抑郁率（p < .001），而UC疗法则提高了抑郁率（p = .002）：结论：HED-Start 是一项低强度、低成本的干预措施，对多项调整指数产生了明显的积极影响，这表明以积极生活技能为重点的项目可以为现有的肾脏护理服务带来增值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Behavioral Medicine PSYCHOLOGY, MULTIDISCIPLINARY-

CiteScore

7.00

自引率

5.30%

发文量

期刊介绍： Annals of Behavioral Medicine aims to foster the exchange of knowledge derived from the disciplines involved in the field of behavioral medicine, and the integration of biological, psychosocial, and behavioral factors and principles as they relate to such areas as health promotion, disease prevention, risk factor modification, disease progression, adjustment and adaptation to physical disorders, and rehabilitation. To achieve these goals, much of the journal is devoted to the publication of original empirical articles including reports of randomized controlled trials, observational studies, or other basic and clinical investigations. Integrative reviews of the evidence for the application of behavioral interventions in health care will also be provided. .