Experiences of a cognitive behavioural therapy (CBT) intervention for fatigue in patients receiving haemodialysis

IF 1.5 4区医学 Q3 NURSING

Journal of renal care Pub Date : 2022-03-25 DOI:10.1111/jorc.12418

Frances Waite MSc, Joseph Chilcot PhD, Rona Moss-Morris PhD, Ken Farrington MD, FRCP, Federica Picariello PhD

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Abstract

Background

A feasibility randomised-controlled trial found that a cognitive-behavioural therapy intervention for renal fatigue has the potential to reduce fatigue in patients receiving haemodialysis, but uptake was low.

Objectives

Nested in the randomised-controlled trial (RC) qualitative interviews were undertaken to understand the acceptability of renal fatigue, the facilitators of, and barriers to, engagement, and the psychosocial processes of change.

Design

The trial included 24 participants at baseline. Semi-structured interviews were conducted with nine participants from the intervention arm (n = 12). Approach Interviews were carried out immediately following treatment (3 months post-randomisation). Data were analysed using inductive thematic analysis.

Findings

Five main themes were formulated. The overarching theme was a sense of coherence (whether the illness, symptoms and treatment made sense to individuals), which appeared to be central to acceptability and engagement. Two themes captured the key barriers and facilitators to engagement, cognitive and illness/treatment burdens and collaboration with the therapist. Participants described changes related to their activity, thoughts and social identity/interactions, which shaped perceptions of change in fatigue. Lastly, participants discussed the optimal delivery of the intervention.

Conclusions

This study revealed the importance of patients' understanding of fatigue and acceptance of the treatment model for the acceptability of and engagement with a cognitive-behavioural therapy-based intervention for fatigue. Overall, there was an indication that such an intervention is acceptable to patients and the mechanisms of change align with the proposed biopsychosocial model of fatigue. However, it needs to be delivered in a way that is appealing and practical to patients, acknowledging the illness and treatment burdens.

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认知行为疗法(CBT)干预血液透析患者疲劳的经验

一项可行性随机对照试验发现，认知行为疗法干预肾疲劳有可能减轻血液透析患者的疲劳，但摄取较低。在随机对照试验(RC)中，进行了定性访谈，以了解肾疲劳的可接受性，参与的促进因素和障碍，以及改变的心理社会过程。试验包括24名基线受试者。对来自干预组的9名参与者(n = 12)进行了半结构化访谈。治疗后立即进行访谈(随机分组后3个月)。数据分析采用归纳专题分析。研究结果:制定了五个主要主题。最重要的主题是连贯性(疾病、症状和治疗对个人是否有意义)，这似乎是可接受性和参与度的核心。两个主题抓住了参与的主要障碍和促进因素，认知和疾病/治疗负担以及与治疗师的合作。参与者描述了与他们的活动、思想和社会身份/互动相关的变化，这些变化形成了对疲劳变化的看法。最后，与会者讨论了干预的最佳交付。结论:本研究揭示了患者对疲劳的理解和对治疗模式的接受对于接受和参与基于认知行为治疗的疲劳干预的重要性。总的来说，有迹象表明这种干预对患者是可以接受的，并且改变的机制与提出的疲劳的生物心理社会模型一致。然而，它需要以一种对患者有吸引力和实用的方式提供，承认疾病和治疗负担。

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

Journal of renal care Nursing-Advanced and Specialized Nursing

CiteScore

3.50

自引率

5.30%

发文量

期刊介绍： The Journal of Renal Care (JORC), formally EDTNA/ERCA Journal, is the official publication of the European Dialysis and Transplant Nursing Association/European Renal Care Association (EDTNA/ERCA). The Journal of Renal Care is an international peer-reviewed journal for the multi-professional health care team caring for people with kidney disease and those who research this specialised area of health care. Kidney disease is a chronic illness with four basic treatments: haemodialysis, peritoneal dialysis conservative management and transplantation, which includes emptive transplantation, living donor & cadavaric transplantation. The continuous world-wide increase of people with chronic kidney disease (CKD) means that research and shared knowledge into the causes and treatment is vital to delay the progression of CKD and to improve treatments and the care given. The Journal of Renal Care is an important journal for all health-care professionals working in this and associated conditions, such as diabetes and cardio-vascular disease amongst others. It covers the trajectory of the disease from the first diagnosis to palliative care and includes acute renal injury. The Journal of Renal Care accepts that kidney disease affects not only the patients but also their families and significant others and provides a forum for both the psycho-social and physiological aspects of the disease.