Positive skills intervention to improve psychological adjustment in patients new on haemodialysis (HED-Start): a quantitative analysis

Abstract

Multiple psycho-behavioural demands are a common issue in the critical transition of patients onto haemodialysis. Interventions guided by self-management and cognitive–behavioural therapy to improve psycho-behavioural outcomes are effective but tend to be resource and time intensive. Positive psychology interventions for End-Stage Kidney Disease (ESKD) are lacking. This randomized controlled trial aimed to determine the effectiveness of HED-Start, a positive skills intervention to improve psychological adjustment (illness perceptions, distress symptoms and adjustment) in patients new on haemodialysis (<6 months at baseline). Haemodialysis patients (n = 99) were randomized to control (n = 58) or HED-Start (n = 41). HED-Start comprised 4 fortnightly sessions focusing on positive emotions, acceptance, cognitive reframing, affirmations, and life-orientated goal setting. Self-report questionnaires [distress/mood (HADS; SPANE); quality of life (WHOQOL-BREF, KDQOL-SF, BIPQ); self-management skills (BFS, heiQ, CD-RISC-2, CDSES)] were collected at baseline and at 12 weeks follow up. Intention-to-treat analyses were conducted. Significant improvements over time were noted in favour of HED-Start for SPANEnegative (p = .049), BIPQtotal (p = .049), BFStotal (p = .021), BFS personal growth subscale (p = .006), and positive and active engagement in life heiQ subscale (p = .015). There were no other significant effects. Despite currently having an underpowered sample, HED-Start had initial significant, positive effects on adjustment indices, suggesting that interventions that enhance new haemodialysis patients’ abilities to accept situations and find meaning are promising.