Process evaluation of a pilot study of a self-managed,online cognitive behavioural therapy programme to address needle-related distress in haemodialysis recipients

Abstract

Background:

Dialysis needle-related distress is prevalent among haemodialysis recipients, with no evidence-based solutions currently available, posing a challenge for both patients and dialysis staff.

Objective:

To assess the feasibility, acceptability and processes of a novel intervention to manage needle related distress in haemodialysis patients.

Methods:

The intervention incorporated (1) psychologist evaluation, (2) a self-managed online cognitive behavioural therapy (CBT) programme and (3) a nursing education programme, with pre- and post-intervention evaluations. The intervention was co-designed with patients, psychologists and dialysis nurses and delivered in a tertiary renal unit in South Australia.

Results:

Of 39 patients referred to the intervention, 18 consented, and only 5 ultimately completed the programme. Barriers to recruitment included the impact of the COVID-19 pandemic, choice of screening tool for needle-fear, discrepancy between self-reported needle-related distress and the distress observed by dialysis nurses. Barriers to intervention delivery included challenges in sustaining patient engagement with the CBT programme due to substantial disease and treatment burden and maintaining nursing staff engagement in high-pressure dialysis environments. Patients who did complete the programme reported it was useful and demonstrated reduction in needle-related distress. The nurse education programme was completed by 133 nurses and was associated with self-reported improvements in knowledge about managing dialysis needle-related distress.

Conclusion:

A self-managed CBT intervention for needle-related distress was challenging to implement in dialysis recipients and would not be suitable for progression to a full clinical trial.