Tailored online cognitive behavioural therapy with or without therapist support calls to target psychological distress in adults receiving haemodialysis: A feasibility randomised controlled trial

- Access to psychological treatments for distress which are tailored to the needs of haemodialysis patients is limited.
- An online Improving Distress in Dialysis (iDiD) cognitive-behavioural therapy (CBT) package provides a pragmatic solution.
- A feasibility and acceptability randomised controlled trial of iDiD online CBT, with or without therapist was conducted.
- Proactive screening for psychological distress was only acceptable for 44% of patients approached.
- The main reason for trial ineligibility was low computer literacy (53%).
- The primary reason for declining trial participation was lack of perceived need (43%).
- A definitive trial evaluating iDiD online CBT using the methods used in this study is unfeasible.

BackgroundPsychological distress is prevalent in haemodialysis (HD) patients yet access to psychotherapy remains limited. This study assessed the feasibility and acceptability of online cognitive-behavioural therapy (CBT) tailored for HD patients, with or without therapist support, for managing psychological distress.MethodsThis feasibility randomised controlled trial recruited patients from a UK HD centre. Following psychological distress screens, patients with mild-moderate psychological distress (Patient Health Questionnaire PHQ-9; score: 5-19 and/or Generalised Anxiety Disorder; GAD-7 score: 5-14) who met remaining inclusion criteria were approached for consent. Consenters were individually randomised (1:1) to online-CBT or online-CBT plus three therapist support calls. Outcomes included recruitment, retention, and adherence rates. Exploratory change analyses were performed for: psychological distress, quality of life (QoL), illness perceptions, and costs. The statistician was blinded to allocation.Results182 (44%) out of 410 patients approached completed psychological distress screens. 26% found screening unacceptable; a further 30% found it unfeasible. Psychological distress was detected in 101 (55%) patients, 60 of these met remaining inclusion criteria. The primary reason for ineligibility was poor computer literacy (N = 17, 53%). Twenty-five patients were randomised to the supported (N = 18) or unsupported arm (N = 7); 92% were retained at follow-up. No differences in psychological distress or cost-effectiveness were observed. No trial adverse events occurred.ConclusionOnline CBT appears feasible but only for computer literate patients who identify with the label psychological distress. A definitive trial using the current methods for psychological distress screening and online care delivery is unfeasible.ClinicalTrials.gov Identifier: NCT02352870