“I see myself as a little warrior”: patient perceptions of online-CBT for distress in haemodialysis

Abstract

Background: Psychological distress is common in haemodialysis. Access to cognitive-behavioural therapy (CBT) tailored specifically to manage distress associated with haemodialysis is limited. Online CBT is a pragmatic solution. This nested qualitative study explored the utility and acceptability of the improving distress in dialysis (iDiD) online CBT programme among haemodialysis patients randomised to either the therapist supported or unsupported arm. Method: Nested semi-structured interviews within the iDiD feasibility randomised controlled trial were performed on 14 haemodialysis patients (11 supported arm; 3 unsupported arm). Interviews occurred either face-to-face or over the phone post-treatment. Thematic analysis was performed. Findings: Four distinct yet interrelated themes were identified. Two themes centred on utility. First, patients valued the tailoring of iDiD CBT “active ingredients†to the renal context. Second, patients commented on downstream improvements on health outcomes – notably confidence, agency, and resilience with limited reference to changes in negative affect. Two themes related to acceptability. First, patients identified external (e.g. time) and psychosocial barriers (e.g. emotional readiness) to engagement. The second theme highlighted the value of human cognitive and emotional intelligence gleaned from patients in the supported arm. An overarching theme also emerged: haemodialysis illness trajectory. Opinions about iDiD were contextually linked to current and past illness stressors. Discussion: iDiD was perceived as a useful intervention. The most commonly reported patient gains were an improved self-concept of their ability to manage multimorbid illness rather than distress specifically. Framing iDiD as a self-management support tool may promote engagement: methods of identifying illness related distress are needed.