HED-Start: A Brief Positive Psychology Cluster-Randomized Controlled Trial to Improve Psychological Adjustment in Patients New on Hemodialysis

健康心理学 随机对照试验 积极心理学 血液透析 星团(航天器) 临床心理学 心理治疗师 心理学 物理疗法 医学 精神科 内科学 护理部 公共卫生 计算机科学 程序设计语言
作者
Konstadina Griva,Phoebe X. H. Lim,Frederick H. F. Chan,Yen Peng Wong,Job Loei,TQ Thach,Judith T. Moskowitz,Behram Ali Khan,Jason Choo
出处
期刊:Annals of Behavioral Medicine [Oxford University Press]
卷期号:58 (12): 809-819
标识
DOI:10.1093/abm/kaae052
摘要

Abstract Background Initiation onto hemodialysis marks a critical transition with intense psychosocial demands. Interventions using cognitive–behavioral therapy to improve distress have been variably effective but require trained staff and are typically delivered only to those who screen positive for clinically significant distress. Interventions guided by positive psychology are lacking. Purpose To investigate the effectiveness of a brief positive-skills RCT in improving psychological adjustment in new hemodialysis patients. Methods Using a parallel (2:1) design, blinded cluster-randomized controlled trial (cRCT) design, incident patients (<6 months at NKF dialysis centers) undergoing hemodialysis were randomized to intervention or usual care (UC). HED-Start intervention comprised four group sessions delivered by healthcare staff on positive emotions, acceptance, and life-orientated goal setting. Measures were taken at baseline (pre-randomization) and at 12 weeks: distress/mood (HADS; SPANE); quality of life (KDQOL-SF, WHOQOL-BREF); benefit-finding (BFS, BIPQ); life-oriented skills (HEIQ, CD-RISC-2); self-efficacy (CD-SES). Results A total of 147 participants enrolled in the trial (response rate, 51.0%; retention [assessment], 90.5%). Study arms were comparable on all baseline and outcome variables except for age, diabetic nephropathy, and hypertensive nephrosclerosis which were subsequently controlled for. Repeated measures ANCOVAs (intention to treat) were used. HED-Start yielded significant reductions over time in depression, and increased quality of life, self-efficacy, benefit finding, and skills relative to UC (moderate effect sizes). Rates of clinically significant depression significantly decreased in HED-Start (p < .001) and increased in UC (p = .002). Conclusions The significant positive effects of HED-Start, a low-intensity and cost intervention, on several adjustment indices, suggest that programs focusing on positive life skills can value add to existing renal care services.
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