Abstract
BackgroundHaemodialysis can negatively impact quality of life and mental health. Arts-based interventions used successfully in other settings to improve health and well-being, could help address the impact of haemodialysis. This study aimed to evaluate the feasibility and acceptability of conducting a randomised controlled trial (RCT) of an arts-based intervention for patients receiving haemodialysis.MethodsA parallel convergent mixed-methods design was used, including a pilot cluster RCT and qualitative process evaluation.Phase 1 evaluated recruitment and retention rates through a pilot cluster RCT at a single haemodialysis unit in Northern Ireland. Participants included patients who received haemodialysis for ESKD, were over the age of 18 and had the capacity to consent. These participants were randomised to the intervention or control group according to their haemodialysis shift. The intervention involved six one-hour, one-to-one facilitated arts sessions during haemodialysis.Phase 2 explored intervention and trial acceptability through a qualitative process evaluation using semi-structured interviews based on the RE-AIM framework. Participants included 13 patients who participated in phase 1 of the study, including 9 participants from the experimental group and four participants from the control group, and nine healthcare professionals who were present on the unit during implementation.ResultsOut of 122 outpatient haemodialysis patients, 94 were assessed as eligible for participation. Twenty-four participants were randomised, meaning 80% of the target sample size was recruited and the attrition rate at 3 months was 12.5% (n = 3). Participants viewed the arts as more accessible and enjoyable than anticipated following implementation. All participants who started the intervention (n = 11) completed the full six sessions. Qualitative benefits of the intervention suggest improvements in mental well-being. Patient choice and facilitation were important factors for successful implementation.ConclusionAn arts-based intervention for patients receiving haemodialysis is acceptable for both patients and healthcare professionals, and a definitive trial is feasible. The intervention may help improve mental-wellbeing in patients receiving haemodialysis, but this requires further investigation in a definitive trial.Trial registrationThe trial was prospectively registered on clinicaltrials.gov on 14/8/2018, registration number NCT03629496.
Highlights
Haemodialysis can negatively impact quality of life and mental health
One component of the treatment experience thought to impact negatively on mental health and wellbeing is the issue of empty time during haemodialysis [3], where there is limited opportunity to engage in meaningful activities, creating profound boredom resulting in rumination and contemplation of illness and death [5]
I answered the question, but I couldn’t see it’s got anything to do with me on dialysis and doing art. -EG03. This is the first feasibility study to pilot a cluster randomised controlled trial (RCT) of a complex arts-based intervention for patients receiving haemodialysis, and establish the acceptability of the intervention for patients and healthcare professionals. 80% of the target sample was successfully recruited from a single site, showing recruitment to a definitive trial is likely feasible
Summary
Haemodialysis can negatively impact quality of life and mental health. Arts-based interventions used successfully in other settings to improve health and well-being, could help address the impact of haemodialysis. While haemodialysis is a life-sustaining treatment it can negatively impact mental health due to the psychological consequences of the treatment experience [3]. Mental health issues such as anxiety and depression increase patients risk of morbidity and mortality, yet these issues are underdiagnosed and undertreated [4]. One component of the treatment experience thought to impact negatively on mental health and wellbeing is the issue of empty time during haemodialysis [3], where there is limited opportunity to engage in meaningful activities, creating profound boredom resulting in rumination and contemplation of illness and death [5]. Artsbased interventions have demonstrated some efficacy in reducing symptoms of anxiety and depression in other patient populations such as cancer, cardiovascular disease and diabetes [8]
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