Hudson Joanna L, Moss-Morris Rona, Norton Sam, Picariello Federica, Game David, Carroll Amy, Spencer Jonathan, McCrone Paul, Hotopf Matthew, Yardley Lucy, Chilcot Joseph
Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Guy's and St Thomas' NHS Trust, UK.
J Psychosom Res. 2017 Nov;102:61-70. doi: 10.1016/j.jpsychores.2017.09.009. Epub 2017 Sep 21.
Psychological 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.
This 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.
182 (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.
Online 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.
心理困扰在血液透析（HD）患者中普遍存在，但获得心理治疗的机会仍然有限。本研究评估了为HD患者量身定制的在线认知行为疗法（CBT）在有或没有治疗师支持的情况下管理心理困扰的可行性和可接受性。
这项可行性随机对照试验从英国一家HD中心招募患者。在进行心理困扰筛查后，对符合其余纳入标准的轻度至中度心理困扰患者（患者健康问卷PHQ-9；得分：5-19和/或广泛性焦虑症；GAD-7得分：5-14）进行同意征求。同意者被随机（1:1）分为在线CBT组或在线CBT加三次治疗师支持电话组。结果包括招募率、保留率和依从率。对心理困扰、生活质量（QoL）、疾病认知和成本进行了探索性变化分析。统计人员对分组情况不知情。
410名接受询问的患者中有182名（44%）完成了心理困扰筛查。26%的人认为筛查不可接受；另有30%的人认为筛查不可行。在101名（55%）患者中检测到心理困扰，其中60名符合其余纳入标准。不符合资格的主要原因是计算机素养差（N=17，53%）。25名患者被随机分配到有支持组（N=18）或无支持组（N=7）；92%的患者在随访时被保留。未观察到心理困扰或成本效益方面的差异。未发生试验不良事件。
在线CBT似乎可行，但仅适用于认同心理困扰标签且具备计算机素养的患者。使用当前心理困扰筛查和在线护理提供方法进行确定性试验是不可行的。ClinicalTrials.gov标识符：NCT02352870。
