Schick-Makaroff Kara, Sawatzky Richard, Greenhalgh Joanne, Cukor Daniel, Wong Hubert, Klarenbach Scott, Berendonk Charlotte, Lee Loretta, Micklitz Katrin, Lo Lori Suet Hang, Kennedy Megan
Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
School of Nursing, Trinity Western University, Langley, British Columbia, Canada
BMJ Open. 2025 Jun 23;15(6):e090228. doi: 10.1136/bmjopen-2024-090228.
Nearly 40% of adults receiving life-saving dialysis for kidney failure report depressive symptoms. With more than 40 000 Canadians on dialysis, this is a significant health burden. Cognitive behavioural therapy (CBT) has been shown to be effective for treating depressive symptoms; however, it is rarely considered or used for people receiving dialysis. The aim of this realist study is to evaluate and explain how, why, for whom and in what circumstances therapist-guided and remotely delivered CBT works in order to provide equitable mental healthcare to individuals with depressive symptoms receiving dialysis.
The project will include a realist synthesis, a quantitative cohort study and a realist evaluation. Realist methodology is a theory-driven approach that seeks to explain how generative mechanisms are shaped by contextual features, giving rise to outcome patterns. We will begin by developing an initial programme theory (IPT) from the literature and interviews with CBT therapists to understand how CBT is intended to work and for whom. We will use data from the quantitative cohort study to identify contexts that may shape outcome patterns in CBT for people receiving dialysis. This includes previously collected survey data and data from a longitudinal cohort study, both sourced from people across Canada undergoing dialysis. We will test and refine the IPT using data from a realist evaluation and existing literature. The realist evaluation will involve participants from the quantitative cohort study who received therapist-guided, remotely delivered CBT.
Ethical approvals have been granted. We have planned a wide range of dissemination strategies: journal manuscripts and conference presentations, executive memos for administrators of renal programmes in Canada, an online inventory of resources for depressive symptoms and presentations of findings together with patient partners at all participating sites.
CRD42023476184.
近40%接受挽救生命的肾衰竭透析治疗的成年人报告有抑郁症状。加拿大有超过4万名患者接受透析治疗，这是一个重大的健康负担。认知行为疗法（CBT）已被证明对治疗抑郁症状有效；然而，对于接受透析治疗的患者，这种疗法很少被考虑或使用。这项务实研究的目的是评估并解释治疗师指导的远程认知行为疗法如何、为何、针对谁以及在何种情况下有效，以便为有抑郁症状的透析患者提供公平的心理保健服务。
该项目将包括务实综合分析、定量队列研究和务实评估。务实方法是一种理论驱动的方法，旨在解释生成机制如何受背景特征影响，从而产生结果模式。我们将首先从文献以及对认知行为疗法治疗师的访谈中得出初始项目理论（IPT），以了解认知行为疗法的预期作用方式及适用人群。我们将使用定量队列研究的数据来确定可能影响接受透析治疗患者的认知行为疗法结果模式的背景因素。这包括先前收集的调查数据以及一项纵向队列研究的数据，两者均来自加拿大各地接受透析治疗的患者。我们将使用务实评估数据和现有文献对初始项目理论进行测试和完善。务实评估将纳入定量队列研究中接受治疗师指导的远程认知行为疗法的参与者。
已获得伦理批准。我们制定了广泛的传播策略：发表期刊论文和在会议上进行展示，为加拿大肾脏项目管理人员撰写行政备忘录，建立抑郁症状在线资源库，并在所有参与地点与患者合作伙伴一起展示研究结果。
PROSPERO注册号：CRD42023476184。
