Doing Better on Dialysis: Tailoring an Entertaining, Technology-Assisted Cognitive Behavioral Therapy for Depression for Patients Receiving Dialysis Treatment

Background: Approximately 470,000 Americans receive dialysis (NIDDK, 2021). Once patients begin dialysis, they must continue receiving dialysis or obtain a kidney transplant. Approximately 20% of patients receiving dialysis meet criteria for depression (Lopes et al., 2002). However, dialysis patients are unlikely to receive treatment due to psychological, medical, and practical barriers (Cukor, 2007). Mitigating these barriers is critical to improve patients’ mood, but also to be eligible for a kidney transplant. To receive a transplant, patients must be deemed medically and emotionally capable of enduring surgery and maintaining self-care recovery standards (Lacson et al., 2012). There is a critical need to increase access to depression treatment for dialysis patients. Technology-assisted cognitive-behavioral therapy (T-CBT) delivered during dialysis sessions, with support from nephrology social workers is a promising way to increase access to care. This study examined receptivity to T-CBT among dialysis patients and nephrology social workers and explored methods to tailor T-CBT to reflect the lived experiences of depressed dialysis patients.

Methods: We conducted a survey of nephrology social workers and qualitative interviews with depressed dialysis patients to examine the feasibility and acceptability of developing a T-CBT for dialysis patients. A web-based survey was administered to 82 nephrology social workers (NSWs) to assess their perceptions of a NSW-assisted T-CBT for depression delivered during dialysis treatment. Qualitative interviews were conducted with eight depressed dialysis patients. Participants were asked about their experiences with both dialysis and depression, as well as their thoughts about receiving T-CBT during their dialysis treatment. Thematic analysis was used to analyze transcribed interview data.

Results: Thirty-three NSWs (40.2%) responded to the web-based survey. 94% indicated depression was common among their patients; yet 55.1% reported patients were unlikely to follow through on a referral for treatment. Almost 90% of respondents believed that T-CBT for depression delivered with brief support from NSWs would help depressed dialysis patients and 93% reported a willingness to offer brief support for T-CBT. Dialysis patients with depression were open about their depressive symptoms, with many attributing their feelings as a normal response to their medical condition. Participants indicated a preference for psychosocial treatment but found it difficult to access care given a myriad of barriers, including time, transportation, and fatigue. There was great receptivity to completing T-CBT during dialysis sessions. Many patients shared that they used tablets etc. during dialysis and reported high technology comfort. However, patients indicated the need to tailor T-CBT for the dialysis population. Participants discussed not being able to engage in activities they used to enjoy, experiencing frequent loss as fellow patients die, and feeling down when not following through with care recommendations as potentially important tailored elements.

Conclusions & Implications: Results indicated delivering T-CBT in dialysis clinics is feasible and acceptable. Findings also demonstrated the need to tailor T-CBT to the lived experiences of dialysis patients. These findings supported the development of a tailored, entertaining, T-CBT (“Doing Better on Dialysis” - DBD). We are conducting a pilot test of DBD to assess its impact on depressive symptoms among dialysis patients.