An integrated behavioural activation intervention to improve depression amongst people with kidney failure undergoing haemodialysis: a feasibility study
Treatment of depression among people with kidney failure receiving in-centre haemodailysis
Participants will be randomised at a cluster level according to haemodialysis shift (Monday/Wednesday/Friday, Tuesday/Thursday/Saturday) as the intervention will be administered during haemodialysis. Participants randomly allocated to the intervention group will receive an adapted behavioural activation intervention, while those allocated to the control group will receive enhanced usual care (they will be provided with information on accessing usual care services, including GP services and third-sector organisations). Intervention group - Integrated behavioural activation (delivered during haemodialysis treatment): The integrated BA intervention will be delivered over a period of 6-8 weeks. Each participant allocated to the intervention group will receive a minimum of 6 one-to-one sessions, delivered at their bedside during their haemodialysis treatment. Participants will receive a BA workbook to support the content of each one-to-one session and to refer to between sessions. At the end of each session, the facilitator and participant will plan take-away activities to do outside of the sessions. In each follow-up session, the participant will begin by checking in with the facilitator and reviewing their progress from the previous week. While the content will be organised into 6 core sessions, the pacing of session content will be tailored to the participants’ needs. Using a standardised training programme, kidney health professionals will be trained to deliver the BA intervention as facilitators. The training will be delivered in one face-to-face workshop. The workshop includes both a theoretical component to explain what BA is and how it works, as well as a skills-based component featuring case scenarios and role-plays. A train-the-trainer approach will be used when recruiting further facilitators, with initial sessions supervised by the initially trained BA facilitators. Control group - Enhanced Usual Care There is no standardised usual care for depression
1. Are over the age of 18 years (no upper age limit) 2. Are receiving maintenance in centre haemodialysis for > 3 months 3. Have the capacity to provide informed consent. 4. Score > 3 on the PHQ-4
1. Started antidepressant medication or forms of talking therapy within the previous three months. 2. Are receiving haemodialysis for acute kidney injury 3. Have a planned kidney transplant within the study period 4. Are planning to move from the dialysis unit during the study period, either because they are moving home to a different catchment area, are planning to move to a satellite dialysis unit, or are planning to start home haemodialysis 5. Do not have the capacity to provide informed consent. The clinical judgement of the dialysis team will determine the capacity to consent. There will be recruitment materials for participants who may require additional communication support, in line with ASSENT guidance, to ensure that eligible patients are not unfairly excluded. 6. Are unable to understand and communicate effectively in the English language.