IMPROVING MANAGEMENT OF NEEDLE DISTRESS DURING THE JOURNEY TO DIALYSIS THROUGH PSYCHOLOGICAL EDUCATION AND TRAINING (INJECT) – A PILOT FEASIBILITY STUDY
Gorjana Radisic1,2, Richard Le Leu1,2, Kathryn Collins3,4, Anne Burke3,4, Anna Chur-Hansen3, Fiona Donnelly1, Emily Duncanson5, Kathy Hill6, Luke Macauley2, Stephen McDonald1,2, Professor Shilpanjali Jesudason1,2
1Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 2Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia, 3School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia, 4Psychology Department, Royal Adelaide Hospital, Adelaide, Australia, 5Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), South Australian Health and Medical Research Institute, Adelaide, Australia, 6University of South Australia, Adelaide, Australia
Aim: To evaluate the feasibility and acceptability of a psychological intervention to assist dialysis patients with self-management of needle related distress.
Background: Needle-related distress is challenging but prevalent problem among haemodialysis patients, and it is often poorly identified with limited management options.
Methods: We developed and tested the feasibility, acceptability, utility and processes of the INJECT intervention which incorporated (1) psychologist evaluation, (2) a self- managed online Cognitive Behavioural Therapy (CBT) program, and (3) nursing education program. The intervention was co-designed with patients, psychologists and dialysis nurses and informed by our past qualitative studies. Haemodialysis patients with needle-related fear were recruited from a tertiary renal unit in SA.
Results: Of 39 patients referred, 18 consented, 7 began and 5 completed the intervention. All 5 participants reported improved needle distress following INJECT. The nurse education program was completed by 133 nurses and led to improved knowledge about managing dialysis needle fear.
Process evaluation identified barriers associated with the intervention categorised into four domains: recruitment, patient engagement in the CBT program, nurse support and engagement and system level challenges. Challenges included preexisting high patient treatment burden in this cohort and being overwhelmed with self-guided intervention, reluctance to acknowledge the necessity of the intervention, stigma associated with being labelled as having needle fear, and challenges within the dialysis unit workforce that hindered the ability of nurses to support patients.
Conclusion: An online CBT program for needle fear self-management had challenges with delivery and uptake but was effective in a small cohort of patients who reached completion.
Biography:
Professor Shilpanjali Jesudason (MBBS PhD FRACP FISN), is an academic nephrologist at the Royal Adelaide Hospital’s Central Northern Adelaide Renal and Transplant Service (CNARTS ) where she is Director of Dialysis, lead of the CNARTS Clinical Research Group and Program Lead for Pregnancy and Kidney Research Australia. She is a Clinical Professor, at the University of Adelaide. From 2017- 2020 she was the National Clinical Director of Kidney Health Australia, the peak body for patients with kidney disease.