EHEALTH TO IMPROVE PSYCHOLOGICAL DISTRESS AND SELF-MANAGEMENT OF CHRONIC KIDNEY DISEASE: A RANDOMIZED CONTROLLED TRIAL

Psychological distress is common among patients with chronic kidney disease (CKD) not receiving dialysis, and can interfere with disease self‐management. The objective of this randomized controlled trial was to assess the effectiveness of the E‐GOAL patient‐tailored eHealth care pathway with screening and guided cognitive‐behavioral therapy, to treat psychological distress and facilitate self‐management behaviors in CKD (N = 121). Primary outcome was psychological distress after the 3‐month intervention and at 6‐month follow‐up. Secondary outcomes were physical and mental health‐related quality of life, self‐efficacy, and self‐management. Personalized outcomes were perceived progress on personally prioritized areas of functioning (e.g., mood or social functioning) and self‐management (e.g., dietary or medication adherence). Linear mixed‐effects analyses showed no significant time‐by‐group interaction effects for our primary outcome. For secondary outcomes, only the improvement in self‐management between baseline and 3 months was significantly larger in the intervention group than for controls (p = .030), with Cohen's d 0.22 (small effect). Cohen's d effect sizes did indicate a larger improvement in the intervention group compared to care as usual controls on all outcomes, except for self‐management at 6 months. For personalized outcomes, ANCOVAs showed significantly more improvement in the intervention group in perceived progress on personally prioritized areas of functioning at 3 months, F(1, 107) = 5.32, p = .023, , and 6 months, F(1, 107) = 7.95, p = .006, with Cohen's ds 0.46 and 0.55 (moderate effects), respectively. Similarly, the intervention group reported more perceived improvement on personally prioritized areas of self‐management at 3 months, F(1, 105) = 6.91, p = .010, , with Cohen's d 0.54 (moderate effect), but not at 6 months, F(1, 107) = 0.02, p = .880, as both groups reported no further improvement or worsening. Compared to regular care only, this eHealth intervention did not reduce psychological distress significantly, although effect sizes were promising and self‐management and personally relevant treatment outcomes did improve significantly post‐intervention. The results suggest that future studies should consider personalized outcomes that reflect individually relevant areas and treatment goals, matching patient‐tailored treatments.