The E-GOAL study: E-health in chronic kidney disease

For patients with chronic kidney disease (CKD), a healthy life style (i.e., regular physical activity, a healthy diet and weight, no smoking, and medication adherence) is crucial, as it can slow down disease progress. Unfortunately, many patients experience problems in adopting and maintaining a healthy life style, often due to psychological factors, such as negative emotions or a lack of self-efficacy. We developed an e-care path with a screening tool, including a personal profile chart, and e-health treatment, aimed at identifying and treating psychological distress, overcoming psychological barriers, and promoting psychological facilitators for behavior change. We will carry out an open multicenter randomized controlled trial to evaluate the effectiveness of this e-care path. All potential participants will fill out an online screening questionnaire and receive a personal feedback chart. Patients who fulfill criteria of heightened psychological distress and related life style problems (n=120) will be randomly assigned to either the control or the intervention condition. Patients in the control condition will receive regular care. Patients in the intervention condition receive regular care and tailored guided online cognitive behavioral therapy, during a period of 3 months. We hypothesize that patients in the intervention condition will show a significantly larger decrease in self-reported psychological distress at post-treatment and 3-month follow-up as compared to baseline than controls. Additionally, we expect larger improvements in various secondary outcomes: personal goal achievement, self-management, self-efficacy, and mental and physical health-related quality of life. Findings will be translated into recommendations about implementing the e-care path.

The effectiveness of the E-health self-management treatment on different domains will be examined.

Primarily, it is hypothesized that the treatment results in a lower level of psychological distress, and thereby might facilitate life style changes, in comparison to care as usual.

Secondarily, it is hypothesized that the E-health self-management treatment will:

1. result in personal goal achievement (that is, meaningful improvements on the areas of interest to the patient, e.g., healthy life style behavior, coping with fatigue, pain, negative mood, and social functioning);

2. increase disease-specific self-efficacy and self-management;

3. improve mental and physical health-related quality of life.

All patients will be screened on psychological barriers and related life style problems, after which those patients at risk will be randomly assigned to one of the two conditions. Participants in the intervention condition will receive a 3-month intervention. Patients in the control condition will receive care as usual. Assessments will be performed at baseline and 3 (post-treatment) and 6 months (3 months post-treatment) after baseline.

All patients will fill out a web-based screening questionnaire. Patients who fulfill the criteria of heightened psychological distress and related life style problems (that is, who insufficiently meet nephrology guidelines for a healthy life style) will be randomized to either the control or the intervention condition. Patients in the control group will receive a feedback form about the results of the screening and further receive regular care. ln the intervention group, patients additionally receive (1) an intake with a psychologist (e-coach) to interpret and discuss results of the screening as displayed in the personal profile chart, make shared decisions on personal treatment goals and how to monitor progress on these goals, (2) a brief and tailored e-coach intervention based on cognitive-behavioral therapy to treat psychological distress, overcome barriers and promote facilitators for healthy life style behaviors for a period of approximately 3 months, and (3) a consultation with the psychologist after completing the e-coach trajectory for evaluation and long-term goals. Treatment will be guided by a psychologist who is specifically trained in the tailored cognitive-behavioral protocol.