Intervention
emotions and cognitive distortions, ESKD, diabetes
END-STAGE KIDNEY DISEASE, DIABETES
The intervention has previously been described in detail [The second step was an approach to improving self-care with education combined with CB strategies, adapted from a similar intervention in patients with diabetes [The intervention sessions were delivered one on one, chair-side. Family members were invited to attend. The curriculum included education relevant for self-care and incorporated CB strategies to overcome barriers to self-care including: 1) review of self-care logs, 2) goal setting, 3) creation of treatment plan, 4) problem-solving techniques, 5) reinforcing techniques, and 6) coping with end-stage kidney disease (ESKD). All sessions ended with individualized homework assignments. A log of completed homework assignments was kept. In order to improve fidelity, CB session slides were accompanied by a script and instructions on how and when to deliver worksheets and handouts during each session. Social workers were required to complete a checklist that ensured certain cognitive behavioral components were incorporated into each session including reviewing homework, addressing barriers to self-management, addressing negative emotions and cognitive distortions, and completing a behavioral shaping exercise. This checklist was reviewed by the PI to ensure completion. We had initially planned to tape sessions and review these tapes to ensure fidelity, however we could not do this due to a policy against audiotaping at one of hemodialysis centers.The final step was monthly re-evaluation to determine if treatment variation was needed.