Examining the acceptability and feasibility of the Compassionate Mindful Resilience (CMR) programme in adult patients with chronic kidney disease: the COSMIC Study

Introduction
People with advanced kidney disease face multiple challenges associated with the disease and renal replacement therapy such as increased anxiety and depression. Access to psychological and emotional support is not well provided or funded and Kidney Care UK (KCUK) was keen to explore the feasibility of delivering mental health support via virtual means to significantly reach and support more patients with mental wellbeing needs. The aim of this study was to support a new service development project with KCUK by implementing the Compassionate Mindful Resilience (CMR) programme, developed by MindfulnessUK, and explore its feasibility for patients who have chronic kidney disease in stages 4 and 5 or who have received transplants.
Methods
A multi-method single-group feasibility design was utilised. Participants (n=75) over 18 years, from the UK, with stage 4 or 5 kidney disease or post-transplant, and who were not currently undergoing psychotherapy, were recruited to the study and participated in the four-week CMR programme. Data was collected at baseline, post-intervention and at three-months post to measure anxiety, depression, self-compassion, mental wellbeing, resilience, and mindfulness. Qualitative interviews were conducted with participants and the Mindfulness Teacher to explore the feasibility and acceptability of the intervention for a kidney disease population.
Results
In total, 65 participants completed the CMR programme. The majority were female (66.2%) and post-transplant (63.1%). Analysis of completed outcome measures at baseline and post-intervention timepoints (n=61), and at three-months post intervention (n=45) revealed significant improvements in participant’s levels of anxiety and depression, self-compassion, mental wellbeing, resilience, and mindfulness.
Thematic analysis of participant interviews (n=19) and the Mindfulness Teacher (n=1) identified three themes (and nine-subthemes); experiences of the CMR programme that facilitated subjective benefit, participants lived and shared experiences, and practicalities of CMR programme participation. All participants interviewed reported that they found participating in the CMR programme to have been a beneficial experience.
Discussion
The findings suggest that the CMR programme has the potential to improve psychological outcomes among people with advanced kidney disease. The research team are currently developing an application for a randomized controlled trial are required to further test the effectiveness of the CMR programme.