Development and feasibility of an arts-based intervention for patients with end-stage kidney disease whilst receiving haemodialysis

Student thesis: Doctoral ThesisDoctor of Philosophy



End stage kidney disease (ESKD) is a life changing illness. Many patients require
haemodialysis, a treatment that involves patients attending hospital three times a week for four hours each time. This treatment impacts profoundly on quality of life (Ho and Li, 2016) and mental health (Bujang et al., 2015). Arts-based interventions have been used in other healthcare settings to improve mental health and quality of life (Boyce et al., 2017). Arts-based interventions could help address the impact of haemodialysis and improve quality of life and mental health, however there is a lack of evidence assessing their effectiveness in this population.


To develop an arts-based intervention for patients with ESKD whilst receiving haemodialysis and evaluate the feasibility of conducting a future randomised controlled trial (RCT).


Intervention Development:

The arts-based intervention was developed using Fancourt’s (2017) framework for
developing arts-based interventions, this included a scoping review and establishment of an interdisciplinary advisory group consisting of key stakeholders. The intervention involved six one-hour long one-to-one facilitated art sessions during haemodialysis treatment.

Feasibility study:

A parallel convergent mixed-methods design was used, incorporating three components: a pilot cluster RCT, a process evaluation and a feasibility economic evaluation. The pilot cluster RCT took place in a single haemodialysis unit in Northern Ireland. The target sample size was 30 and participants were randomised to intervention or control group according to the time of day they attended haemodialysis. Clinical outcome measures collected included the Kidney Disease Quality of Life - SF36, the Hospital Anxiety and Depression Scale, and the EQ-5D-5L. Reasons for withdrawal were collected throughout the study. The process evaluation was guided by the RE-AIM framework and involved semi-structured interviews with 13 participants from the pilot cluster RCT, and 9 healthcare professionals who were 13 present during implementation. The feasibility economic evaluation involved providing participants with healthcare resource use logs at baseline and throughout the study. The intervention was costed and future costing considerations identified.


A total of 24 participants were recruited into the pilot cluster RCT. 80% of the target sample size was reached prior to randomisation. The total attrition rate at 3 months was 12.5% (n=3). Perception of the intervention changed following implementation, with participants viewing art as more accessible and enjoyable than anticipated. Benefits of the intervention were identified, including improvements in self-esteem and an improved dialysis experience. Patient choice and facilitation were important factors for successful implementation. There were poor response rates with the healthcare resource use logs and participants identified a preference for completing measures with researcher assistance.


An arts-based intervention for patients with ESKD whilst receiving haemodialysis I highly acceptable for both patients and healthcare professionals, and a definitive trial is feasible with some small modifications.
Date of AwardDec 2020
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SupervisorHelen Noble (Supervisor), Joanne Reid (Supervisor) & Ian Walsh (Supervisor)


  • Kidney disease
  • Haemodialysis
  • Feasibility study
  • Arts and health
  • Arts-based intervention
  • Randomised control trial
  • Complex interventions

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