Cognitive Bias Modification Training Targeting Fatigue in Patients With Kidney Disease: Usability Study

Abstract

Background Fatigue is an important symptom for many patients, including patients with kidney disease. Cognitive biases, such as attentional bias and self-identity bias, are thought to influence fatigue. Cognitive bias modification (CBM) training is a promising technique to counter fatigue. Objective We aimed to evaluate a CBM training among patients with kidney disease and health care professionals (HCPs) and assess acceptability and applicability in the clinical setting using an iterative design process to evaluate expectations and experiences with the training. Methods This was a longitudinal, qualitative, and multiple stakeholder–perspective usability study in which we interviewed end users and HCPs during the prototyping phase and after the end of training. We conducted semistructured interviews with 29 patients and 16 HCPs. The interviews were transcribed and analyzed thematically. Next to a general evaluation of the training, the acceptability of the training was evaluated using the Theoretical Framework of Acceptability, and applicability was assessed by evaluating obstacles and solutions for implementation in the kidney care setting. Results Generally, participants were positive about the training and its applicability. The biggest negatives were doubts about effectiveness and annoyance about the repetitive character of CBM. Acceptability was judged with a mixed evaluation, with a negative evaluation of perceived effectiveness; mixed results for burden, intervention coherence, and self-efficacy; and positive results for affective attitude, ethicality, and opportunity costs. Barriers for applicability were patients’ varying computer skills, subjectivity of fatigue, and integration with regular treatment (eg, the role of HCPs). Possible solutions included assigning representatives among nurses, offering training on an app, and providing assistance via a help desk. The iterative design process, including repeated waves of testing user expectations and experiences, yielded complementary data. Conclusions To the best of our knowledge, this study is the first to introduce a CBM training targeting fatigue. Furthermore, this study provides one of the first user evaluations of a CBM training, both among patients with kidney disease and their care providers. Overall, the training was evaluated positively, although acceptability showed mixed results. Applicability was positive although barriers were identified. The proposed solutions require further testing, preferably following the same frameworks, as the iteration in this study contributed positively to the quality of the training. Therefore, future research should follow the same frameworks and consider stakeholders and end users in eHealth intervention design.

A Protocol for a feasibility study of Cognitive Bias Modification training (IVY 2.0) countering fatigue in people with breast cancer

“…Both of these studies evaluated the application with multiple stakeholders (patients and health care professionals) and revealed positive results. Although in this usability study with people suffering from breast-cancer, preliminary data analyses only revealed a trend in altering self-identity bias (33), a pilot study with people suffering from chronic kidney disease revealed strong CBM effects on cognitive bias, and promising results on symptoms and related behaviour (34).…”

“…Next, following the iterative human-centred design framework (32), our research team has investigated this novel eHealth application by researching usability. This has been done with people suffering from breast cancer (33) and from chronic kidney disease (34). Both of these studies evaluated the application with multiple stakeholders (patients and health care professionals) and revealed positive results.…”

The presence of attentional and interpretation biases in patients with severe MS‐related fatigue

“…To get a better understanding of the potential mechanistic role of information processing biases, longitudinal studies are needed that change these biases and assess any corresponding change in symptom experience. Recently, promising steps have been made to develop Cognitive Bias Modification training to reduce fatigue in kidney patients (Geerts et al, 2023). It would be interesting to study if the implicit IB is moderated via existing treatments such as cognitive behavioural therapy for MS-related fatigue, in which cognitions and attentional processes are explicitly addressed.…”