Complex arts-based interventions for patients receiving haemodialysis: A realist review

Abstract

Background: Many patients who develop end stage kidney disease require haemodialysis, a treatment that requires attending hospital three times a week for four hours each visit. This treatment impacts profoundly on quality of life (QoL) and mental health. Arts-based interventions for patients receiving haemodialysis could help address the impact of this treatment; however there is a lack of consensus on the methods of implementation and the mechanisms of these interventions in specific clinical contexts.Methods: Using a realist approach, relevant articles were synthesised to inform theory relating to the mechanism and implementation of complex arts-based interventions for patients receiving haemodialysis. Results: The theoretical framework includes two implementation phases, firstly one to one delivery of person-centred arts activities during haemodialysis and secondly, display of completed artwork within the unit. This intervention triggers mechanisms such as flow, social capital and an aesthetic experience. Implementation is hindered by the constraints of the haemodialysis unit and patients lack of confidence in their artistic skills. The impacts of these issues are reduced by a flexible approach to implementation, patient's desire to pass time and support from healthcare professionals. KeywordsArts-based intervention, arts in medicine, haemodialysis, arts in health, end-stage kidney disease, Realist synthesis included in their remit; they are not presented as classifications in themselves. Previously Arts Council England outlined seven areas of arts in their policy, these include combined arts, dance, interdisciplinary arts, literature, music, theatre and visual arts (Arts Council England, 2006). These classifications are determined by the focus of the policy, not a developed classification system.Evidence-based classifications have been developed for the purpose of health research. Davies et al., (2012) acknowledged the inconsistencies in defining arts within the literature. They conducted an online survey, sampling 57 international experts in the field of art or arts in health, to develop a definition of arts engagement. Five classifications of art forms were defined: performing arts, visual arts, design and craft, literature, online, digital and electronic arts, and community and cultural festivals, fairs and events. A factor analysis of the identified arts engagement activities identified two dominant factors; active or receptive engagement. Active engagement was defined as creating art, while receptive engagement is observing or listening to the arts. This taxonomy is acknowledges both artistic medium and level of engagement as important factors in arts research (Davies et al., 2012). This enables health research not only to examine the effectiveness of particular arts forms, but examine how different levels of engagement can impact patients.There also remains a lack of clarity in health research literature when defining arts-based interventions.This results from a lack of consensus on whether arts therapi...

A mixed-methods feasibility study of an arts-based intervention for patients receiving maintenance haemodialysis

“…[3] Arts-based interventions have been suggested in the literature as a vehicle to address this issue, as they provide an engaging activity during a di cult treatment, allowing distraction from existential boredom. [6] The arts also induce a subjective experience called a ow state, which can result in the perception of time passing much faster than it actually is. [7] Additionally, artsbased interventions have demonstrated some e cacy in reducing symptoms of anxiety and depression in other patient populations such as cancer, cardiovascular disease and diabetes.…”

A Mixed-Methods Feasibility Study of an Arts-Based Intervention for Patients Receiving Maintenance Haemodialysis.

“…Acceptability of the intervention was highlighted throughout the process evaluation, both for patients and HCPs. Whilst participants identi ed potential barriers to implementation, these had previously been identi ed during the development of the intervention [6,23] and therefore were resolved prior to implementation. The intervention was not burdensome or disruptive for HCPs, an issue that can negatively impact clinical care.…”

“…The intervention was developed using the Arts in Health framework [20], guided by an interdisciplinary PPI advisory group,[21] a scoping review, [22] realist synthesis [6] and consultations with patients and healthcare professionals. [23] The intervention was developed based on the psychological theory of ow, which posits the existence of a ' ow state', a state of optimal experience that results from complete absorption in a task.…”

“…[7] Qualitative literature has suggested arts-in-medicine programmes can induce the hallmark experiences of a ow state in patients who participate, such as an altered perception of time and reduction in rumination and anxiety. [6] The intervention consisted of six one-hour, one-to-one facilitated arts sessions at the participant's bedside during their haemodialysis treatment, and implemented by CC. [23] The facilitator was a registered mental health and amateur artist who was involved in the development of the intervention.…”

“…[5] Arts-based interventions have been suggested in the literature as a vehicle to address this issue, as they provide an engaging activity during a di cult treatment, allowing distraction from existential boredom. [6] The arts also induce a subjective experience called a ow state, which can result in the perception of time passing much faster than it actually is. [7] Additionally, arts-based interventions have demonstrated some e cacy in reducing symptoms of anxiety and depression in other patient populations such as cancer, cardiovascular disease and diabetes.…”