Group-based telehealth stress management—lifestyle interventions are feasible for patients with chronic liver disease

BACKGROUND: Group-based, telehealth behavioral interventions may be efficient, effective, and acceptable treatment modalities for patients with chronic liver diseases; however, pilot feasibility and patient satisfaction data are needed to justify efficacy trials. Given the poor quality of life, symptoms, and health risk factors, patients with chronic hepatitis C-associated liver disease (HCV-LD) may benefit from psychosocial interventions. A pilot feasibility study of a videoconferencing-delivered cognitive behavioral coping skills intervention ("VC-CBCS") was conducted to evaluate multiple indicators of feasibility, levels of patient satisfaction, and changes in patient-reported outcomes (PROs). METHODS: We pilot tested a 14-week, 90-minute VC-CBCS intervention by conducting a small randomized controlled trial. Thirty-two adults with HCV-LD and high stress/symptom levels were randomized to the protocolized VC-CBCS intervention (n=24) or standard of care (n=8), in 4 waves of 7-9 participants in 2020-2021. RESULTS: Based upon rates of approach to enrollment (60%), retention (84%), PRO data collection (99.4%), and session attendance (91%), a future efficacy trial appears highly feasible. Levels of participant satisfaction were encouraging for VC delivery, intervention content and structure, and group processes. Technological and behavioral issues were minor. Collection of in-home saliva testing was not feasible. Moderate to large pre-post-intervention effect sizes were observed for some mediators (perceived stress, coping, relaxation, self-efficacy, sleep hygiene), with some of these changes correlating with small to moderate improvements in mental health and symptoms (eg, depression, fatigue; effect size range: 0.23-0.47). No consistent patterns were evident between changes in eating and exercise behaviors and PROs. CONCLUSIONS: A group-based VC-CBCS intervention appears feasible and may address unmet psychosocial needs in patients living with chronic liver disease.