In the landscape of modern medicine, the management of end-stage renal disease (ESRD) continues to pose substantial challenges, especially when intertwined with the psychological burden of depression. Patients undergoing dialysis are often caught in a complex interplay of physical and mental health struggles that profoundly influence their treatment outcomes. A groundbreaking study published in BMC Psychiatry in 2025 sheds new light on how tele-based continuous care can revolutionize treatment compliance in dialysis patients, particularly distinguishing the impacts on those with and without depression.
End-stage renal disease, a condition marked by the gradual and irreversible loss of kidney function, necessitates sustained and rigorous treatment regimens, including dialysis. This life-sustaining therapy requires consistent patient adherence to both clinical protocols and medication schedules. However, the concomitant presence of depression—a prevalent yet frequently under-addressed comorbidity in ESRD patients—often complicates adherence, leading to poorer health outcomes. Recognizing these intertwined challenges, researchers sought to explore how tele-based interventions, offering continuous care remotely, could enhance patient compliance.
The study recruited 549 participants from fifteen tertiary A-grade hospitals in Anhui Province, China, over a three-month period. These participants were rigorously screened to meet predefined inclusion and exclusion criteria to ensure the robustness of data. Employing covariance-based structural equation modeling (CB-SEM), the researchers analyzed the nuanced relationships among tele-based care, nurse-patient dynamics, health beliefs, and treatment adherence. Notably, the study introduced a multi-group comparison to elucidate differences between depressed and non-depressed dialysis patients, striving to unravel how mental health status might modulate the effectiveness of tele-based care.
Remarkably, the findings underscored a significant positive correlation between tele-based continuous care and treatment compliance across the dialysis cohort. This suggests that when patients receive consistent, remote healthcare engagement, they are more likely to adhere to their complex therapeutic regimens. Such an outcome is particularly salient in the context of chronic diseases, where ongoing monitoring and support are critical to sustained health improvements and avoidance of complications.
Delving deeper, the study investigated the roles of the nurse-patient relationship and patients’ health beliefs as potential mediators in this dynamic. While conventional wisdom often emphasizes the importance of rapport between healthcare provider and patient in fostering adherence, this research presented a nuanced perspective. In the overall dialysis population, the direct impact of the nurse-patient relationship on compliance was found to be statistically insignificant. This unexpected revelation challenges preconceived notions, suggesting that mere interpersonal connection may not directly translate to better treatment adherence in this context.
However, the narrative takes a compelling turn when patients are stratified by depression status. Among patients grappling with depression, tele-based continuous care exerted its positive influence on compliance exclusively through the enhancement of health beliefs—patients’ perceptions and attitudes towards their health and treatment. In other words, reinforcing patients’ confidence and understanding about their illness and treatment proved pivotal in encouraging adherence within the depressed subgroup.
Conversely, for patients without depression, tele-based continuous care positively affected compliance via multiple channels, excluding the nurse-patient relationship, which remained non-significant. This differential pathway is crucial, as it spotlights the distinctive psychological and behavioral mechanisms at play depending on the presence or absence of depression. It highlights the imperative of personalized care strategies that address both the mental health status and the cognitive frameworks of patients.
This profound insight carries broad implications for the design of telehealth programs in nephrology and beyond. Tele-based continuous care, by providing ongoing support and fostering positive health beliefs, can mitigate some of the barriers to treatment adherence intrinsic to both physical and psychological burdens. Importantly, it suggests that such interventions must be particularly tailored to bolster health belief systems in patients experiencing depression, which can often undermine motivation and compliance.
Furthermore, the study’s methodological rigor—utilizing structural equation modeling—enabled the disentanglement of complex, multi-layered relationships between variables. This analytical approach provides a more granular understanding of not only whether tele-based care works, but how and why it works differently across subgroups. Such knowledge is invaluable for healthcare providers and policymakers intent on optimizing intervention strategies and resource allocation.
The implications for public health policy are equally significant. As telehealth becomes increasingly ingrained in healthcare delivery frameworks worldwide, evidence-based validation of its efficacy across varied patient populations must guide integration efforts. Incorporating mental health considerations explicitly into telehealth protocols for chronic disease management is an emerging priority highlighted by this research.
Moreover, this study sheds light on the evolving role of nursing professionals in telehealth environments. While the nurse-patient relationship did not exhibit direct mediation effects in this particular setting, nurses remain vital interlocutors in delivering care, providing education, and addressing emergent issues remotely. Understanding how to maximize the impact of nurse engagement in telehealth remains an exciting frontier for further investigation.
In conclusion, the research published by Hong and colleagues in BMC Psychiatry advances our comprehension of the mechanisms through which tele-based continuous care influences treatment compliance in dialysis patients. By delineating how health beliefs mediate this relationship especially in depressed patients, the study advocates for integrating psychological support within telehealth models. As ESRD and mental health challenges continue to escalate globally, such insights offer a beacon for enhancing patient outcomes through innovative, patient-centered care strategies enabled by technology.
The findings invite broader discourse on the future of healthcare delivery, emphasizing the necessity for multidisciplinary approaches that bridge physical and mental health domains. Tele-based continuous care emerges not merely as a convenience but as a potent tool to surmount treatment barriers, particularly for vulnerable dialysis patients contending with depression. This research marks a pivotal step towards refining telemedicine practices to achieve holistic, effective chronic disease management in the digital era.
Subject of Research: Tele-based continuous care and treatment compliance in dialysis patients with and without depression, focusing on the mediating roles of nurse-patient relationship and health belief.
Article Title: Tele-based continuous care and treatment compliance in dialysis patients with and without depression: the serial mediating effect of nurse-patient relationship and health belief
Article References:
Hong, W., Cheng, G., Ma, Y. et al. Tele-based continuous care and treatment compliance in dialysis patients with and without depression: the serial mediating effect of nurse-patient relationship and health belief. BMC Psychiatry 25, 1090 (2025). https://doi.org/10.1186/s12888-025-07534-4
Image Credits: AI Generated
DOI: 13 November 2025
