Strengths and Limitations
fatigue, pain
RECRUITMENT
A strength of this study was the diverse racial and ethnic representation from 2 geographic areas, which enhances its external validity. In addition, the trial included urban and rural dialysis units, which provided evidence for use of this collaborative care model to address symptom burden among underserved populations. The adherence rate to CBT was high, and outcomes were assessed centrally by trained interviewers who were blinded to treatment assignment. Lastly, the use of an attention control instead of usual care reduced bias and enhanced interpretability of the results.Study limitations included higher than expected loss of follow-up owing in part to changes in practice in response to the COVID-19 pandemic. This loss was addressed by increasing recruitment goals to offset the observed dropouts. Screening tests for fatigue and pain used single-item assessments that have not been validated and may have missed some true positives. This trial had a limited ability to test for heterogeneity of treatment effects. Lastly, there may be future opportunities to culturally tailor the intervention.