Discussion
fatigue, cancer, pain, depression, heart failure
HEART FAILURE, CHRONIC ILLNESS, CANCER
In this multicenter randomized clinical trial targeting key symptoms in patients receiving long-term hemodialysis, a stepped collaborative care intervention led to clinically significant improvements in fatigue and pain at 3 months, which were sustained for 6 months. Improvements in depression at 3 months were statistically significant but small. Targeting symptom clusters allowed for improvement in multiple symptoms that commonly coexist. When presented with therapeutic options, most patients preferred CBT over pharmacotherapy; adherence to CBT was high. Lastly, telemedicine-delivered collaborative care was effective, safe, and reliable during in-center hemodialysis.The TĀCcare study addresses gaps in the care for this population given that previous work has shown a marked symptom burden that is underrecognized and poorly treated.Our collaborative care intervention extends findings from other populations with chronic illness, such as patients with heart failure and cancer.In the present study, improvements in depression were statistically significant but small. This finding contrasted with those of prior studies which showed significant improvements with CBT in patients undergoing hemodialysis.Unlike some of the prior trials in long-term hemodialysis,