Setting and Participants
depression, fatigue, pain
Adult patients (≥18 years) receiving in-center 3-times-weekly maintenance hemodialysis from 6 dialysis units in Western Pennsylvania and 8 dialysis units in New Mexico were recruited for study participation. Participants were enrolled from March 1, 2018, to Dec 31, 2021, and were followed uo through June 31, 2022. All patients were asked to complete a screening for fatigue (Likert scale, 0-10 with higher score indicating worse fatigue), pain (Likert scale, 0-10 with higher score indicating worse pain), and depression (Patient Health Questionnaire-9, higher score indicating worse depression) experienced during the past 2 weeks.Of the 896 patients screened, 678 (76%) met eligibility criteria, and 517 (76%) completed screening for symptom severity and readiness to seek treatment. Of the 387 patients (75%) who had clinical levels of at least 1 symptom (fatigue, pain, or depression) and were at least in the contemplation phase of readiness to seek treatment, 215 (65%) consented to participate, and 160 (74%) of them were randomized (