Introduction
depression, fatigue, ESKD, pain
END-STAGE KIDNEY DISEASE
Patients with end-stage kidney disease (ESKD) undergoing treatment with long-term hemodialysis experience a high symptom burden that contributes to poor health-related quality of life (HRQOL).Currently available treatments for these symptoms are limited for patients receiving hemodialysis. The most promising results have been for treatment of depression using pharmacotherapy or psychotherapy.To address these gaps in symptom management, we designed the Technology Assisted Stepped Collaborative Care (TĀCcare) intervention to target a common symptom cluster—fatigue, pain, and depression—and used a flexible approach to offer clinical treatment options that were tailored to individual preferences and treatment responses. Either CBT and/or pharmacotherapy can be initiated sequentially, and subsequently, both psychotherapy and medication dosages may be escalated in a stepped fashion using evidence-based protocols. Additionally, a collaborative model was incorporated to promote care coordination among dialysis and primary care teams. The goal of our study was to compare the effectiveness of the TĀCcare intervention with an attention control in improving fatigue, pain, and depression among patients with ESKD who are undergoing long-term hemodialysis.