Intervention Group
depression, fatigue, pain
ADVERSE EVENTS
Participants randomized to the TĀCcare group received treatment targeted at 1 or more symptoms (fatigue, pain, and/or depression) based on patients’ reported levels of each symptom and preference. Using an individualized and shared decision-making approach, pharmacotherapy, and/or CBT were offered to patients for a 12-week period. A stepped approach to treatment intensification allowed for monitoring patient adherence, treatment response, preferences, and outcomes, and modifying the treatment to achieve the best possible outcome for each patient. The CBT strategies were contextualized to address the unique challenges and needs of each patient receiving hemodialysis.If patients preferred pharmacotherapy or did not respond to CBT, medications for pain and/or depression were initiated, or dosages were escalated in a stepped fashion using clinically used evidence-based protocols. There was no pharmacotherapy option for fatigue given the lack of any approved evidence-based fatigue medications for this population. The research team’s medication recommendations were conveyed to the patient’s primary care physician and/or nephrologist by the therapists or the study nephrologist. The collaborative care model ensured a multidisciplinary approach to the patient’s physical and mental health by aligning symptom management with the overall plan of care. Therapists facilitated care coordination, medication management, and monitoring of adherence and adverse events by serving as liaisons among patients, dialysis teams, and other health care professionals.