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Abstract: TH-PO977

Effect of Technology Assisted Stepped Collaborative Care Intervention on Fatigue, Pain, and Depression in Patients on Hemodialysis: The TACcare Trial

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Jhamb, Manisha, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Steel, Jennifer L., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Yabes, Jonathan, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Roumelioti, Maria-Eleni, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
  • Erickson, Sarah Jane, University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
  • Devaraj, Susan M., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Vowles, Kevin, Queens University of Belfast, Belfast, United Kingdom
  • Vodovotz, Yoram, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Beach, Scott, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Weisbord, Steven D., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Rollman, Bruce L., University of Pittsburgh, Pittsburgh, Pennsylvania, United States
  • Unruh, Mark L., University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
Background

Patients receiving hemodialysis experience a high symptom burden including pain, fatigue, and depression, and effective treatment options are limited. Our goal was to compare the efficacy of a stepped collaborative care intervention with an attention control group on these patient-centered outcomes.

Methods

In this multi-site, parallel-group, randomized controlled trial, patients undergoing hemodialysis at sites in New Mexico or Pennsylvania, with at least one of the 3 symptoms (fatigue, pain, or depression) and at least in contemplation phase of behavior change were enrolled. The intervention arm comprised of a stepped approach of cognitive behavioral therapy (CBT) and/or pharmacotherapy, in collaboration with the dialysis and primary care teams. Twelve sessions of CBT were delivered weekly using telemedicine in dialysis units or at home. The control arm received 6 sessions of health education using telemedicine. The co-primary outcomes were change in fatigue [Functional Assessment of Chronic Illness Therapy Fatigue], pain [Brief Pain Inventory] or depression [Beck Depression Inventory-II] scores measured post-intervention. Mixed models with linear contrast at post-intervention were employed adjusting for pre-specified covariates (age, sex, site, and comorbidity score) and used Benjamini-Hochberg-adjusted p-values.

Results

Among the 160 (Intervention n=83; Control n=77) randomized patients (mean age 58±14 yrs, 45% female, 28% Blacks, 13% American Indian, 18% Hispanics), the baseline symptom prevalence was 95% for fatigue, 46% for pain and 43% for depression. All intervention patients chose to receive CBT and <5% chose additional pharmacotherapy. Compared to controls, patients in the intervention arm experienced greater reduction in fatigue (mean difference [md] 2.81 [95% CI, 0.86 to 4.75]; p=0.014), pain (md -0.96 [CI, -1.70 to -0.23]; p=0.032), and depression (md -1.73 [CI, -3.18 to -0.28]; p=0.06) post-intervention, with similar adverse events in both arms.

Conclusion

Among patients on hemodialysis, a 12-week psychotherapy-based stepped collaborative care intervention resulted in clinically significant improvement in fatigue and pain.

Funding

  • NIDDK Support