Technology Assisted Stepped Collaborative Care Intervention

End-stage renal disease patients on hemodialysis experience substantial symptom burden with
fatigue, pain and depression among the most debilitating and existing as symptom clusters.
These symptom clusters can exacerbate one another, and are independent and strong predictors
of poor health-related quality of life in hemodialysis patients. This study will look at the
effect of a 12 week stepped care intervention on changes in depression, pain or fatigue and
health related quality of life.

Inclusion Criteria:

1. 18 years or older

2. undergoing thrice-weekly maintenance hemodialysis for > 3 months

3. English speaking

4. able to provide informed consent

5. no evidence of thought disorder, delusions or active suicidal ideation

Exclusion Criteria:

1. thought disorder, delusions or active suicidal ideation

2. active substance abuse

3. too ill or cognitively impaired to participate based on clinicians' judgment

4. anticipated life expectancy of less than 1 year

5. unable or unwilling to adhere to study protocol

6. participating in another clinical trial or taking an investigational drug

7. scheduled for living donor kidney transplant within next 6 months

8. relocating to another dialysis unit within 6 months