Improving Veteran Adherence to Treatment for PTSD through Partnering with Families

通过与家人合作提高退伍军人对创伤后应激障碍 (PTSD) 治疗的依从性

• 批准号: 10197052
• 负责人: Laura Meis
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-09-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10197052
• 关键词: Address; Adherence; Blood; Caregivers; Caring; Clinical; Clinical Trials; Cognitive; Couples Therapy; Data; Disabled Persons; Distress; Dropout; Ensure; Evaluation; Evidence based treatment; Evolution; Family; Family member; Friends; Goals; Health; Healthcare; Individual; Institute of Medicine (U.S.); International; Measures; Mediating; Medical center; Mental Depression; Mental Health; Methods; Modeling; National Institute of Mental Health; Outcome; Pain management; Participant; Pathway interactions; Patient Self-Report; Patient-Centered Care; Patients; Perception; Personal Satisfaction; Policies; Post-Traumatic Stress Disorders; Practice Guidelines; Process; Provider; Psychotherapy; Quality of life; Randomized; Randomized Controlled Trials; Recovery; Rehabilitation therapy; Reporting; Research; Services; Severities; Site; Societies; Statutes and Laws; Strategic Planning; Suicide prevention; Surgeon; Surveys; Symptoms; Testing; Translating; Trauma; Veterans; Work; World Health Organization; clinically significant; combat; combat veteran; comorbidity; cost; design; effectiveness evaluation; effectiveness implementation study; effectiveness testing; efficacious treatment; evidence base; experience; family support; flexibility; implementation barriers; implementation facilitators; improved; innovation; interest; meetings; military service; military veteran; novel; novel strategies; patient population; post-traumatic symptoms; reduce symptoms; rehabilitation management; retention rate; routine care; social; tool

Impacts. This study aims to improve Veterans' adherence to evidence-based treatment for PTSD, through increasing family support for treatment. Improving retention rates in evidence-based PTSD treatment will positively impact Veterans' health and well-being, lower the cost of treating PTSD, and decrease long-term demand for PTSD services. If effective, this approach could help resolve national calls for routine inclusion of family involvement in PTSD treatment. Once demonstrated for PTSD, these strategies could be utilized for other conditions and problems relevant to Veteran populations (e.g., suicide prevention, TBI rehabilitation) and stimulate shifts across practice and policy to better routine and evidence-based involvement of families in care. Background. PTSD occurs in as many as 1 in 5 combat Veterans and is associated with a host of negative, long-term consequences to the individual, their families, and society at large. Evidence- based psychotherapies, such as Prolonged Exposure (PE), result in clinically significant symptom relief for many. Yet, adherence to these treatments (i.e., session attendance and homework compliance), which is vital to ensuring recovery, can be poor. Engaging families in Veterans' treatment may provide a powerful method for promoting EBP adherence. Our data indicate that 70% of Veterans express some interest in involving their family in their care for PTSD; yet, only 17% of providers have had any contact with Veterans' families. The objective of the proposed study is to evaluate the effectiveness of improving family support as a tool to improve Veterans' EBP adherence. This research agenda directly addresses two VA HSR&D priorities: 1) innovative mental health care; 2) improving the quality of life for Veterans and their caregivers. The work aligns with the VHA Blueprint for Excellence and Strategic Plan through meeting the unique needs of military-service disabled Veterans, providing a novel treatment approach, and emphasizing patient- and family-centered care. Objectives/Aims. Aim 1: To improve Veterans' adherence to PE through engaging families in care. H1: Veterans randomized to family supported PE will attend more sessions (H1a) and report greater homework compliance (H1b) than Veterans randomized to standard PE delivered in routine care. Aim 2: To improve the clinical outcomes of Veterans receiving PE through engaging families in care. H2: Family supported PE will be more effective than standard PE in reducing PTSD severity and comorbid problems (depression, quality of life, relationship functioning) from baseline to posttreatment. Aim 3: To examine barriers/facilitators of implementing family support for PE. Exploratory Aim: To identify mechanisms underlying adherence differences between treatment conditions. We will explore if adherence differences are mediated by changes on key social influence variables (family perceptions of treatment credibility, family support for PE, and family symptom accommodation). Methods. We are proposing a practical randomized controlled trial to compare Veteran adherence, and to PE with and without family attendance at PE's educational sessions, with the ultimate goal to improve Veterans' clinical outcomes. For Aim 3, we will use a concurrent process evaluation to identify potential implementation facilitators and barriers to family involvement in PE within VA. Participants will include Veterans with clinically significant symptoms of PTSD across three sites, plus a family member or friend of the Veteran. Aim 1 outcome variables include session attendance and homework compliance. Aim 2 outcomes include PTSD symptom severity, depression, quality of life, and relationship functioning, measured monthly over the course of treatment. Key social influences (Exploratory Aim) will be assessed through brief weekly self-reports.

影响。这项研究旨在提高退伍军人对创伤后应激障碍循证治疗的依从性， 通过增加家庭对治疗的支持。提高循证PTSD的保留率 治疗将积极影响退伍军人的健康和福祉，降低治疗创伤后应激障碍的成本， 减少对PTSD服务的长期需求。如果有效，这种方法可以帮助解决国家问题。 要求将家庭参与常规纳入PTSD治疗。一旦出现创伤后应激障碍， 这些策略可以用于与退伍军人群体相关的其他条件和问题 (e.g.,自杀预防，TBI康复），并刺激实践和政策的转变，以更好地 家庭以常规和循证方式参与护理。 背景PTSD发生在多达五分之一的战斗退伍军人中，并与许多 对个人、家庭和整个社会造成长期的负面影响。证据- 基于心理疗法，如长期暴露（PE），导致临床显著症状 对许多人来说是一种解脱。然而，坚持这些治疗（即，课程出勤和家庭作业 合规性），这对确保复苏至关重要，可能很差。让家庭参与退伍军人的治疗 可以提供促进EBP依从性的强有力的方法。数据显示，70%的退伍军人 表示有兴趣让他们的家人参与他们对创伤后应激障碍的护理;然而，只有17%的提供者 和退伍军人的家人有联系拟议研究的目的是评估 提高家庭支持作为提高退伍军人EBP依从性的工具的有效性。这 研究议程直接涉及两个VA HSR&D优先事项：1）创新精神卫生保健; 2） 改善退伍军人及其照顾者的生活质量。工作与VHA蓝图一致 卓越和战略计划，通过满足军队服务残疾人的独特需求 退伍军人，提供一种新的治疗方法，并强调以病人和家庭为中心的护理。 目的/目标。目标1：通过让家庭参与护理来提高退伍军人对PE的坚持。 H1：随机分配至家庭支持PE的退伍军人将参加更多的会议（H1 a），并报告更多 家庭作业依从性（H1b）比随机分配到常规护理中提供的标准PE的退伍军人。 目的2：通过让家庭参与护理来改善接受PE的退伍军人的临床结局。 H2：家庭支持的PE在降低PTSD严重程度方面比标准PE更有效， 从基线至治疗后的共病问题（抑郁、生活质量、关系功能）。 目标3：研究实施家庭支持体育的障碍/促进因素。 探索性目的：确定治疗条件之间依从性差异的潜在机制。 我们将探讨，如果坚持差异介导的变化，对关键的社会影响变量 （家庭对治疗可信度的看法，家庭对PE的支持和家庭症状适应）。 方法.我们提出了一个实际的随机对照试验，以比较退伍军人的坚持， 以及有家庭和没有家庭参加体育教育课程的体育，最终目标是 改善退伍军人的临床结果。对于目标3，我们将使用并发过程评估， 确定潜在的实施促进者和家庭参与VA内PE的障碍。 参与者将包括三个地点的具有临床显著PTSD症状的退伍军人， 退伍军人的家人或朋友。目标1的结果变量包括会议出席率和 家庭作业合规。目标2结果包括PTSD症状严重程度、抑郁、生活质量， 和关系功能，在治疗过程中每月测量。主要社会影响 （探索性目标）将通过每周简短的自我报告进行评估。

项目成果

Can families help veterans get more from PTSD treatment? A randomized clinical trial examining Prolonged Exposure with and without family involvement.

• DOI: 10.1186/s13063-022-06183-2
• 发表时间: 2022-03-30
• 期刊: Trials
• 影响因子: 2.5
• 作者: Meis LA;Glynn SM;Spoont MR;Kehle-Forbes SM;Nelson D;Isenhart CE;Eftekhari A;Ackland PE;Linden EB;Orazem RJ;Cutting A;Hagel Campbell EM;Astin MC;Porter KE;Smith E;Chuick CD;Lamp KE;Vuper TC;Oakley TA;Khan LB;Keckeisen SK;Polusny MA
• 通讯作者: Polusny MA