Improving Participation in Pulmonary Rehabilitation through Peer-Support and Storytelling

摘要 慢性阻塞性肺疾病(COPD)的恶化导致约150万急诊和 每年有70万人次住院。恢复缓慢，并伴随着高水平的急性护理利用率 和死亡率。肺康复(PR)是一个有组织的锻炼和自我管理支持计划 这已被证明可以缓解呼吸困难，提高生活质量。临床指南推荐PR治疗 COPD稳定期和病情加重后的患者。不幸的是，即使在医生的建议下，我们的 研究表明，很少有可能从PR中受益的患者开始治疗。这样做的主要目标是 该项目的目的是确定促进和持续参与公共关系的有效战略。 同伴支持包括将患者与来自相似背景的训练有素的同伴配对，并面临相似的 健康挑战，世卫组织已完成公关。越来越多的证据表明这是可行的， 慢性病管理电话同伴支持的可接受性和有效性。叙述性 干预，或“讲故事”，是改变患者态度和行为的新方法， 包括创建和传播由具有相同条件的亲身经历的个人讲述的视频 或者面临同样的待遇。讲故事的干预措施已被证明可以帮助患者获得更好的血液 压力控制和讲故事正在各种其他临床环境中进行研究。 在R61阶段，我们将招募和培训一批行为改变技术的同行教练，并将 招募不同的故事讲述者小组，在视频中捕捉他们的叙述，并创建一个由6-8名强大的人组成的图书馆 故事。我们将最终确定我们的协议，试验基础设施，并试行我们的招聘战略。在R33期间 阶段，我们将招募305名因COPD恶化而接受治疗的成年人，并将他们随机分配到1)强化组 “日常护理”(EUC)；2)EUC+讲故事；或3)EUC+同伴支持。我们将评估这一计划的有效性 每种策略都与EUC进行比较，并相互比较，以促进6个月后参与公关。使用 混合方法，我们将从以下方面评估干预的可接受性、可持续性和成本 患者和同行教练以及公关项目工作人员和医院领导层的观点。我们将使用 这些调查结果将完善战略，并传播执行一揽子计划，使其他公关能够 计划采用这些方法。 这个项目让关键的利益相关者参与研究的概念化、执行和传播，并且是 响应NHLBI/CDC COPD国家行动计划，该计划呼吁制定战略，以 增加从公关中受益的美国人的数量。

ABSTRACT Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) lead to roughly 1.5 million ED visits and 700,000 hospitalizations annually. Recovery is slow, and accompanied by high levels of acute care utilization and mortality. Pulmonary Rehabilitation (PR) is a structured program of exercise and self-management support that has been shown to relieve dyspnea and improve quality of life. Clinical guidelines recommend PR for patients with stable COPD and after an exacerbation. Unfortunately, even when referred by physicians, our research has shown that few patients who might benefit from PR ever begin treatment. The primary goal of this project is to identify effective strategies for promoting and sustaining participation in PR. Peer Support involves pairing a patient with a trained peer from a similar background, and facing similar health challenges, who has completed PR. There is a growing body of evidence demonstrating the feasibility, acceptability, and effectiveness of telephonic peer support for chronic disease management. Narrative interventions, or `Storytelling', are novel approaches for changing attitudes and behaviors of patients that involve creating and disseminating videos narrated by individuals with lived experience with the same condition or facing the same treatment. Storytelling interventions have been shown to help patients achieve better blood pressure control, and storytelling is being studied in a variety of other clinical contexts. In the R61 Phase, we will recruit and train a cohort of peer coaches in behavior change techniques, and will recruit a diverse group of storytellers, capture their narratives on video, and create a library of 6-8 powerful stories. We will finalize our protocol, trial infrastructure, and pilot our recruitment strategy. During the R33 Phase, we will recruit 305 adults treated for exacerbation of COPD, and randomize them to 1) Enhanced “Usual Care” (eUC); 2) eUC + Storytelling; or 3) eUC + Peer Support. We will evaluate the effectiveness of each strategy compared to eUC, and to each other, at promoting participation in PR at 6 months. Using a mixed-methods approach, we will evaluate intervention acceptability, sustainability, and cost, from the perspectives of the patients and peer coaches as well as PR program staff and hospital leadership. We will use these findings to refine the strategies and to disseminate an implementation package that will enable other PR programs to adopt these approaches. This project engages key stakeholders in study conceptualization, execution, and dissemination, and is responsive to the NHLBI/CDC COPD National Action Plan that calls for the development of strategies to increase the number of Americans that benefit from PR.