Improving Participation in Pulmonary Rehabilitation through Peer-Support and Storytelling

通过同伴支持和讲故事提高肺康复的参与度

• 批准号: 10474109
• 负责人: Peter Kyle Lindenauer
• 金额: $ 72.28万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474109
• 关键词: Adopted; Adult; Advisory Committees; Affect; American; Attitude; Behavior; Belief; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Chronic Obstructive Pulmonary Disease; Clinical; Consent; Development; Disease Management; Dyspnea; Effectiveness; Emergency department visit; Europe; Expectancy; Goals; Guidelines; Health; Health Status; Health system; Hospitalization; Hospitals; Individual; Infrastructure; Intervention; Interview; Knowledge; Lead; Leadership; Libraries; Mediating; Methods; Modeling; National Heart, Lung, and Blood Institute; Outcome; Patient Participation; Patients; Phase; Physicians; Policies; Procedures; Professional Organizations; Protocols documentation; Quality of life; Randomized; Recovery; Recurrence; Research; Self Efficacy; Self Management; Shortness of Breath; Social support; Structure; Surveys; Techniques; Telephone; Testing; Training; Transportation; United States; Visit; acute care; arm; base; behavior change; blood pressure control; cohort; compare effectiveness; cost; deconditioning; diabetes self-management; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; exercise program; experience; group intervention; health literacy; health related quality of life; hospital readmission; implementation outcomes; implementation strategy; improved; intervention effect; mortality; motivational enhancement therapy; novel strategies; peer; peer coaching; peer support; prevent; programs; pulmonary rehabilitation; recruit; treatment as usual; uptake

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.

抽象的 慢性阻塞性肺疾病 (COPD) 恶化导致约 150 万人次就诊至急诊室， 每年有 700,000 人住院。恢复缓慢，且急性护理利用率高 和死亡率。肺康复 (PR) 是一项结构化的锻炼和自我管理支持计划 已被证明可以缓解呼吸困难并提高生活质量。临床指南推荐 PR 慢性阻塞性肺病稳定期和病情加重后的患者。不幸的是，即使由医生转介，我们的 研究表明，很少有可能受益于 PR 的患者会开始治疗。本次活动的首要目标 该项目的目的是确定促进和维持公关参与的有效策略。 同伴支持包括将患者与来自相似背景且经过培训的同伴配对，并面临相似的情况 已完成公关的健康挑战。越来越多的证据表明其可行性， 电话同伴支持对慢性病管理的可接受性和有效性。叙述 干预措施或“讲故事”是改变患者态度和行为的新颖方法， 涉及制作和传播由具有相同条件的生活经历的个人讲述的视频 或面临同样的待遇。讲故事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方面的同伴教练，并将 招募不同的故事讲述者群体，将他们的故事捕捉到视频中，并创建一个包含 6-8 个强大人物的图书馆 故事。我们将最终确定我们的方案、试验基础设施，并试点我们的招募策略。 R33期间 第一阶段，我们将招募 305 名接受 COPD 恶化治疗的成年人，并将他们随机分为 1) 增强组 “日常护理”(eUC)； 2）eUC+讲故事；或 3) eUC + 同行支持。我们将评估其有效性 每个策略与 eUC 以及彼此之间在促进 6 个月时 PR 参与方面的比较。使用 通过混合方法，我们将评估干预措施的可接受性、可持续性和成本， 患者和同伴教练以及公关项目人员和医院领导层的观点。我们将使用 这些发现可以完善策略并传播实施方案，从而使其他公关 采用这些方法的计划。 该项目让主要利益相关者参与研究概念化、执行和传播，并且 响应 NHLBI/CDC COPD 国家行动计划，该计划呼吁制定战略 增加受益于公关的美国人数量。