Improving Psychological Outcomes for Acute Respiratory Failure Survivors using a Self-Management Intervention

在美国，越来越多的成年人患上急性呼吸衰竭(ARF)，需要机械治疗 重症监护病房(ICU)的通风。为了改善患者的预后，循证指南 建议滴定镇静剂，以便患者在ICU时保持清醒。然而，在清醒的ARF中 对于患者来说，焦虑可能是一个常见且长期存在的问题。在ICU环境之外，自我管理 干预措施是为焦虑症患者建立的、基于证据的一线治疗。然而，还有 急性肾功能衰竭患者自我管理干预的可行性和益处的证据有限 住院治疗。因此，这项K23建议寻求：1)对住院患者进行定性研究，以 在急性呼吸衰竭(SMARF)干预中完善现有的自我管理(目标1)和2)实施 ICU和病房改良SMARF干预与常规护理的试点随机对照试验(RCT) 确定其在降低焦虑方面的可行性、可接受性(主要结果；目标2a)和潜在疗效 出院时的症状和相关结果(目标2b)和3个月的随访(次级 结果；目标3)。 梅根·霍西博士，约翰·霍普金斯大学的执业临床心理学家和助理教授 医学院，有一个长期的职业目标是成为一名独立的，以患者为中心的研究人员 急性呼吸衰竭，研究早期干预措施，以减轻心理症状和改善长期 期末功能结局。通过这个K23奖项，Hosey博士将实现以下职业目标：1)获得 通过教学课程和指导实践经验在定性研究方面的专业知识，2)深化 通过完成健康科学硕士(MHS)在以患者为中心的研究方面的知识和经验 临床研究和开展随机对照试验的学位，以及3)获得科学指导经验 出版和赠款写作。该奖项将产生初步数据和技能，为 一项成功的未来R级拨款和获得独立调查员地位的途径。这个奖项将建立 基于Hosey博士在ARF患者和她的自我管理干预方面的广泛临床专业知识 通过提供有针对性的教学训练从ARF中恢复的心理社会方面的研究背景 和世界级团队的指导研究经验，所有这些都发生在资源丰富的学术机构 环境。

An increasing number of adults in the U.S. develop acute respiratory failure (ARF) requiring mechanical ventilation in an intensive care unit (ICU). To improve patient outcomes, evidence-based guidelines recommend titrating sedatives to allow for patient wakefulness while in the ICU. However, among awake ARF patients, anxiety can be a common and long-lasting problem. Outside of the ICU setting, self-management interventions are established, evidence-based, first-line treatments for patients with anxiety. However, there is limited evidence about the feasibility and benefit of self-management interventions for ARF patients during hospitalization. Hence, this K23 proposal seeks to: 1) conduct a qualitative study in hospitalized patients to refine an existing Self-Management in Acute Respiratory Failure (SMARF) intervention (Aim 1), and 2) conduct a pilot randomized controlled trial (RCT) of the refined SMARF intervention vs. usual care in the ICU and wards to establish its feasibility, acceptability (primary outcome; Aim 2a), and potential efficacy in reducing anxiety symptoms and associated outcomes at hospital discharge (Aim 2b) and at 3-month follow-up (secondary outcomes; Aim 3). Megan Hosey, PhD, a practicing clinical psychologist and Assistant Professor at the Johns Hopkins School of Medicine, has a long-term career goal of becoming an independent, patient-oriented researcher in acute respiratory failure, examining early interventions to reduce psychological symptoms and improve long- term functional outcomes. Through this K23 award, Dr. Hosey will achieve the following career goals: 1) gain expertise in qualitative research via didactic coursework and mentored practical experience, 2) deepen knowledge and experience in patient-oriented research by completing a Master of Health Science (MHS) degree in Clinical Investigation and conducting a pilot RCT, and 3) gain mentored experience with scientific publication and grant writing. This award will result in preliminary data and skills that will lay the foundation for a successful future R-level grant and pathway towards independent investigator status. This award will build upon Dr. Hosey’s extensive clinical expertise in self-management interventions for ARF patients and her research background in the psychosocial aspects of recovery from ARF via providing tailored didactic training and mentored research experience with a world-class team, all occurring in a resource-rich academic environment.