Developing a Couples Coping Intervention for Veterans with Heart Failure

为患有心力衰竭的退伍军人制定夫妻应对干预措施

• 批准号: 8278413
• 负责人: Ranak Trivedi
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-04-01 至 2017-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8278413
• 关键词: Address; Adherence; Affect; Age; Anxiety; Caregiver Burden; Caregivers; Caring; Chronic Disease; Chronically Ill; Clinical; Collaborations; Communication; Complex; Consultations; Coping Skills; Couples; Development; Diagnosis; Disabled Persons; Disease; Disease Management; Distress; Elements; Emotional; Endogenous depression; Ensure; Equilibrium; Foundations; Goals; Health; Health Services Research; Heart Diseases; Heart failure; Home environment; Hospitalization; Hospitals; Improve Access; Individual; Intervention; Lead; Life; Life Style; Manuals; Medical; Mental Depression; Mentors; Methodology; Occupations; Outcome; Patients; Personal Satisfaction; Persons; Pharmaceutical Preparations; Pilot Projects; Play; Provider; Psychologist; Psychosocial Factor; Quality of life; Recommendation; Research; Research Activity; Research Personnel; Research Training; Role; Rural; Sampling; Self Management; Services; Shapes; Social Network; Social support; Source; Spouses; Stress; Symptoms; Telephone; Testing; Time; Training; Training Activity; Training Programs; Travel; Treatment Efficacy; Treatment Protocols; Universities; Veterans; Visit; Washington; Woman; affection; base; career; coping; depressive symptoms; design; disability; efficacy testing; experience; functional disability; improved; interest; intervention program; loved ones; male; malignant breast neoplasm; meetings; mortality; outreach; programs; prototype; public health relevance; rural area; stressor; therapy design; therapy development

DESCRIPTION (provided by applicant): Background: I am a core investigator at the Seattle HSR&D CoE and a clinical health psychologist with a long-standing interest in the intersection of psychosocial factors and chronic illness outcomes. Over the last several years, I have examined how depressive symptoms, social support, and coping influence adherence to medical recommendations, hospitalizations, and mortality among patients with heart disease. I have become interested in the influence of informal caregivers, especially spouses or significant others ("partners"). Partners are integral t Veteran care yet may experience stress and burden when caring for a heart failure patient. Engaging couples and other patient-caregiver dyads may be effective in improving patient outcomes provided this does not lead to additional burden. One approach is to design and test dyadic interventions with couples to enhance coping skills. I am seeking additional training through the CDA2 mechanism to 1) To gain a thorough understanding of the methodological issues of conducting dyadic research; 2) To gain expertise in developing interventions involving patients and their partners; 3) to design and conduct RCTs to evaluate these interventions; 4) To develop a health services research program in dyadic research; 5) To understand how to implement an intervention for wider dissemination within the VA. Key Elements of Research Plan: With the guidance of my mentors, I plan to develop a telephone-based couples' intervention aimed at improving coping in Veterans with heart failure and their partners. The planned intervention will be based on the Partners in Coping Program, an intervention found to be efficacious in improving coping in women with breast cancer and their partners. The research proposed in the CDA involves developing a treatment manual after obtaining input from providers, Veterans with heart failure, and their partners; pilot test the acceptability and feasibility on a sample of 30 Veterans with heart failure and their partners; refine the interventin based on the results of the pilot study; and lay the foundation for an RCT of 100 couples to determine its efficacy in improving quality of life, couples' coping, and self-management among Veterans with heart failure and their partners. Mentors: I will be supported in my training and research activities by my primary mentor Dr. John Piette and secondary mentors Drs. Karin Nelson, Steve Fihn, and Dan Kivlahan. I will obtain methodological oversight through consultations with Dr. David Atkins (dyadic methodology expert) and Dr. James Pfeiffer (qualitative methodology expert), both at the University of Washington in Seattle. Career Goal: My career plans are to become an expert in developing and disseminating interventions that target Veteran-caregiver dyads in which Veterans have a complex chronic illness. During my CDA, I will focus on Veterans with heart failure as a prototypical subset of chronically ill patiens, and spousal partners as a subset of caregivers, while understanding that the eventual intervention may be relevant to Veterans with other chronic illnesses and other informal caregivers. The intervention I will develop and study will be telephone- based to ensure outreach to rural and/or disabled Veterans and their partners. My proposed CDA research will lead to the development of a couples' intervention that will enhance quality of life, coping, and self- management in complex chronic illness. PUBLIC HEALTH RELEVANCE: Heart failure is the number one discharge diagnosis among Veterans. Having heart failure can be stressful for both Veterans and their partners, leading to poor individual quality of life and poor functioning as a couple. This may adversely influence self-management which in turn may lead to poorer outcomes. One way to improve outcomes may be to provide effective coping skills, improve communication, and improve collaboration between couples. In doing so, we have the opportunity to improve individual quality of life, well-being of the couple, and the couples' participation in self-management. Such an approach may not only benefit heart failure patients and their partners; it has the potential for improving outcomes among other complex chronic illnesses which require intensive self-management and caregiver participation.

描述（由申请人提供）： 工作背景：我是西雅图HSR&D卓越中心的核心研究员，也是一名临床健康心理学家，长期以来一直对心理社会因素和慢性疾病结果的交叉点感兴趣。在过去的几年里，我研究了抑郁症状、社会支持和应对方式如何影响心脏病患者对医疗建议的依从性、住院率和死亡率。我开始对非正式照顾者的影响感兴趣，特别是配偶或重要的其他人（“合作伙伴”）。合作伙伴是不可或缺的退伍军人护理，但可能会遇到压力和负担时，照顾心力衰竭患者。参与夫妇和其他患者-护理人员配对可能有效改善患者结局，前提是这不会导致额外负担。一种方法是设计和测试与夫妇的二元干预措施，以提高应对技能。我正在通过CDA 2机制寻求额外的培训，以1）深入了解进行二元研究的方法学问题; 2）获得开发涉及患者及其伴侣的干预措施的专业知识; 3）设计和进行RCT以评估这些干预措施; 4）开发二元研究中的卫生服务研究计划; 5）了解如何实施干预措施，以便在退伍军人事务部内更广泛地传播。研究计划的关键要素：在导师的指导下，我计划开发一种基于电话的夫妻干预方法，旨在改善心力衰竭退伍军人及其伴侣的应对方式。计划中的干预措施将以应对方案伙伴为基础，这一干预措施被认为在改善乳腺癌妇女及其伙伴的应对方面有效。CDA提出的研究包括在获得提供者、心力衰竭退伍军人及其伴侣意见后制定一份治疗手册;对30名心力衰竭退伍军人及其伴侣进行可接受性和可行性试点测试;根据试点研究结果改进干预措施;并为100对夫妇的随机对照试验奠定基础，以确定其在改善心力衰竭退伍军人及其伴侣的生活质量、夫妇应对和自我管理方面的疗效。导师：我的主要导师John Piette博士和次要导师Karin纳尔逊、Steve Fihn和Dan Kivlahan博士将支持我的培训和研究活动。我将通过与西雅图的华盛顿大学的大卫阿特金斯博士（二元方法学专家）和詹姆斯菲佛博士（定性方法学专家）的磋商来获得方法学的监督。职业目标：我的职业计划是成为一名专家，制定和传播针对退伍军人护理人员的干预措施，其中退伍军人患有复杂的慢性疾病。在我的CDA期间，我将专注于心力衰竭退伍军人作为慢性病患者的典型子集，配偶作为照顾者的子集，同时了解最终的干预可能与其他慢性病退伍军人和其他非正式照顾者有关。我将制定和研究的干预措施将以电话为基础，以确保与农村和/或残疾退伍军人及其合作伙伴的联系。我提出的CDA研究将导致夫妇干预的发展，这将提高复杂慢性病的生活质量，应对和自我管理。 公共卫生相关性： 心力衰竭是退伍军人中的头号出院诊断。患有心力衰竭对退伍军人和他们的伴侣来说都是有压力的，导致个人生活质量差，夫妻生活质量差。这可能会对自我管理产生不利影响，进而可能导致更差的结果。改善结果的一种方法可能是提供有效的应对技巧，改善沟通，并改善夫妻之间的合作。这样做，我们就有机会提高个人生活质量、夫妇的福祉以及夫妇参与自我管理。这种方法不仅可以使心力衰竭患者及其伴侣受益，而且有可能改善其他需要强化自我管理和护理人员参与的复杂慢性疾病的结局。