Leveraging the dyad: mechanisms of an intervention for psychological distress in chronic lung disease

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PROJECT SUMMARY Patients with chronic obstructive pulmonary disease (COPD), a debilitating lung disease affecting over 16 million Americans, experience a high burden of chronic symptoms. Patients with COPD and their caregivers identify patients’ high burden of psychological distress (e.g., symptoms of depression and anxiety) as their top palliative care priority. Psychological distress is also strongly associated with poor clinical outcomes in COPD. Yet, patients with COPD rarely receive care for psychological distress. Family caregivers are uniquely positioned to facilitate the delivery of palliative care interventions due to their longitudinal contact with the patient and because social relationships provide direct health benefits and buffer against health stressors. A critical evidence gap that prevents effective and efficient palliative care delivery is an understanding of how palliative care interventions may best leverage these existing relationships to meet the dyad’s needs. This application proposes a two-arm mechanistic randomized trial comparing the effect of the Coping Skills Training (CST) program and a minimally enhanced usual care attention control arm on improving patients’ and caregivers’ outcomes. Over 12 remotely delivered, weekly sessions, the patient-caregiver dyad learns and practices coping skills tailored to COPD. CST’s content focuses on (1) improving patients’ abilities to cope with stress and illness and (2) teaching caregivers both how to cope and how to be an effective coping skills coach. In prior testing, CST improved patients’ psychological quality of life and functional abilities, yet the mechanisms of action remain unknown and the prior study population did not reflect the health disparities populations most affected by COPD. The primary objective of the proposed trial is to apply behavioral science theories to identify key mechanisms through which the CST program reduces patients’ psychological distress through caregiver support. The project will also assess heterogeneity in the efficacy of CST at reducing distress among patients who differ by key characteristics and identify patient, caregiver, and contextual factors associated with program uptake and completion, both emphasizing modifiable, structural barriers to participation and relevancy. A stakeholder advisory committee will continue to collaborate with investigators. The trial will enroll 375 dyads of outpatients with COPD experiencing psychological distress and their caregivers recruited from University of Pennsylvania and Henry Ford Health Systems’ outpatient clinics that primarily serve patients identifying as Black, low-income, and/or living in rural communities. The study will identify the novel mechanisms through which a palliative care intervention that includes and leverages patients’ caregivers can reduce the burden of chronic illness carried by the dyad. Completing this project will provide the knowledge necessary to refine and (1) develop scalable palliative care interventions that optimally incorporate patients’ existing relationships and social resources and (2) inform strategies to surmount subgroup-specific barriers to facilitate future implementation, including addressing structural barriers to palliative care access that lead to health disparities.