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

项目摘要 患有慢性阻塞性肺疾病（COPD）的患者，这是一种影响16岁以上的衰弱性肺病 数百万美国人，经历了慢性症状的高负担。COPD患者及其护理人员 确定患者的心理困扰的高负担（例如，抑郁和焦虑的症状）作为他们的顶部 姑息治疗优先心理困扰也与COPD的不良临床结局密切相关。 然而，COPD患者很少接受心理困扰的护理。家庭照顾者是独一无二的 定位以便于提供姑息治疗干预措施，因为它们纵向接触 因为社会关系提供了直接的健康益处，并缓冲了健康压力。一 关键的证据差距，防止有效和高效的姑息治疗提供是一个了解如何 姑息治疗干预可能最好地利用这些现有的关系，以满足二分体的需要。这 应用程序提出了一个双臂机械随机试验，比较应对技能训练的效果 (CST)计划和最低限度地加强日常护理注意力控制臂， 照顾者的结果。超过12个远程交付，每周一次的会议，病人照顾者二分体学习， 练习针对COPD的应对技巧。CST的内容主要集中在（1）提高患者应对 压力和疾病和（2）教照顾者如何科普和如何成为一个有效的应对技能教练。 在先前的测试中，CST改善了患者的心理生活质量和功能能力，但其机制 行动的效果仍然未知，先前的研究人群没有反映出大多数人群的健康差异。 受COPD影响。拟议试验的主要目标是应用行为科学理论来识别 CST计划通过照顾者减少患者心理困扰的关键机制 支持.该项目还将评估CST在减少患者痛苦方面的疗效异质性 他们的关键特征不同，并确定与计划相关的患者、护理人员和背景因素 吸收和完成，两者都强调参与和相关性的可改变的结构性障碍。一 利益攸关方咨询委员会将继续与调查人员合作。该试验将招募375对 COPD门诊患者经历心理困扰和他们的照顾者招募从大学 宾夕法尼亚州和亨利福特卫生系统的门诊诊所，主要为患者确定为 黑人，低收入和/或生活在农村社区。这项研究将通过以下方式确定新的机制： 包括并利用患者护理人员的姑息治疗干预可以减轻患者的负担， 二分体携带的慢性疾病。完成这个项目将提供必要的知识，以完善和 (1)制定可扩展的姑息治疗干预措施，以最佳方式整合患者的现有关系， 社会资源和（2）提供信息的战略，以克服特定的障碍，以促进未来 执行工作，包括解决导致健康差距的姑息治疗获得方面的结构性障碍。

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.