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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

基本信息

批准号：
10687114
负责人：
Peter Kyle Lindenauer
金额：
$ 69.84万
依托单位：
BAYSTATE MEDICAL CENTER, INC.
依托单位国家：
美国
项目类别：
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/10687114
关键词：
Adopted Adult Advisory Committees Affect American Attitude Behavior Belief Chronic Disease Chronic Obstructive Pulmonary Disease Clinical Consent Development Disease Management Dyspnea Effectiveness Eligibility Determination 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 Narration National Heart, Lung, and Blood Institute Outcome Patient Participation Patients Phase Physicians Policies Procedures Professional Organizations Protocols documentation Quality of life Randomized Recommendation 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 behavior change blood pressure control clinical outcome assessment cohort compare effectiveness cost deconditioning diabetes self-management effectiveness evaluation effectiveness/implementation trial exercise program experience group intervention health literacy health related quality of life hospital readmission implementation outcomes implementation strategy improved intervention effect intervention refinement mortality motivational enhancement therapy novel strategies peer peer coaching peer support prevent programs pulmonary rehabilitation recruit treatment as usual uptake

项目摘要

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.

摘要