Pre-transplant health coaching to improve patient-reported outcomes in lung transplant candidates

项目总结/摘要 自我管理能力反映了患者管理情绪，社会角色和慢性医疗的能力。 条件事实上，自我管理能力与肺移植候选人的情绪密切相关， 健康在等待肺移植时，自我管理能力和情绪健康都可以预测术后 移植后的生活质量此外，候选人的自我管理能力和情绪健康状况也会影响到候选人的健康。 与移植后对免疫抑制药物的依从性有关。鉴于 这些移植前因素的重要作用，本研究的目的是优化移植前的自我， 管理能力和情绪健康，长期目标是提高移植后的质量， 生命和移植结果。健康指导是改善情绪健康和自我的有效策略， 其他人群和非移植候选人的慢性阻塞性肺疾病管理能力 疾病我们使用半结构化的，定性的肺移植利益相关者访谈，以制定相关的 健康辅导干预的成年肺移植候选人在等待名单上。在我们的小，单中心 我们的试点试验表明，电话健康指导显示出移植前自我管理的改善 能力，情绪健康和生活质量与常规护理相比。在本申请中，我们提出了一种 一项随机试验，每周一次，持续12周，每次30分钟的电话健康指导干预（与 在佛罗里达或明尼苏达州的马约诊所或 UW医学在华盛顿州。患者报告的结果工具测量情绪健康，自我， 管理和生活质量将在基线、入组后12-16周和入组后12-16周进行测量。 移植我们的主要结果将是慢性呼吸问卷中的组间差异 (CRQ)掌握领域（自我管理的一种衡量标准）和情绪功能的基线调整 价值观次要结果将比较其他心理测量问卷的组间差异 根据基线调整的评分以及移植后短期结果。长期目标是 应用是通过有效的移植前干预措施优化移植后结果。我们的中央 假设健康指导可以提高肺移植患者的自我管理能力、情绪 健康和移植前的生活质量。我们进一步假设，未来的研究将证明，这些 移植前自我管理能力和情绪健康的改善将转化为移植后的改善， 移植后的生活质量这项研究的结果将用于改进干预措施， 多中心试验，旨在优化在不同环境中的传播和实施。这项建议 通过努力改善肺病患者的预后，同时支持一项新的 研究人员在她过渡到研究独立。

PROJECT SUMMARY/ABSTRACT Self-management abilities reflect patients’ capacity to manage emotions, social roles, and chronic medical conditions. In fact, self-management abilities are strongly associated with lung transplant candidates’ emotional health. Both self-management abilities and emotional health while waiting for lung transplant predict post- transplant quality of life. Additionally, a candidate’s self-management abilities and emotional health pre- transplant are associated with post-transplant adherence to immunosuppressive medications. Given the important role of these pre-transplant factors, the objective of this study is to optimize pre-transplant self- management abilities and emotional health with the long-term objective of improving post-transplant quality of life and transplant outcomes. Health coaching is an effective strategy to improve emotional health and self- management abilities in other populations and in non-transplant candidates with chronic obstructive pulmonary disease. We used semi-structured, qualitative interviews of lung transplant stakeholders to develop a relevant health coaching intervention for adult lung transplant candidates on the waiting list. In our small, single-center pilot trial we showed telephonic health coaching demonstrated improved pre-transplant self-management abilities, emotional health, and quality of life in comparison to usual care. In this application, we propose a randomized trial of a 30-minute telephonic health-coaching intervention once weekly for 12 weeks (compared to usual care) in 230 lung transplant candidates on the waiting list at the Mayo Clinic in Florida or Minnesota or at UW Medicine in Washington state. Patient-reported outcome instruments measuring emotional health, self- management, and quality of life will be measured at baseline, 12-16 weeks following enrollment, and post- transplant. Our primary outcomes will be differences between groups in Chronic Respiratory Questionnaire (CRQ) domains of Mastery (a measure of self-management) and Emotional function adjusted for baseline values. Secondary outcomes will compare the differences between groups of other psychometric questionnaire scores, adjusted for baseline, as well as short-term post-transplant outcomes. The long-term goal of this application is to optimize post-transplant outcomes through effective pre-transplant interventions. Our central hypothesis is that health coaching will improve lung transplant patients’ self-management abilities, emotional health, and quality of life pre-transplant. We further hypothesize that future studies will demonstrate that these pre-transplant improvements in self-management abilities and emotional health will translate into improved post- transplant quality of life. The results of this study will be used to refine the intervention and plan for a larger, multi-center trial designed to optimize dissemination and implementation in diverse settings. This proposal supports the NIH mission by striving to improve outcomes in lung disease patients while supporting a new investigator in her to transition to research independence.