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

项目摘要/摘要 自我管理能力反映了患者管理情绪、社会角色和慢性疾病的能力 条件。事实上，自我管理能力与肺移植患者的情绪密切相关 健康。自我管理能力和等待肺移植期间的情绪健康都可以预测肺移植后 移植后的生活质量。此外，应聘者的自我管理能力和情绪健康状况 移植与移植后对免疫抑制药物的坚持有关。给定 这些移植前因素的重要作用，本研究的目的是优化移植前自身 管理能力和情绪健康以提高移植后质量为长期目标 生命和移植结果。健康辅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慢性阻塞性肺病患者的管理能力 疾病。我们使用了对肺移植利益相关者的半结构化、定性访谈来制定相关的 对候补名单上的成人肺移植受者进行健康指导干预。在我们狭小的单一中心 我们的试点试验表明，电话健康指导改善了移植前的自我管理 能力、情绪健康和生活质量与平时护理相比。在本申请中，我们提出了一种 为期12周、每周一次、每次30分钟的电话健康指导干预的随机试验(与 常规护理)在佛罗里达州或明尼苏达州的梅奥诊所等待名单上的230名肺移植候选人中 华盛顿州的威斯康星大学医学院。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、注册后12-16周和之后进行测量 移植。我们的主要结果将是慢性呼吸问卷中不同群体之间的差异 (CRQ)掌握领域(自我管理的一种衡量标准)和根据基线调整的情绪功能 价值观。次要结果将比较其他心理测量问卷组之间的差异 根据基线和移植后短期结果进行调整的评分。这样做的长期目标是 应用是通过有效的移植前干预来优化移植后的结果。我们的中央 假设是健康指导会提高肺移植患者的自我管理能力，情绪 移植前的健康和生活质量。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。这项研究的结果将被用来完善干预措施并计划更大规模的 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 支持NIH的使命，努力改善肺部疾病患者的预后，同时支持新的 调查员在她身上过渡到研究独立。

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.