Telephone-based coping skills training for COPD

描述(由申请人提供)：这份修订后的竞争性续签申请旨在将我们之前的工作扩展到终末期肺部疾病患者中，以评估针对慢性阻塞性肺疾病(COPD)患者的新型增强型应对技能培训(CST)方案的有效性。COPD是一种阻塞性呼吸道疾病，以呼吸困难、阵发性咳嗽、疼痛、疲劳和失眠为特征。大约有1210万美国人被诊断出患有慢性阻塞性肺疾病，其中70%的患者年龄在65岁以下。处于疾病早期的COPD患者通常会经历症状的逐渐恶化，而疾病的晚期可能会经常去急诊科就诊或因COPD急性加重而住院治疗。重要的是，慢性阻塞性肺病也是许多患者的致命疾病，是美国男性和女性可预防死亡的第四大原因，2002年报告的死亡人数超过12万人。虽然慢性阻塞性肺病是可以预防的(即不吸烟)，但这种疾病无法治愈，因此必须有效地控制症状。众所周知，简短、集中的认知行为疗法可以显著改善内科疾病患者的心理功能，但COPD患者的广泛地理分布，以及他们的慢性疾病恶化，使得面对面提供这种治疗非常困难。我们以前的工作表明，对等待肺移植的患者进行电话应对技能干预(CST)在改善生活质量方面有效，但不能改善身体功能或存活率。在这项研究中，处于疾病过程早期的COPD患者似乎从CST中受益最多。因此，本申请提出了一项规模更大的双部位(杜克大学和俄亥俄州立大学)在COPD患者中进行的随机试验，使用一套全面的结果测量方法，对延长的随访期进行评估。600名COPD患者将被随机分配到基于电话的增强型护理人员辅助的CST干预组或常规护理加教育和症状监测控制组。患者和他们自认为的照顾者将在为期16周的干预前后接受身体和心理社会功能的全面评估。这项研究将研究CST对心理痛苦和生活质量的短期和长期影响，以及在长达4年的随访期内干预对发病率、死亡率和医疗费用的影响。这项研究计划的最终目标是开发更有效的方法来帮助慢性肺病患者和他们的照顾者更有效地应对有问题的症状，减少痛苦，改善生活质量，增强身体功能，提高存活率。 公共卫生相关性：慢性阻塞性肺疾病(COPD)是美国和全世界的一个重大健康问题，被认为是美国第四大死因。这项研究将检验通过电话为COPD患者及其照顾者提供的增强应对技能培训计划对患者的心理社会和身体功能以及长期生存的影响。

DESCRIPTION (provided by applicant): This revised competing renewal application seeks to extend our previous work among patients with end stage lung disease to evaluate the effectiveness of a novel, enhanced coping skills training (CST) protocol for patients with chronic obstructive pulmonary disease (COPD). COPD is an obstructive airway disease marked by symptoms of dyspnea, paroxysmal coughing, pain, fatigue, and insomnia. Approximately 12.1 million Americans have been diagnosed with COPD and 70 percent of these cases represent individuals under the age of 65. COPD patients who are at an early stage of their disease often experience a progressive worsening of symptoms, while the advanced stages of the disease may be marked by frequent visits to the emergency department or inpatient hospitalizations for acute COPD exacerbations. Importantly, COPD also is a fatal condition for many patients, and is the fourth leading cause of preventable death for both men and women in the United States, with over 120,000 deaths reported in 2002. Although COPD is preventable (i.e., by not smoking), there is no cure for the disease and therefore the symptoms must be managed effectively. It has been well-established that brief, focused cognitive-behavioral therapy can significantly improve psychological function in medically ill persons, the wide geographic distribution of patients with COPD, along with their chronic exacerbations of illness, make face-to-face delivery of such therapy extremely difficult. Our previous work demonstrated that a telephone-based coping skills intervention (CST) with patients awaiting lung transplantation was effective in improving quality of life but did not improve physical functioning or survival. In that study, patients with COPD at an earlier stage of their disease process appeared to benefit most from CST. Thus, the present application proposes a larger, dual-site (Duke and Ohio State University), randomized trial among patients with COPD, using a comprehensive set of outcome measures over an extended follow-up period. Six hundred COPD patients will be randomly assigned to either a telephone-based enhanced, caregiver-assisted CST intervention or to a Usual care plus education and symptom monitoring Control group. Patients and their self-identified caregivers will undergo comprehensive assessments of physical and psychosocial functioning before and after a 16-week intervention. The study will examine the short- and longer- term impact of CST on psychological distress and quality of life as well as the effects of the intervention on morbidity, mortality, and medical costs over a follow-up period of up to 4 years. The ultimate goal of this research program is to develop more effective ways to help patients with chronic lung disease and their caregivers cope more effectively with problematic symptoms, reduce distress, improve quality of life, enhance physical functioning, and increase survival. Public Health Relevance: Chronic Obstructive Pulmonary Disease (COPD) is a significant health problem in the United States and throughout the world, and is considered the fourth leading cause of death in the US. This study will examine the effects of an enhanced coping skills training program for COPD patients and their caregivers, delivered by telephone, on patients' psychosocial and physical functioning and long-term survival.