Motivating Improved Self-Management Among Older Teens & Adults with CF

描述（由申请人提供）：在过去的二十年中，CF治疗的进展导致了生存率的提高，并以防止肺功能丧失为中心。2005年，囊性纤维化基金会患者登记的中位预测生存期为36.8岁，超过40%的CF患者是成年人。然而，治疗方案已经演变成一个复杂的家庭治疗方案，需要大量的患者承诺执行，并且对CF治疗的许多组成部分的依从性通常很差。虽然该方案在改善肺部健康和死亡率方面是有效的，但关于最大限度地提高健康结果所需的依从性水平的数据有限。同样，在CF中很少有已发表的促进依从性的研究，而且这些研究仅限于儿科人群。因此，需要针对老年青少年和成人的干预措施，以应对随着年龄的增长和独立性的提高而管理CF的独特挑战。动机性访谈（MI）是一种很有前途的干预方法，它采用以客户为中心的非指导性方法来增强改变健康行为的动机，并且有希望的数据作为一种有效的依从性促进干预，用于患有其他慢性疾病的青少年和成人。心理咨询并不假定健康将是激励客户的最重要因素，而是承认并纳入客户确定的其他激励因素。与标准CF教育干预（CFE；注意对照组）相比，我们建议评估动机访谈为重点的干预（MI）在改善老年青少年和成人的依从性和降低CF相关发病率方面的功效。具体来说，我们假设在153例16岁以上的CF患者中，与CFE对照组相比，心肌梗死将改善疾病自我管理，降低CF发病率，这些患者在基线时临床稳定。我们的主要假设是，与CFE组相比，接受心肌梗死的参与者在随机分组后12个月（通过药房补充记录测量）具有更高的综合药物依从性评分。次要结局包括自我报告的依从性、肺功能（FEV1的cf特异性百分位数）、肺恶化、体重指数和生活质量。这项研究将使我们能够评估依从性与健康结果之间的纵向关联。我们还将评估自我效能感、动机和CF知识对干预结果的中介作用，以及年龄、自主性、抑郁、社会支持和生活事件等调节作用。

DESCRIPTION (provided by applicant): Treatment advances during the past two decades in the treatment of CF have resulted in improved survival and center around preventing the loss of lung function. In 2005 the median predicted survival for people on the Cystic Fibrosis Foundation Patient Registry was 36.8 years and over 40% of all living people with CF are adults. The therapeutic treatment regimen, however, has evolved into a complex home treatment program that requires a substantial amount of patient commitment to perform and adherence to many components of CF treatment is often poor. While the regimen is efficacious in improving lung health and mortality, there is limited data on the level of adherence needed to maximize health outcomes. Similarly, there are few published adherence-promoting studies in CF and these have been limited to pediatric populations. Older adolescent and adult-focused interventions are therefore needed that target the unique challenges managing CF as one gets older and more independent. Motivational Interviewing (MI) is a promising interventional approach that uses a client-centered, non- directive approach for enhancing motivation to change health behaviors and has promising data as an effective adherence promoting intervention for adolescents and adults with other chronic illnesses. MI does not assume that health will be the most important factor motivating the client, but rather acknowledges and incorporates other motivators identified by the client. We propose to evaluate the efficacy of an Motivational Interviewing-focused intervention (MI) in improving adherence and reducing CF-related morbidity among older adolescents and adults compare to a standard CF education intervention (CFE; attention control group). Specifically, we hypothesize that MI will result in improved disease self-management and reduced CF morbidity compared to the CFE control group in a sample of 153 individuals with CF age 16+ years who are clinically stable at baseline. Our primary hypothesis is that participants receiving MI will have a higher composite medication adherence score at 12-months post-randomization (measured by pharmacy refill records) compared to the CFE group. Secondary outcomes include self-reported adherence, lung function (CF-specific percentiles of FEV1), pulmonary exacerbations, body mass index, and quality of life. This study will allow us to evaluate the longitudinal association between adherence and health outcomes. We will also evaluate the mediating effects of self-efficacy, motivation and CF knowledge on the intervention outcomes as well as moderator effects, such as age, autonomy, depression, social support, and life events.