Telephone-based coping skills training for COPD

描述（由申请人提供）：本修订后的竞争性续期申请旨在扩展我们先前在终末期肺病患者中的工作，以评估新型增强型应对技能培训（CST）方案对慢性阻塞性肺病（COPD）患者的有效性。COPD是一种阻塞性气道疾病，其特征是呼吸困难、阵发性咳嗽、疼痛、疲劳和失眠。大约有1210万美国人被诊断患有COPD，其中70%的病例代表65岁以下的个体。处于疾病早期阶段的COPD患者通常会经历症状的进行性恶化，而疾病的晚期阶段可能以频繁前往急诊科或因急性COPD恶化而住院治疗为标志。重要的是，COPD对于许多患者来说也是致命的病症，并且是美国男性和女性可预防死亡的第四大原因，2002年报告了超过120，000例死亡。虽然COPD是可以预防的（即，不吸烟），但该病无药可医，因此必须有效控制症状。已经充分确定，简短的、集中的认知行为治疗可以显著改善医学上患病的人的心理功能，患有COPD的患者的广泛地理分布，沿着他们的慢性疾病恶化，使得面对面地提供这种治疗极其困难。我们以前的工作表明，对等待肺移植的患者进行基于电话的应对技能干预（CST）可有效改善生活质量，但不能改善身体功能或生存率。在该研究中，处于疾病早期阶段的COPD患者似乎从CST中获益最多。因此，本申请提出了一种在COPD患者中进行的更大的、双中心（杜克和俄亥俄州州立大学）随机试验，在延长的随访期内使用一组全面的结果测量。600名COPD患者将被随机分配到基于电话的增强型、呼吸机辅助的CST干预组或家庭护理加教育和症状监测对照组。患者及其自我认定的照顾者将在16周的干预前后接受身体和心理社会功能的全面评估。该研究将检查CST对心理困扰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及其护理人员更有效地科普问题症状，减少痛苦，改善生活质量，增强身体功能，提高生存率。 公共卫生相关性：慢性阻塞性肺疾病（COPD）是美国和全世界的重要健康问题，并且被认为是美国的第四大死亡原因。本研究将探讨通过电话为COPD患者及其护理人员提供的增强应对技能培训计划对患者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.