Improving Participation in Pulmonary Rehabilitation through Peer-Support and Storytelling

通过同伴支持和讲故事提高肺康复的参与度

• 批准号: 10474109
• 负责人: Peter Kyle Lindenauer
• 金额: $ 72.28万
• 依托单位: BAYSTATE MEDICAL CENTER, INC.
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10474109
• 关键词: Adopted; Adult; Advisory Committees; Affect; American; Attitude; Behavior; Belief; Centers for Disease Control and Prevention (U.S.); Chronic Disease; Chronic Obstructive Pulmonary Disease; Clinical; Consent; Development; Disease Management; Dyspnea; Effectiveness; Emergency department visit; Europe; Expectancy; Goals; Guidelines; Health; Health Status; Health system; Hospitalization; Hospitals; Individual; Infrastructure; Intervention; Interview; Knowledge; Lead; Leadership; Libraries; Mediating; Methods; Modeling; National Heart, Lung, and Blood Institute; Outcome; Patient Participation; Patients; Phase; Physicians; Policies; Procedures; Professional Organizations; Protocols documentation; Quality of life; Randomized; Recovery; Recurrence; Research; Self Efficacy; Self Management; Shortness of Breath; Social support; Structure; Surveys; Techniques; Telephone; Testing; Training; Transportation; United States; Visit; acute care; arm; base; behavior change; blood pressure control; cohort; compare effectiveness; cost; deconditioning; diabetes self-management; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; exercise program; experience; group intervention; health literacy; health related quality of life; hospital readmission; implementation outcomes; implementation strategy; improved; intervention effect; mortality; motivational enhancement therapy; novel strategies; peer; peer coaching; peer support; prevent; programs; pulmonary rehabilitation; recruit; treatment as usual; uptake

ABSTRACT Exacerbations of Chronic Obstructive Pulmonary Disease (COPD) lead to roughly 1.5 million ED visits and 700,000 hospitalizations annually. Recovery is slow, and accompanied by high levels of acute care utilization and mortality. Pulmonary Rehabilitation (PR) is a structured program of exercise and self-management support that has been shown to relieve dyspnea and improve quality of life. Clinical guidelines recommend PR for patients with stable COPD and after an exacerbation. Unfortunately, even when referred by physicians, our research has shown that few patients who might benefit from PR ever begin treatment. The primary goal of this project is to identify effective strategies for promoting and sustaining participation in PR. Peer Support involves pairing a patient with a trained peer from a similar background, and facing similar health challenges, who has completed PR. There is a growing body of evidence demonstrating the feasibility, acceptability, and effectiveness of telephonic peer support for chronic disease management. Narrative interventions, or `Storytelling', are novel approaches for changing attitudes and behaviors of patients that involve creating and disseminating videos narrated by individuals with lived experience with the same condition or facing the same treatment. Storytelling interventions have been shown to help patients achieve better blood pressure control, and storytelling is being studied in a variety of other clinical contexts. In the R61 Phase, we will recruit and train a cohort of peer coaches in behavior change techniques, and will recruit a diverse group of storytellers, capture their narratives on video, and create a library of 6-8 powerful stories. We will finalize our protocol, trial infrastructure, and pilot our recruitment strategy. During the R33 Phase, we will recruit 305 adults treated for exacerbation of COPD, and randomize them to 1) Enhanced “Usual Care” (eUC); 2) eUC + Storytelling; or 3) eUC + Peer Support. We will evaluate the effectiveness of each strategy compared to eUC, and to each other, at promoting participation in PR at 6 months. Using a mixed-methods approach, we will evaluate intervention acceptability, sustainability, and cost, from the perspectives of the patients and peer coaches as well as PR program staff and hospital leadership. We will use these findings to refine the strategies and to disseminate an implementation package that will enable other PR programs to adopt these approaches. This project engages key stakeholders in study conceptualization, execution, and dissemination, and is responsive to the NHLBI/CDC COPD National Action Plan that calls for the development of strategies to increase the number of Americans that benefit from PR.

抽象的 慢性阻塞性肺疾病（COPD）的加重导致大约150万ED访问和 每年700,000次住院时间很慢。 和死亡率。 Thas被证明可以缓解呼吸困难并改善生命的生命。 患有稳定的COPD的患者，经过恶化后。 研究表明，很少有可能从中受益的患者。 项目是确定促进和维持私人参与的有效策略。 同伴支持涉及将患者与来自类似背景的训练有素的同伴配对，并且面对类似 健康的挑战，已经构成PR。 可接受性和对慢性疾病管理的电话同伴支持。 干预措施或“待售”是改变患者的态度和行为的新方法 涉及创建和传播由具有相同状况的人叙述的视频 或面对相同的待遇。 在其他各种临床环境中，正在研究压力控制和讲故事。 在R61阶段，我们将招募和培训一组同伴教练在行为改变技术中，并将 招募一群讲故事的人，在视频中捕捉他们的叙述，并创建一个6-8强大的图书馆 故事 阶段，我们将招募305名因加剧COPD处理的成年人，并将其随机分为1） “通常的护理”（EUC）； 每种策略与EUC相比，彼此相比，在促进6个月内促进促进活动时。 混合方法方法，我们将评估干预措施的解脱性，可持续性和成本。 我们将使用使用USPITAL领导。 这些发现是为了完善策略并传播一个燃烧包包，以使其他PR能够 采用这些方法的程序。 该项目与关键的利益持有者参与研究概念化，执行和传播，并且是 响应NHLBI/CDC COPD国家行动计划，该计划呼吁制定战略 增加受益于公关的美国人的美国人数量。