To test the efficacy of a tailored telephone-based intervention consisting of supportive counseling and cognitive behavioral techniques for individuals awaiting lung transplantation on measures of quality of life and general well-being.
Patients were randomly assigned to either a telephone-based special intervention (SI; n = 36) for 8 weeks (average session length, 16.3 min) or a usual care (UC) control condition (n = 35) in which subjects received usual medical care but no special treatment or phone calls. At baseline, and immediately following the 8-week intervention, patients completed a psychometric test battery.
Duke University Medical Center, Pulmonary Transplantation Program.
Seventy-one patients with end-stage pulmonary disease listed for lung transplantation. Primary outcome measures: Measures of health-related quality of life (both general and disease-specific), general psychological well-being, and social support.
Multivariate analysis of covariance, adjusting for pretreatment baseline scores, age, gender, and time waiting on the transplant list, revealed that patients in the SI condition compared to the UC reported greater general well-being (p < 0.05), better general quality of life (p < 0.01), better disease-specific quality of life (p < 0.05), and higher levels of social support (p < 0.0001).
A brief, relatively inexpensive, telephone-based psychosocial intervention is an effective method for reducing distress and increasing health-related quality of life in patients awaiting lung transplantation.
"Three patient-centered intervention studies, which focused on psychological distress and coping during the waiting period, showed that interventions improve psychological measures of depression and anxiety [15–17]. Lung transplant candidates use adaptive problem and emotion focused coping strategies . "
[Show abstract][Hide abstract] ABSTRACT: Before 2005, time accrued on the lung transplant waiting list counted towards who was next in line for a donor lung. Then in 2005 the lung allocation scoring system was implemented, which meant the higher the illness severity scores, the higher the priority on the transplant list. Little is known of the lung transplant candidates who were listed before 2005 and were caught in the transition when the lung allocation scoring system was implemented. A narrative analysis was conducted to explore the illness narratives of seven lung transplant candidates between 2006 and 2007. Arthur Kleinman's concept of illness narratives was used as a conceptual framework for this study to give voice to the illness narratives of lung transplant candidates. Results of this study illustrate that lung transplant candidates expressed a need to tell their personal story of waiting and to be heard. Recommendation from this study calls for healthcare providers to create the time to enable illness narratives of the suffering of waiting to be told. Narrative skills of listening to stories of emotional suffering would enhance how healthcare providers could attend to patients' stories and hear what is most meaningful in their lives.
"That said, a small randomised trial evaluating a nurse led, shared care monthly intervention consisting of health education and motivational interviews for wait-listed coronary artery bypass surgery candidates significantly improved cardiovascular risk factors as well as general health status, levels of depression, anxiety, and physical activity levels compared to usual care . Similarly, improvements in quality of life, well-being and social support were reported in a telephone-based psychosocial intervention for patients awaiting lung transplantation . Studies evaluating similar interventions in bariatric populations should be considered, although because of the large number of individuals wait-listed, group interventions would likely be required. "
[Show abstract][Hide abstract] ABSTRACT: Protracted, multi-year wait times exist for bariatric care in Canada. Our objective was to examine wait-listed patients' health status and perceptions regarding the consequences of prolonged wait times using a cross-sectional study design nested within a prospective cohort.
150 consecutive consenting subjects wait-listed for multi-disciplinary bariatric assessment in a population-based medical/surgical bariatric program were surveyed. Health status was measured using a visual analogue scale (VAS). A Waiting List Impact Questionnaire (WLIQ) examined employment, physical stress, social support, frustration, quality of life, and satisfaction with care. Multivariable linear regression analysis adjusted for age, sex and BMI identified independent predictors of lower VAS scores.
136 (91%) subjects were women, mean age was 43 years (SD 9), mean BMI was 49.4 (SD 8.3) kg/m2 and average time wait-listed was 64 days (SD 76). The mean VAS score was 53/100 (SD 22). According to the WLIQ, 47% of subjects agreed/strongly agreed that waiting affected their quality of life, 65% described wait times as 'concerning' and 81% as 'frustrating'. 86% reported worsening of physical symptoms over time. Nevertheless, only 31% were dissatisfied/very dissatisfied with their overall medical care. Independent predictors of lower VAS scores were higher BMI (beta coefficient 0.42; p = 0.03), unemployment (13.7; p = 0.01) and depression (10.3; p = 0.003).
Patients wait-listed for bariatric care self-reported very impaired health status and other adverse consequences, attributing these to protracted waits. These data may help benchmark the level of health impairment in this population, understand the physical and mental toll of waiting, and assist with wait list management.
BMC Health Services Research 06/2012; 12(1):139. DOI:10.1186/1472-6963-12-139 · 1.71 Impact Factor
"For example, patients in the TAU condition in Simon's and Tutty's studies (Simon et al., 2004; Tutty et al., 2000) were under the care of primarycare physicians who prescribed antidepressant medications . Most of the remaining studies were conducted with patients who had some form of severe medical condition (e.g., multiple sclerosis, lung cancer, breast cancer, AIDS), which put them in frequent contact with medical care providers who may or may not have prescribed medications (Bailey et al., 2004; Heckman et al., 2006; Mohr et al., 2000; Napolitano et al., 2002; Sandgren & McCaul, 2003). In contrast, many psychotherapy studies using no-treatment conditions prohibit any psychological or pharmacological intervention outside the study and/or do not include patients with medical conditions that bring them into frequent contact with physicians who could potentially identify and treat the depression. "
[Show abstract][Hide abstract] ABSTRACT: Increasingly, the telephone is being used to deliver psychotherapy for depression, in part as a means to reduce barriers to treatment. Twelve trials of telephone-administered psychotherapies, in which depressive symptoms were assessed, were included. There was a significant reduction in depressive symptoms for patients enrolled in telephone-administered psychotherapy as compared to control conditions (d = 0.26, 95% confidence interval [CI] = 0.14-0.39, p < .0001). There was also a significant reduction in depressive symptoms in analyses of pretreatment to posttreatment change (d = 0.81, 95% CI = 0.50-1.13, p < .0001). The mean attrition rate was 7.56% (95% CI = 4.23-10.90). These findings suggest that telephone-administered psychotherapy can produce significant reductions in depressive symptoms. Attrition rates were considerably lower than rates reported in face-to-face psychotherapy.
Clinical Psychology Science and Practice 09/2008; 15(3):243-253. DOI:10.1111/j.1468-2850.2008.00134.x · 2.92 Impact Factor
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