Effects of a telephone-based psychosocial intervention for patients awaiting lung transplantation
ABSTRACT 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.
- SourceAvailable from: David C. Mohr
[Show abstract] [Hide abstract]
- "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. "
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
- [Show abstract] [Hide abstract]
ABSTRACT: Pulmonary rehabilitation is beneficial for patients with chronic lung disease. However, long-term maintenance has been difficult to achieve after short-term treatment. We evaluated a telephone-based maintenance program after pulmonary rehabilitation in 172 patients with chronic lung disease recruited from pulmonary rehabilitation graduates. Subjects were randomly assigned to a 12-month maintenance intervention with weekly telephone contacts and monthly supervised reinforcement sessions (n = 87) or standard care (n = 85) and followed for 24 months. Except for a slight imbalance between sexes, experimental and control groups were equivalent at baseline and showed similar improvements after rehabilitation. During the 12-month intervention, exercise tolerance (maximum treadmill workload and 6-minute walk distance) and overall health status ratings were better maintained in the experimental group together with a reduction in hospital days. There were no group differences for other measures of pulmonary function, dyspnea, self-efficacy, generic and disease-specific quality of life, and health care use. By 24 months, there were no significant group differences. Patients returned to levels close to but above prerehabilitation measures. We conclude that a maintenance program of weekly telephone calls and monthly supervised sessions produced only modest improvements in the maintenance of benefits after pulmonary rehabilitation.American Journal of Respiratory and Critical Care Medicine 04/2003; 167(6):880-8. DOI:10.1164/rccm.200204-318OC · 11.99 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Despite the potential differences in patient characteristics, study designs, and types of instruments used, this review of the literature showed several common findings. Important improvements in QOL are reported after lung transplantation. These improvements were observed when cross-sectional comparisons were made across the cohort of candidates and recipients and during longitudinal follow-up of patients at pretransplant and posttransplant time points. The improvements in QOL after transplantation seem to be sustained for at least 1 to 3 years after transplant. Lung transplant recipients generally were satisfied with their decision to have undergone transplantation. Many issues require further clarification. Variables that may influence QOL before and after lung transplantation, such as age, sex, pretransplant diagnosis, and type of procedure performed, should be considered carefully as study variables. Carefully designed, prospective longitudinal studies with many patients would result in stronger conclusions regarding the importance of QOL assessment in lung transplantation. It would be useful for a few QOL measurement tools to emerge as standard instruments so that many centers and investigators could adopt them to use independently. Standard instruments would allow comparison of outcomes between centers and would allow meta-analyses of multiple studies using the same methodology. Interpretation of the studies would be improved because there would be improved familiarity with a few tools, rather than vague recognition of a large variety of tools.Thoracic Surgery Clinics 09/2004; 14(3):385-407. DOI:10.1016/S1547-4127(04)00025-8 · 0.77 Impact Factor