Background: I am a core investigator at the Seattle HSR&D CoE and a clinical health psychologist with a long-standing interest in the intersection of psychosocial factors and chronic illness outcomes. Over the last several years, I have examined how depressive symptoms, social support, and coping influence adherence to medical recommendations, hospitalizations, and mortality among patients with heart disease. I have become interested in the influence of informal caregivers, especially spouses or significant others (""""""""partners""""""""). Partners are integral t Veteran care yet may experience stress and burden when caring for a heart failure patient. Engaging couples and other patient-caregiver dyads may be effective in improving patient outcomes provided this does not lead to additional burden. One approach is to design and test dyadic interventions with couples to enhance coping skills. I am seeking additional training through the CDA2 mechanism to 1) To gain a thorough understanding of the methodological issues of conducting dyadic research;2) To gain expertise in developing interventions involving patients and their partners;3) to design and conduct RCTs to evaluate these interventions;4) To develop a health services research program in dyadic research;5) To understand how to implement an intervention for wider dissemination within the VA. Key Elements of Research Plan: With the guidance of my mentors, I plan to develop a telephone-based couples'intervention aimed at improving coping in Veterans with heart failure and their partners. The planned intervention will be based on the Partners in Coping Program, an intervention found to be efficacious in improving coping in women with breast cancer and their partners. The research proposed in the CDA involves developing a treatment manual after obtaining input from providers, Veterans with heart failure, and their partners;pilot test the acceptability and feasibility on a sample of 30 Veterans with heart failure and their partners;refine the interventin based on the results of the pilot study;and lay the foundation for an RCT of 100 couples to determine its efficacy in improving quality of life, couples'coping, and self-management among Veterans with heart failure and their partners. Mentors: I will be supported in my training and research activities by my primary mentor Dr. John Piette and secondary mentors Drs. Karin Nelson, Steve Fihn, and Dan Kivlahan. I will obtain methodological oversight through consultations with Dr. David Atkins (dyadic methodology expert) and Dr. James Pfeiffer (qualitative methodology expert), both at the University of Washington in Seattle. Career Goal: My career plans are to become an expert in developing and disseminating interventions that target Veteran-caregiver dyads in which Veterans have a complex chronic illness. During my CDA, I will focus on Veterans with heart failure as a prototypical subset of chronically ill patiens, and spousal partners as a subset of caregivers, while understanding that the eventual intervention may be relevant to Veterans with other chronic illnesses and other informal caregivers. The intervention I will develop and study will be telephone- based to ensure outreach to rural and/or disabled Veterans and their partners. My proposed CDA research will lead to the development of a couples'intervention that will enhance quality of life, coping, and self- management in complex chronic illness.
Heart failure is the number one discharge diagnosis among Veterans. Having heart failure can be stressful for both Veterans and their partners, leading to poor individual quality of life and poor functioning as a couple. This may adversely influence self-management which in turn may lead to poorer outcomes. One way to improve outcomes may be to provide effective coping skills, improve communication, and improve collaboration between couples. In doing so, we have the opportunity to improve individual quality of life, well-being of the couple, and the couples'participation in self-management. Such an approach may not only benefit heart failure patients and their partners;it has the potential for improving outcomes among other complex chronic illnesses which require intensive self-management and caregiver participation.